Online Program

PMTCT Adherence and Gender Power Dynamics in Urban Zambia: Results of a Clinic-Based Survey in Lusaka

Tuesday, November 3, 2015

Karen Hampanda, MPH, PhD candidate, Department of Health and Behavioral Sciences, University of Colorado Denver, Denver, CO
Background:Prevention of mother-to-child transmission of HIV (PMTCT) depends critically on pregnant/breastfeeding women’s adherence to antiretroviral medication. One aspect that has been neglected is the role that gender power dynamics may play on PMTCT adherence in high HIV prevalence settings in Africa. This study determines if there is a relationship between women’s low power within couples and PMTCT adherence in Zambia. Additionally, it analyzes which power dynamics have the greatest effect on non-adherence to PMTCT medication.

Methods:Data were collected through a face-to-face clinic based-survey (n=320) within the Maternal and Child Health Department of a large public health center in Lusaka, Zambia. Trained research assistants verbally administered the survey in the local language. Medication adherence was defined as taking at least 95% of prescribed doses. Multivariate logistic regression models determined statistically significant differences in the odds of adhering to PMTCT medication during pregnancy, childbirth, and postpartum among 1) women who had or had not experienced different forms of intimate partner violence; 2) women who had more or less household decision making power; and 3) women whose income was higher or lower than their partner.

Results:Physical, sexual, and emotional/psychological violence have a negative relationship on PMTCT adherence. PMTCT adherence is highest when both women and men make household decisions together. Economic inequity does not have a significant effect on mothers’ PMTCT adherence.

Conclusions: Intimate partner violence and low household decision making have a statistically significant impact on the likelihood that HIV-positive mothers in Lusaka will be non-adherent to PMTCT medication.

Learning Areas:

Public health or related research
Social and behavioral sciences

Learning Objectives:
Identify how HIV-positive women's low power within heterosexual Zambian couples effects prevention of mother-to-child transmission (PMTCT) medication adherence. Describe which gender power dynamics decrease the likelihood of medication adherence among HIV-positive mothers during pregnancy, chidlbirth, and postpartum.

Keyword(s): HIV/AIDS, Gender

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: In 2009, I was the technical advisor for a PMTCT project in Zambia through a local NGO. Since then, my research has focused on barriers to PMTCT in urban Zambia. I have been conducting primary research on the intersections of gender inequality and HIV/AIDS in sub-Saharan Africa since 2007. I have several published peer-reviewed articles on my research in journals such as AIDS Care.
Any relevant financial relationships? No

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.