Recently, the Kaduna State Media Corporation in collaboration with the United Nations Children's Fund (UNICEF) and Kaduna State Agency for the Control of AIDS (KASACA), had an awareness meeting to deliberate on the current HIV situation in the state. It involved among others, how the state has fared and what needs to be done to reverse the trend.

In 2008, a study conducted by the National AIDS Reproductive Health Survey (NARHS), put the HIV/AIDS prevalence rate in Kaduna State at 7 per cent, and in 2011, another study put the prevalence rate at 5.1 per cent. That means for every 100 people, five are positive.

Recently, modes of transmission study was carried out in Kaduna and the state's media cooperation in collaboration with the state's agency for the control of AIDS (KADSACA) and the United Nations Children International Education Fund (UNICEF), hosted a two-day awareness meeting on the current situation of HIV/AIDS in Kaduna State and the FCT.

According to the study, contrary to widespread reports, female sex workers are not contributing much to the HIV burden in the state as they only account for about 3.5 per cent of the new infections while the bulk of the new infections are from the general population.

The report also revealed that condom use is still on the average as it is only about 60 per cent.

Condom, says experts, is one of the preventive measures in terms of HIV transmission and prevention.

Looking at the A, B and C of HIV prevention messages, the C, which is the condom aspect, provides up to 98 per cent of protection, they say.

According to the State Programme Advisor, Enhancing Nigeria's Response to HIV/AIDS(ENR), Faruk Musa, it is a known fact that 80 per cent of HIV/AIDS transmission is through sex. "If you look at condom versus sex and HIV/ AIDS transmission, you see that condom plays a very vital role because it can give up to 98 per cent protection while the other two per cent is maybe, human error or whatever."

However, he maintained that if condom is properly used the way it is supposed to, it can provide 99 per cent protection.

"The issue with condom is generally about awareness and having specific strategies on how to, because it's not just enough for me to design a programme for a certain group of people and tell them the advantages of condom without giving them the skills."

He stated that what ENR is doing in partnership with the state government is to ensure that it opens up access to condom so that more people can reach them.

"Don't forget that condom in itself is the only contraceptive that provides dual protection, against pregnancy, STIs, and HIV inclusive."

"For us, condom is central to the process of halting and reversing HIV transmission in Nigeria."

"Looking at the issue of PLWHA, if I am positive, I am not expecting that my wife will run away from me. The only way we can keep the marriage going is condom use until my situation improves, where I can drop the condom and even have kids."

Musa admitted that there have been a lot of challenges in terms of condom use, saying, "There is the cultural and religious challenge where people do not want to talk about condoms. I think gradually, things are beginning to change. Condoms are now being promoted as a dual protection mechanism.

"It is a bit easier now to promote it, especially now among the faith based, that look you can use it in two ways, like you can use it in child spacing. In child spacing, there are so many reasons. Its either the woman is sick, or after her first delivery, she has high blood pressure, or maybe she doesn't want to conceive again, or she doesn't want to use other contraceptives, she could use a condom."

Another major challenge with condom is the issue of female condoms. Most women do not know female condoms, not to talk of the males.

We are trying as much as possible to make it available, disclosed Musa. "In the last three months, we have distributed over 200,000 pieces of female condoms and it's surprising that women, even educated women, haven't seen it before. So you can imagine the ordinary women in the rural areas."

"So, what we are trying to do is to try and make female condoms as popular and accessible as we have the male condoms."

"Before now, the female condoms were very expensive. That was one of our challenges. But now, it is available, and it is almost the same price with the cheapest condoms you can have in the market.

"And the issue of condom is not about pricing. For instance; take the Gold Circle condom. The reason why it is so cheap is because we have waivers. So, in importation, we do not pay import duty and everything."

