Factors influencing acceptability of voluntary counselling and HIV-testing among pregnant women in Northern Tanzania

Abstract

Guided by the conceptual framework of the Health Belief Model, this study aimed to identify factors associated with pregnant women's expressed willingness to accept voluntary counselling and HIV-testing (VCT). A cross-sectional interview survey of 500 pregnant women, complemented by focus group discussions, was conducted in the Kilimanjaro region of Tanzania. Constructs derived from the Health Belief Model explained 41.7% of women's willingness to accept VCT. Perceived high personal susceptibility to HIV/AIDS, barriers related to confidentiality and partner involvement, self-efficacy regarding alternative feeding methods and religion were all shown to be associated with willingness to accept VCT. The women's acceptance of VCT seems to depend upon their perceiving that VCT and alternative feeding strategies provide clear benefits, primarily for the child. Whether a positive attitude to VCT and alternative feeding strategies are transformed into actual behaviour depends on a set of complicated decisions in which several potential psychological consequences are assessed. Sharing the diagnosis with partners may not have the intended effect if there is a lack of sensitivity to the women's fear of blame and rejection. If pregnant women are to fully participate in and benefit from mother-to-child-transmission prevention efforts, their partners must be committed and involved in the process.

Are infant feeding options that are recommended for mothers with HIV acceptable, feasible, affordable, sustainable and safe? Pregnant women's perspectives

“…The women were not tested for HIV and their actual HIV status was not inquired about. The results concerning previous infant feeding practices and expressed willingness to accept voluntary counselling and HIV testing have been presented elsewhere 12,16 . The structured survey was guided by the conceptual framework of Social Cognitive Theory 17 .…”

A Multilevel Analysis of the Determinants of HIV Testing in Zimbabwe: Evidence from the Demographic and Health Surveys

“…23 The risk perception of contracting HIV may either increases or decreases the likelihood of using health care services. 24 An example of this phenomenon could be that, since HIV prevalence is reported to be positively associated with higher socio-economic status and education, 25 individuals with higher educational attainment and those who are wealthier may perceive themselves to be at risk of HIV infection, and therefore have recourse for HIV testing, compared to those who are less well-off. 16 There is also evidence of a positive association between HIV awareness and HIV testing, 14 and awareness and education are highly correlated.…”

Women’s willingness to be tested for human immunodeficiency virus during pregnancy: A review

“…Dube and Nkosi [43] found that half of the women in their study felt 50% of respondents expressed willingness to be tested in a Chinese study by Li et al [36] and in an Ethiopian study by Moges and Amberbir [37] ; in contrast, other studies reported higher willingness to be tested (more than 75% of respondents expressed willingness to be tested) [38][39][40] . Some African studies demonstrated significant gaps between the willingness of pregnant women to receive HIV testing and their actual testing rates, as in studies from Sudan [41] and Tanzania [42] . Similarly, a South African study showed that pregnant women had a good level of knowledge and understanding about HIV testing in pregnancy, and their perceptions of HIV testing were positive, but they were not consistent with their behavior.…”

“…That is, the women's positive attitudes towards HIV testing were not reflected in their actual behavior [43] . The difference between women's willingness to receive HIV testing and actual testing rates implies that willingness to be tested for HIV during pregnancy is a complex phenomenon influenced by an interplay of factors [42,44] . Based on the classification used by Deblonde et al [45] in their literature review on impediments to HIV testing in Europe, in the present review factors related to the willingness of women to be tested for HIV during pregnancy have been classified as policy-related factors, womanrelated factors, and health care provider-related factors.…”

“…An important role in the willingness of women to be tested for HIV during pregnancy has been attributed to the male partner, who can be either a barrier or a source of support [31,37,40,42,55,[63][64][65] . Women feel that their spouses' support and approval for HIV testing is a necessary condition for them to agree to receive an HIV test during pregnancy [37,63,[66][67][68] .…”