267072 Stigma and lack of disclosure as barriers to use of maternity and HIV services by HIV-positive pregnant women in rural Kenya

Wednesday, October 31, 2012 : 1:15 PM - 1:30 PM

Janet Turan, PhD, MPH , School of Public Health, Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, AL
Maricianah Onono, MBChB , Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu, Kenya
Craig Cohen, MD, MPH , OB/GYN and Reproductive Sciences, University of California, San Francisco, San Francisco, CA
Elizabeth Bukusi, MD, MPH, PGD, PHD , Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Nairobi, Kenya
Background: In the MAMAS Study, we examined the role of HIV-related stigma in use of health services by HIV-positive pregnant women in rural Nyanza Kenya—a setting where one in every five pregnant women is HIV-infected. Methods: Of 239 HIV-positive women in the MAMAS cohort, 165 (70%) could be located and participated in structured interviews 4-8 weeks postnatally. Data on service utilization were also obtained from medical records. We examined associations of multi-item measures of HIV-related stigma with disclosure and HIV-infected women's utilization of prevention of mother-to-child transmission (PMTCT), facility-based childbirth, and HIV care services using logistic regression methods. Results: Of postpartum HIV-infected women, only 59% had disclosed their HIV status to anyone and only 31% had disclosed to their male partner. Around one-third had used facility-based childbirth services, 72% reported taking drugs for PMTCT, and 54% had enrolled in HIV care. Women who had disclosed their HIV-positive status to others were 3.5 times more likely to have taken drugs for PMTCT (95% CI: 1.68-7.36) and 5.1 times more likely to give birth in a health facility (95% CI: 2.21-11.56) than those who had not disclosed. Women with high levels of internalized HIV stigma were less likely to have enrolled in HIV care than those with low levels of internalized HIV stigma (OR=0.56, 95% CI: 0.36-0.87). Conclusions: Even in a setting where HIV infection is common among pregnant women, HIV-related stigma and the associated lack of disclosure are important barriers to HIV-infected women's use of life-saving maternity and HIV services.

Learning Areas:
Provision of health care to the public
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. Identify four dimensions of HIV-related stigma that can negatively affect quality of life and healthcare utilization for persons living with HIV (PLWH). 2. Explain how fears and experiences of HIV-related stigma and resultant lack of disclosure may prevent HIV-positive pregnant women from using health services. 3. Describe the importance of reducing HIV-related stigma and promoting safe disclosure for reaching the UNAIDS goals of virtual elimination of vertical transmission and reduction of HIV-related maternal deaths.

Keywords: HIV/AIDS, Pregnancy

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator of an NIH-funded program of research examining the effects of HIV-related stigma on use of health services by pregnant women in Kenya.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
The Futures Group International, LLC health policy Consultant

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.