Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries

Abstract

BackgroundAmbitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes.MethodsOur mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study's main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services; 2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support; (3) in-depth interviews with key informants and PMTCT healthcare workers; and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher's exact tests.ResultsThe majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret; only 37% had disclosed to their husband.ConclusionTo achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously.

Antenatal Care and Couples’ HIV Testing in Rural Northern Uganda: A Gender Relations Analysis

“…Throughout sub-Saharan Africa, health systems are challenged to identify HIV during pregnancy in order to PMTCT, and sometimes resort to coercion (Hardon et al, 2012), such as was the case for women testing in Malawi (Angotti, Dionne, & Gaydosh, 2011). Coercive practices have been given new weight in Uganda by the recently passed HIV Prevention and Control Act (2014;Devi, 2014).…”

Unsupervised Self-testing as Part Public Health Screening for HIV in Resource-Poor Environments: Some Ethical Considerations

“…Due to their social status and lack of legal protection, such vulnerable populations may be subjected to mistreatment and coercion. Women, for example, are more vulnerable to violence, abandonment, destitution or death at the hands of their partners, families or communities [24,26,29,30]. There is also evidence that women living with HIV can suffer greater violence post-diagnosis than men [31].…”

“…Given that we know that more women and girls are living with HIV, for example, and given that they are particularly vulnerable in resource-poor environments where social norms and legislative structure do not, or cannot, offer adequate protection of basic rights, HIVST does appear to increase potential risks. An acknowledgement of the risks of testing for HIV could be argued to underlie the omission to collect test results by some pregnant women, who are routinely tested for HIV in antenatal clinics and their reluctance to disclose positive results to their partners [30].It is the case, due to routine testing of pregnant women, that more women have access to HIV testing (and to treatment) than other vulnerable groups; such as migrant and domestic workers and MSM. However some of the risks of screening for HIV may be very similar for these groups.…”

Interdisciplinary action in counseling for pregnant women with HIV/Aids/Ação interdisciplinar no aconselhamento para gestantes com HIV/Aids/Acción interdisciplinar en el consejo para mujeres embarazadas con HIV/Sida

“…Uma boa avaliação da qualidade do aconselhamento está associada ao apoio emocional oferecido pelos profissionais e ao tempo para fazer perguntas e discutir sobre a situação de saúde (20) . …”