Women’s views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries
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Date
2012
Journal Title
Journal ISSN
Volume Title
Publisher
BMC Public Health
Abstract
Ambitious 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.
Methods: Our 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.
Results: The 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.
Conclusion: To 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.
Description
Keywords
PMTCT, Africa, HIV testing, Counseling, Consent, Disclosure
Citation
Hardon, A., Vernooij, E., Bongololo-Mbera, G., Cherutich, P., Desclaux, A., Kyaddondo, D., ... & Obermeyer, C. (2012). Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries. BMC Public health, 12(1), 1-15.