"That is the FG's contribution to people using condoms to protect themselves. So they provide the waiver"

"So, when all other condoms come in, they pay import duties. They are naturally supposed to be high. It's the same thing with latex rubber. What people do is just to garnish it, make it blue or make it red, and call it whatever name. But the female sex worker will always tell you she prefers the Gold Circle condoms."

However, UNICEF's HIV/AIDS Specialist, Dr Idris Baba, noted that there is still a challenge with the number of pregnant women accessing PMTCT services in the country as a whole.

Apparently, he said the number of women who attend ante natal clinic (ANC), which is the entry point of PMTCT, is not what it should be in this country, and the non- availability of the personnel to provide the PMTCT services.

"The other is the issue of awareness and reclaiming my own right as a woman to have access to the PMTCT. In the issue of ANC, every pregnant woman is supposed to attend antenatal clinic by right."

He asked, "but how many women attend ANC and among those who attend the ANC, how many are fortunate to attend ANC at sites that PMTCT services are available?

"For even those who go to those sites that PMTCT are available, how many of those women are willing to take PMTCT services at pregnancy? So, these are the issues that we are looking at."

Baba said there is need to mobilize more women to come out to access services in PMTCT.

According to him, if a woman comes to any facility, and there is no PMTCT, she should be referred to where there are PMTCT services.

"If you look at our financial and economic situation in the country, maybe it is an impediment to a woman travelling a distance to access PMTCT services."

"But the government has realized that the issue of access is key; they have decentralized it into the PHCs where the people are."

"So this is an attempt to make sure that the woman has access to the service. Currently, the drive is in decentralization and integration."

"Integration in the sense that PMTCT should be part of ANC, so for every ANC service that does not have PMTCT service is not complete. That is what government is saying."

"PHC service centres should now provide PMTCT services, because that is where the people are and that is where the people access most, the rural dwellers should be able to have access to PHCs, and at that PHCs, there should be PMTCT services."

"Government is now looking at decentralizing the services down to PHC levels in order to improve access to PMTCT services.

"In Kaduna, we won't say we have inadequate PHCs. There are close to 100 health centres in Kaduna State and we have 23 local government areas, and in essence, there is no local government that you will go to that you will not find more than 50 PHCs."

"It's not an issue of insufficient PHCs; the issue is that, are all the PHCs providing ANC? And are all the PHCs providing PMTCT?"

"We are now riding on the back of the NPHCDA driven MSS to ensure that every MSS centre is a PMTCT site so as to improve the access and increase the number of sites that have skilled personnel to deliver PMTCT."

"Remember that PMTCT is a very simple intervention. It's not a high tech intervention. It only takes the midwife or the nurse to know that this woman is HIV positive, then do some little intervention by giving her adequate knowledge that she needs to know about breastfeeding absence, and then provide the drugs."

"She doesn't need much investigation in order for you to institute your PMTCT options. So it's something we can do at the PHC level. The PHCs are there and we are trying to ensure that there are skilled personnel in each of the PHCs that will be able to deliver the PMTCT services. It's not about the issue of number, but the issue of the site that have adequate personnel who can deliver PMTCT services. With the MSS scheme, that is a platform where the PMTCT will be scaled up for more sites."

He said that Kaduna State has presently put up machineries in place to scale up to over 60 MSS sites where all of them will have PMTCT services. The complete package of PMTCT is to ensure that there are skilled personnel to deliver the service to women.

On the partnership with the FCT, he said the state is partnering with the FCT to train all the midwives there, just like what was done in Kaduna on PMTCT services.

"They should be able to deliver PMTCT services, wherever they are, even if the woman is delivering at home. PMTCT services can also be delivered at home. The most important person who should be there is the midwife so that she should know exactly what is to be done in terms of minimal evasiveness, in terms of the type of drugs to be given to the woman if she is HIV positive, and where the woman is HIV negative, the type of information to be given to her to remain HIV negative," maintaining that it's a function of skilled and informed midwives to be able to deliver these services, which in his words, they are trying to scale up.