Stigma, Facility Constraints, and Personal Disbelief: Why Women Disengage from HIV Care During and After Pregnancy in Morogoro Region, Tanzania

October 2016 - Structural Prevention

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McMahon, S.A., Kennedy, C.E., Winch, P.J., et al. AIDS and Behavior (August 2016), doi: 10.1007/s10461-016-1505-8.

This qualitative study (2011–2013) examined reasons why pregnant women fall out of HIV care during pregnancy. The authors interviewed 40 women in Tanzania who had begun services for prevention of mother-to-child transmission (PMTCT) but stopped attending. Most women (n=38) fell out of care during pregnancy, most often after one or two antenatal care visits. Two defaulted after four postnatal visits. The authors grouped findings into three categories. Category 1, “Antiretroviral therapy (ART) as beneficial but inaccessible,” described observed and experienced stigma associated with ART, lack of privacy at facilities, and insufficient time and funds to access ART, since women often travel to more remote facilities to maximize privacy. Stigma was the most powerful and common obstacle experienced. Category 2, “ART as unnecessary or harmful,” described women who did not believe that ART was necessary because they felt healthy or were in denial about their status; and women who preferred alternative healing techniques, were concerned about side effects, or no longer cared to live. Category 3, “Not knowing or forgetting to use ART,” described lack of information from clinicians about appointments and medications, or forgetting to take ART, as a cause of drop-out. The authors concluded that programmers must address stigma, limitations of facilities, and patient denial to improve retention in PMTCT care.

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