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Author Notes:

Correspondence to: Janet M. Turan, PhD, MPH, Department of Health Care Organization and Policy, Maternal and Child Health Concentration, School of Public Health, University of Alabama at Birmingham, Birmingham, AL 35294 (e-mail: jmturan@uab.edu).

The authors thank all of the Kenyan women who participated in the MAMAS Study and shared their experiences with us.

They acknowledge the important logistical support of the KEMRI-UCSF Collaborative Group and especially Family AIDS Care and Education Services.

They also gratefully acknowledge the Director of KEMRI, the Director of KEMRI's Centre for Microbiology, and the Nyanza Provincial Ministries of Health for their invaluable support in conducting this research.

The authors have no conflicts of interest to disclose.

Subjects:

Research Funding:

Supported by the US National Institute of Mental Health, Award Number K01MH081777.

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • HIV/AIDS
  • disclosure
  • stigma
  • PMTCT
  • maternal health
  • Kenya
  • TO-CHILD TRANSMISSION
  • DOSE NEVIRAPINE REGIMEN
  • SEROSTATUS DISCLOSURE
  • DEVELOPING-COUNTRIES
  • PREGNANT-WOMEN
  • OBSTETRIC CARE
  • SOUTH-AFRICA
  • PREVENTION
  • UGANDA
  • STIGMA

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

Tools:

Journal Title:

Journal of Acquired Immune Deficiency Syndromes

Volume:

Volume 67

Publisher:

, Pages S235-S242

Type of Work:

Article | Final Publisher PDF

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.

Copyright information:

© 2014 by Lippincott Williams & Wilkins.

This is an Open Access work distributed under the terms of the Creative Commons Attribution-NonCommerical-NoDerivs 3.0 Unported License (http://creativecommons.org/licenses/by-nc-nd/3.0/).

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