Testing Positive and Disclosing in Pregnancy: A Phenomenological Study of the Experiences of Adolescents and Young Women in Maseru, Lesotho

Abstract

The routine antenatal screening through the prevention of mother to child transmission of HIV (PMTCT) services results in pregnancy being often the point at which an HIV diagnosis is made. Disclosure to partners presents particular complexities during pregnancy. However, research on the pattern and experiences of disclosure in pregnancy is limited in Lesotho, despite the high prevalence of HIV among pregnant women. The aim of this study was to explore and describe the disclosure experiences of adolescent girls and young women (AGYW) after receiving a positive HIV test result during pregnancy. Methods. Descriptive phenomenology using semistructured in-depth interview was used to collect data from AGYM sampled purposively from PMTCT sites located in urban areas of Maseru, Lesotho. Data analysis was inductive and followed the thematic approach. Findings. There were 15 AGYW involved in this study with the mean age of 20 years. Fourteen reported being pregnant with their first child and perceived HIV testing in antenatal care as compulsory. Ten AGYM disclosed their HIV status in the immediate posttesting period to protect their partners from HIV infection. The narratives revealed that the AGYM hoped that after disclosing, the partner would be tested for HIV. Furthermore, the AGYM disclosed because they wanted freedom to take their medication. Their experience of disclosure was relief, as they did not have to hide their HIV status. The AGYM reported being supported to adhere to medication and clinic attendance by their partners who also provided emotional support to them to deal with being HIV positive and pregnant. Conclusion. The AGYM recounted an overall positive experience of disclosure to their partners who agreed to test for HIV and adopted safe sex practices. This has positive implications for the PMTCT programme and the involvement of men in reproductive health. Therefore, there is need to integrate disclosure and partner testing interventions in the cascade of services in PMTCT programmes.

HIV and Pregnancy among Adolescents in Sub-Saharan Africa: A Scoping Review

“…Existing studies have shown that early sexual debut is a significant risk factor for both unintended pregnancies and HIV infection due to various factors such as limited knowledge about safe sex practices, lack of access to contraceptives, and potential engagement in risky sexual behaviours [38,39]. This may also be linked to adolescent mothers learning of their HIV status for the first time when they confirm that they are pregnant [30,40]. This review also highlights that adolescent mothers are more likely to be involved in relationships where they have poor relationship power, gender inequitable norms, intimate partner violence, and little HIV preventive communication with higher-risk partners [43,44, 41,42].…”

From Policy to Practice: A Process Evaluation of Implementing Opt-Out HIV Testing in Antenatal Clinics Across Ghana

“…Early research found that pregnant women believed ANCs provided inadequate information about care, particularly HIV testing (Carlsson et al, 2021). Furthermore, some pregnant women perceived HIV testing in antenatal care as compulsory, indicating a lack of autonomy in decision-making (Madiba & Putsoane, 2020). Coercive HIV testing procedures can be a substantial obstacle to HIV testing during pregnancy (Razzaq et al, 2021), as they violate the concepts of autonomy and informed decision-making (Marchant et al, 2022).…”

Factors Associated with an Human Immunodeficiency Virus (HIV) Testing Uptake and Differences by Sex in Lesotho

“…AOR from our analysis suggested that a considerable difference between women and men. HIV testing in antenatal care (Madiba & Putsoane, 2020). In Lesotho, women in the age range of 25-29 frequently experience childbirth (Ministry of Health & ICF International, 2016).…”