4 research outputs found
Is 'Opt-Out HIV Testing' a real option among pregnant women in rural districts in Kenya?
PMTCT allows people living with HIV to actualize childbearing. However, it also
complicates motherhood, as the medical consequences and public health implications
of non-adherence to PMTCT service recommendations disrupt socio-cultural
expectations of childbearing and parenthood. This thesis aimed to study childbearing
and adherence to PMTCT interventions focusing on how women living with HIV
realize motherhood in Kenya. We sought to answer how women on ART experience
motherhood and how motherhood aggravate adherence to PMTCT services
Methods: A quantitative cross sectional study (I) with a questionnaire survey
conducted among pregnant women at their first visit to antenatal clinic to study consent
to HIV testing and three qualitative studies analyzed with content analysis (II and IV)
and narrative structuring (III) were included. Qualitative interviews were performed
with women living with HIV who were pregnant, recently delivered and those actively
planning a pregnancy to explore views and experiences when seeking a pregnancy (II),
the reasoning and deciding about adherence to PMTCT (III) and how motherhood
interferes with HIV treatment (IV).
Results: âStriving for motherhoodâ was the overriding theme describing the desire of
women on ART to be parents while negotiating the challenges of living with HIV (IIV).
Children improve womenâs position in society and are a sign of a happy and
fulfilled life (II-IV). Of 900 pregnant women surveyed at their first visit to antenatal
care clinic, only 17% understood that HIV testing is optional (I). Making an informed
decision to decline HIV testing was associated with knowing that testing was optional
(OR=5.44, 95%CI 3.44-8.59), not having a stable relationship with the childâs father
(OR=1.76, 95%CI 1.02-3.03), and not having discussed HIV testing with a partner
before the ANC visit (OR=2.64 95%CI 1.79-3.86). Socio-economic affluence and
residence influence behaviors such as no condom use, non-disclosure of HIV infection,
use of traditional medicine simultaneously with ART, home delivery and stigma and
discrimination from partners, family and community, all of which undermine adherence
to PMTCT services (II-IV). Structural shortcomings in PMTCT result in the lack of
antiretroviral HIV medicines, practice of mixed infant feeding and missed
appointments (I, III, IV).
Conclusion: Motherhood is achieved at the cost of striving to balance socio-cultural
expectations of childbearing that also conceals their HIV infection at the cost of nonadherence
to PMTCT recommendations. Being infected with HIV does not remove the
desire of motherhood and related socio-cultural demands. It is important to
acknowledge the significance childbearing among women infected with HIV to
improve adherence. Women with chronic illness such as HIV-infection who are
dependent on continuous medication and health check-ups struggle to balance the
desire for children with the needs related to their illness and the expectations of being a âgood motherâ
"I will not let my HIV status stand in the way." Decisions on motherhood among women on ART in a slum in Kenya- a qualitative study
Abstract Background The African Medical Research Foundation antiretroviral therapy program at the community health centre in Kibera counsels women to wait with pregnancy until they reach the acceptable level of 350 cells/ml CD4 count and to discuss their pregnancy intentions with their health care providers. A 2007 internal assessment showed that women were becoming pregnant before attaining the 350 cells/ml CD4 count and without consulting health care providers. This qualitative study explored experiences of intentionally becoming pregnant among women receiving highly active antiretroviral therapy (HAART). Methods Nine pregnant women, six newly delivered mothers and five women wanting to get pregnant were purposefully selected for in-depth interviews. Content analysis was used to organize and interpret the women's experiences of becoming pregnant. Results Women's choices for pregnancy could be categorized into one overarching theme 'strive for motherhood' consisting of three sub-themes. A child is thought of as a prerequisite for a fulfilled and happy life. The women accepted that good health was required to bear a pregnancy and thought that feeling well, taking their antiretroviral treatment and eating nutritious food was enough. Consulting health care providers was perceived as interfering with the women's decisions to get pregnant. Becoming pregnant as an HIV-infected woman was, however, complicated by the dilemmas related to disclosing HIV infection and discussing pregnancy intentions with their partners. Conclusions Motherhood is important to women on antiretroviral treatment. But they seemed to lack understanding of the relationship between a high CD4 cell count and a low chance of transmission of HIV to offspring. Better education about the relationship of perceived good physical health, low CD4 cell count and the risk of mother to child transmission is required. Women want to control the domain of childbearing but need enough information to make healthy choices without risking transmission.</p