Stigmatization and Social Support of Pregnant Women With HIV or Syphilis in Eastern China: A Mixed-Method Study

Abstract

BackgroundStigmatization and poor social support are challenges faced by individuals living with HIV or sexually transmitted disease, which can have a profound negative impact on their healthcare. Mother-to-child transmission of either HIV or syphilis can lead to adverse maternal and fetal outcomes. The aim of this study was to investigate stigmatization and social support of pregnant women with HIV or syphilis in eastern China.MethodsThis was an explanatory sequential mixed-method study conducted in Zhejiang province, China in 2019. Stigmatization, social support, and the associated factors toward HIV or syphilis were evaluated using questionnaires. The social support rating scale was used to evaluate social support, where a score <25% was defined as poor social support. A logistic regression model was used to explore the association between stigmatization and poor social support.ResultsA total of 448 women (HIV positive, N = 93; syphilis, N = 355) were recruited in this study. Higher stigmatization was observed in pregnant women with HIV compared to those with syphilis (53.76% vs. 24.36%, p < 0.001), and poorer social support was observed in women with HIV compared with those with syphilis (40.86% vs. 19.86%, p < 0.001), with significant distributions of the total social support scores (Z = −1.976, p = 0.048) and scores on objectivity (Z = −2.036, p = 0.042) and subjectivity (Z = −2.500, p = 0.012). Similar social support among HIV or syphilis pregnant women was observed in medical healthcare facilities. In multivariable logistic model analysis, stigmatization (ORadj = 2.927; 95%CI, 1.714–4.996; p < 0.001) and ethnic minority (ORadj = 2.373; 95%CI, 1.113–5.056; p = 0.025) were negatively associated with social support. Interestingly, employment status was associated with improved social support (ORadj = 0.345; 95%CI, 0.180–0.662; p = 0.001).ConclusionStigmatization among pregnant women with HIV or syphilis remains high. We demonstrated that stigmatization was a significant predictor of low social support in pregnant women with HIV or syphilis. The support shown in medical facilities was similar toward pregnant women with HIV or syphilis. Implementation of stigmatization eradication and social support strategies targeting pregnant women with HIV or syphilis may therefore improve the dual elimination of mother-to-child transmission service.

Psychological and Social Impact of HIV on Women Living with HIV and Their Families in Low- and Middle-Income Asian Countries: A Systematic Search and Critical Review

“…Table 1 summarises the descriptive characteristics of the 17 included articles. Of the 17 articles, six studies were conducted in India [ 4 , 10 , 33 , 34 , 35 , 36 ], three in Indonesia [ 12 , 37 , 38 ], two in Vietnam [ 39 , 40 ], two in Thailand [ 41 , 42 ], two in China [ 8 , 43 ], one in Cambodia [ 18 ] and one in Indonesia, India, Thailand and the Philippines [ 44 ]. Of the 17 articles, 13 were qualitative studies collecting data through one-on-one and semi-structured or unstructured interviews and focus group discussions [ 10 , 12 , 18 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ].…”

“…Of the 17 articles, 13 were qualitative studies collecting data through one-on-one and semi-structured or unstructured interviews and focus group discussions [ 10 , 12 , 18 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 ]. Three articles used quantitative methods (cross-sectional design) [ 4 , 8 , 44 ] and one was a mixed-method study using a cross-sectional and in-depth interview [ 43 ]. A total of 1575 WLHIV participated in these studies, of whom 310 and 1265, respectively, were involved in qualitative and quantitative studies.…”

“…A total of 1575 WLHIV participated in these studies, of whom 310 and 1265, respectively, were involved in qualitative and quantitative studies. Several studies involved a combination of WLHIV and Men Living with HIV (MLHIV) [ 12 , 42 , 44 ] and HIV negative women or women with unknown HIV status [ 43 ]; however, only the results regarding WLHIV or the views of WLHIV were included in this review ( Table 1 ). The sample sizes or the number of WLHIV who participated in the qualitative and quantitative studies reviewed varied from 2 to 52 and 90 to 633 people, respectively.…”

“…Five studies involved only married women [ 4 , 8 , 18 , 38 , 40 ], eight involved a combination of married, widowed and single women [ 10 , 12 , 33 , 36 , 37 , 39 , 41 , 44 ] and one study involved single women [ 42 ]. Three studies did not report the marital status of the participants [ 34 , 35 , 43 ]. Participants’ ages ranged from 15 to 60 years old; however, three studies did not report the participants’ ages [ 35 , 43 , 44 ].…”

“…Three studies did not report the marital status of the participants [ 34 , 35 , 43 ]. Participants’ ages ranged from 15 to 60 years old; however, three studies did not report the participants’ ages [ 35 , 43 , 44 ]. The qualitative studies used content analysis [ 33 , 34 , 35 , 36 , 38 , 43 ] and thematic analysis [ 10 , 12 , 37 , 39 , 40 , 41 , 42 ] approaches for data analysis; however, one study employed a combination of thematic analysis, analysis of episode and the identification of paradigm cases [ 18 ].…”