Missed opportunities for early HIV diagnosis: critical insights from the stories of Kenyan women living with HIV

Abstract

Early HIV testing is critical to prevention and timely treatment. Missed opportunities for HIV diagnosis can result in unnecessary deaths at a time when access to antiretroviral treatment proves life saving. While HIV prevention and treatment research has increased, less research exists on women's experiences with HIV diagnosis, despite the fact that women are most affected. Insights from local women are critical in designing culturally meaningful interventions that thwart missed opportunities for early HIV diagnosis. The purpose of our study was to uncover steps women took to know their HIV diagnosis. Using narrative inquiry methodology informed by post-colonial feminism, we interviewed 40 HIV- positive women in Kenya. Five themes emerged related to uptake of HIV testing for women: (a) spouse's critical illness or death; (b) years of suffering from HIV-related symptoms; (c) sick children; (d) prenatal testing; and (e) personal desire to know one's HIV status. These findings centered on women experiences provide an important basis for health promotion interventions related to HIV prevention, earlier detection, and treatment.

Barriers and facilitators to HIV and syphilis rapid diagnostic testing in antenatal care settings in low-income and middle-income countries: a systematic review

“…About a quarter of included studies (n=15) described sociocultural norms, such as traditional beliefs, gender roles and gender norms, as key factors influencing pregnant women’s acceptability of HIV/syphilis RDT at ANCs 35 36 39 41 51 57 63 69 70 75 80 92–96. Five studies reported that traditional beliefs regarding pregnancy can prevent women from seeking care at ANCs 35 39 57 63 92.…”

“…A case study from Indonesia reported healthcare workers had denied the request from pregnant women of HIV testing if their husbands refused to give permission 46. Intentional and unintentional breaches of pregnant women confidentiality to their husband or family members were also more likely to occur in these settings 41 46 93 96. We found six studies that included male partners in the study design in an effort to enhance women’s acceptability of testing 69 70 75 80 94 95.…”

“HIV Changed My Life Forever”: An Illustrative Case of a Sub-Saharan African Migrant Woman Living with HIV in Belgium

“…Early diagnosis and start of medical treatment might have greatly contributed to participant’s survival. Many studies have reported missed diagnoses that have resulted in a number of deaths that could have been prevented with antiretroviral treatment [ 49 , 50 ]. However, we do not know if P’s husband already knew that he was HIV positive and used P’s aunt (a nurse) as a means to get P tested without questioning the rationale for HIV testing in a monogamous marriage that supposedly excludes third party relationship.…”

Falling through the cracks? Missed opportunities for earlier HIV diagnosis in a New York City Hospital

“…This US phenomenon of missed opportunities in HIV testing reflects a common global theme: works have described missed opportunities in Ethiopia, France, Ireland, Kenya, and Scotland in recent years. 26–31 Deblonde reports an estimated 30% of people living with HIV in the European Union and neighbouring countries are unaware of their infection and suggests missed opportunities for diagnosis due to a variety of factors including patient perceptions, legal or financial factors, and attitudes and practices of health care providers. 32 HIV testing guidelines have been introduced in Scotland and the United Kingdom; similarly to the US, both countries have had challenges in applying these guidelines in practice.…”