HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: Results from the MAMAS Study

Background: HIV/AIDS stigma is a common thread in the narratives of pregnant women refusing HIV testing or opting out of prevention of mother-to-child transmission (PMTCT) programs globally. We examined the relationships of quantitative measures of HIV/AIDS stigma with pregnant women's refusal of HIV testing. Methods: We conducted an observational study of pregnant women attending nine antenatal care (ANC) clinics in rural Nyanza Kenya (N=1525). Women presenting for their first ANC visit of the pregnancy responded to a questionnaire before the ANC visit, and information on HIV test refusal was obtained from medical records after the visit. Associations of multi-item stigma measures with HIV testing refusal were examined by calculating unadjusted ORs and 95% CIs, followed by multivariate logistic regression. Results: Refusal of an HIV test ranged from 16% (March-May 2008), to 2% (Dec 2008-Feb 2009), with an overall rate of 6%. Measures of anticipated male partner and family stigma were strongly associated with HIV test refusal, whereas perceived community stigma scores were not. Anticipated male partner stigma (OR=1.95, 95% CI: 1.09-3.47) remained significantly associated with HIV test refusal after adjusting for socio-demographics and HIV knowledge. Conclusions: This study demonstrated that anticipations of HIV/AIDS stigma can impede acceptance of HIV testing by pregnant women, even in an environment where HIV testing in the ANC clinic is becoming the norm. It will be important to examine the roles of fears and experiences of HIV/AIDS stigma in service uptake after HIV testing and to develop stigma-reduction interventions which focus on women's primary relationships.