On a January morning, 12-year-old Yusuf Adamu slumps in his father’s lap, head pressed against his chest. Infected at birth with HIV, he is tiny for his age and has birdlike limbs. He has been feverish for 3 days, which is why his father, Ibrahim, brought him to the pediatric HIV/AIDS clinic at Asokoro District Hospital in Abuja.
“He’s been losing weight, he is not eating well, he’s still taking his drugs, and he’s complaining of chest pains and coughing,” Ibrahim tells the nurse. Yusuf’s records show that at his last blood check 6 months ago, HIV had already ravaged the boy’s immune system, even though he was receiving ARV drugs.
When the doctor, Oma Amadi, examines his mouth, it is filled with white sores from candidiasis, a fungal infection. “The boy has been sick for so long,” she says. “I’m going to admit him.”
Yusuf’s mother was never tested for HIV before he was born: She received no prenatal care and delivered at home. Yusuf was not tested for the virus until she died of AIDS 3 years later. Ibrahim then learned that he, too, is HIV-positive, as are his two other wives. One ended up transmitting the virus to a second child, now 4.
Ibrahim, a security guard, earns the equivalent of only about $20 a month. The Adamus live 20 kilometers and three bus rides from the hospital. The round trip bus fare costs $2, and Ibrahim has to miss a day of work for each checkup, when he also picks up his son’s ARVs. Ibrahim simply can’t afford regular treatment for his son. “There is no food at home,” Ibrahim says.
Yet poverty alone does not explain the root of Yusuf’s plight—which hundreds of thousands of other Nigerian children living with HIV now face. At a time when rates of mother-to-child transmission of HIV have plummeted, even in far poorer countries, Nigeria accounted for 37,000 of the world’s 160,000 new cases of babies born with HIV in 2016. The most populous country in Africa, Nigeria does have an exceptionally large HIV-infected population of 3.2 million people. But South Africa—the hardest-hit country in the world, with 7.1 million people living with the virus—had only 12,000 newly infected children in 2016.
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