HIV-Positive Status Disclosure and Use of Essential PMTCT and Maternal Health Services in Rural Kenya

• Type of Material: Article
• Authors: Sydney Spangler, Emory University; Maricianah Onono, Kenya Medical Research Institute (KEMRI); Elizabeth A. Bukusi, Kenya Medical Research Institute (KEMRI); Craig R. Cohen, University of California San Francisco; Janet M. Turan, University of Alabama Birmingham
• Language: English
• Date: 2014-12-01
• Publisher: Lippincott, Williams & Wilkins
• Publication Version: Final Published Version
• Copyright Statement: © 2014 by Lippincott Williams & Wilkins.
• License: Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported
• Final Published Version (URL): http://dx.doi.org/10.1097/QAI.0000000000000376
• Title of Journal or Parent Work: Journal of Acquired Immune Deficiency Syndromes
• ISSN: 1525-4135
• Volume: 67
• Start Page: S235
• End Page: S242
• Grant/Funding Information: Supported by the US National Institute of Mental Health, Award Number K01MH081777.
• Keywords: DEVELOPING-COUNTRIES; Life Sciences & Biomedicine; STIGMA; PREGNANT-WOMEN; UGANDA; Kenya; stigma; disclosure; TO-CHILD TRANSMISSION; DOSE NEVIRAPINE REGIMEN; Immunology; OBSTETRIC CARE; SEROSTATUS DISCLOSURE; PREVENTION; Infectious Diseases; maternal health; PMTCT; HIV/AIDS; SOUTH-AFRICA; Science & Technology
• Research Categories: Biology, Microbiology; Health Sciences, Obstetrics and Gynecology; Health Sciences, Nursing

Abstract

Background: In sub-Saharan Africa, women's disclosure of HIVpositive status to others may affect their use of services for prevention of mother-to-child transmission of HIV (PMTCT) of HIV and maternal and child health-including antenatal care, antiretroviral drugs (ARVs) for PMTCT, and skilled birth attendance.Methods: Using data from the Migori and AIDS Stigma Study conducted in rural Nyanza Province, Kenya, we compared the use of PMTCT and maternal health services for all women by HIV status and disclosure category (n = 390). Among HIV-infected women (n = 145), associations between disclosure of HIV-positive status and the use of services were further examined with bivariate and multivariate logistic regression analyses.Results: Women living with HIV who had not disclosed to anyone had the lowest levels of maternity and PMTCT service utilization. For example, only 21% of these women gave birth in a health facility, compared with 35% of HIV-negative women and 49% of HIV-positive women who had disclosed (P < 0.001). Among HIVpositive women, the effect of disclosure to anyone on ARV drug use [odds ratio (OR) = 5.8; 95% confidence interval (CI): 1.9 to 17.8] and facility birth (OR = 2.9; 95% CI: 1.4 to 5.7) remained large and significant after adjusting for confounders. Disclosure to a male partner had a particularly strong effect on the use of ARVs for PMTCT (OR = 7.9; 95% CI: 3.7 to 17.1).Conclusions: HIV-positive status disclosure seems to be a complex yet critical factor for the use of PMTCT and maternal health services in this setting. The design of interventions to promote such disclosure must recognize the impact of HIV-related stigma on disclosure decisions and protect women's rights, autonomy, and safety.