Reasoning and deciding PMTCT-adherence during pregnancy among women living with HIV in Kenya

Abstract

This study explores type identities among rural and urban slum women on antiretroviral therapies who become pregnant. Narrative structuring was chosen to develop type narratives that illustrate how rural and urban women handle their HIV-infection and how they reason and decide about PMTCT-adherence during pregnancy and childbirth. Women in rural areas described their lives as 'secure and family controlled'. This gave the women security and predictability in life, but also meant that it was difficult to keep secrets about HIV infection. For women in the urban slum area the narratives were a tale of the uncertain and hard to predict reality in the slum, but also about self-reliance and decisiveness. They portrayed themselves as 'vulnerable and striving to survive' thus managing a tough situation without long-term solutions. We conclude that pregnancy poses different social challenges in rural and urban areas affecting how women choose to manage their adherence to PMTCT, which is also affected by HIV stigma and lack of disclosure.

Bidirectional links between HIV and intimate partner violence in pregnancy: implications for prevention of mother‐to‐child transmission

“…Poor adherence among pregnant women may relate to challenges around partner disclosure [44]. In a recent systematic review of PMTCT, partner disclosure was associated with poor PMTCT uptake in a majority of both quantitative (6 of 9) and qualitative (17 of 24) studies [45].…”

Intimate partner violence and HIV-positive women's non-adherence to antiretroviral medication for the purpose of prevention of mother-to-child transmission in Lusaka, Zambia

“…Often, HIV-positive women’s attitude, perceived norms, and personal agency are cited as ways to understand and address PMTCT adherence (Awiti Ujiji et al, 2011; Nyasulu & Naysulu, 2011; Varga & Brookes, 2008). The problem with examining PMTCT adherence using only intrapersonal constructs is that the sole responsibility to prevent MTCT is thereby placed on the HIV-positive mother, without taking into account the context in which these health behaviors occur and the large gender inequities that persist both within society and sexual relationships (Campbell et al, 2008).…”

The Role of HIV-Related Stigma in Utilization of Skilled Childbirth Services in Rural Kenya: A Prospective Mixed-Methods Study

“…Qualitative studies in sub-Saharan Africa have suggested that pregnant women avoid health clinics if they fear HIV testing or unwanted HIV status disclosure [13]–[15]. Indeed, stigma and discrimination have been revealed as among the most important barriers to pregnant women's acceptance of HIV testing during antenatal care [16]–[18], their initial participation in programs for PMTCT [19],[20], and their retention and adherence in these programs [21]–[23].…”

“…Qualitative studies suggest that for pregnant women in high HIV-prevalence settings, HIV-related stigma—especially from a woman's male partner—may be a key factor causing women to avoid antenatal clinics (ANC) and childbirth in health facilities [33],[34]. Maternity services have become prime locations for HIV testing and provision of PMTCT interventions in Kenya and many other countries.…”