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BMC Public Health. 2012; 12: 26.
Published online Jan 11, 2012. doi:  10.1186/1471-2458-12-26
PMCID: PMC3295711
Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries
Anita Hardon,corresponding author1 Eva Vernooij,1 Grace Bongololo-Mbera,2 Peter Cherutich,3 Alice Desclaux,4 David Kyaddondo,5 Odette Ky-Zerbo,6 Melissa Neuman,7 Rhoda Wanyenze,8 and Carla Obermeyer9
1Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands
2Research for Equity and Community Health Trust, Lilongwe, Malawi
3National AIDS/STD Control Programme, Ministry of Health, Nairobi, Kenya
4Université Paul Cézanne d'Aix-Marseille/Institut de Recherche pour le Développement, Dakar, Sénégal
5Makerere University Department of Social Work/Child Health and Development Centre, Kampala, Uganda. Fellow at Wissenschaftskolleg, 2010-11, Berlin
6Programme d'Appui au Monde Associatif & Communautaire de Lutte Contre le VIH/SIDA, Ouagadougou, Burkina Faso
7Department of Society, Human Development, and Health, Harvard School of Public Health, Boston, USA
8Makerere University School of Public Health, Kampala, Uganda
9Faculty of Health Sciences, American University of Beirut, Beirut, Lebanon
corresponding authorCorresponding author.
Anita Hardon: A.P.Hardon/at/uva.nl; Eva Vernooij: E.E.Vernooij/at/uva.nl; Grace Bongololo-Mbera: grace/at/equi-tb-malawi.org; Peter Cherutich: pcheru2000/at/yahoo.com; Alice Desclaux: alice.desclaux/at/ird.fr; David Kyaddondo: kyaddondo/at/chdc.mak.ac.ug; Odette Ky-Zerbo: Kyzerbo_Odette/at/yahoo.fr; Melissa Neuman: Mel.Neuman/at/yahoo.com; Rhoda Wanyenze: rwanyenze/at/hotmail.com; Carla Obermeyer: cm39/at/aub.edu.lb
Received July 22, 2011; Accepted January 11, 2012.
Abstract
Background
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.
Keywords: PMTCT, Africa, HIV testing, Counseling, Consent, Disclosure
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