Shame, Guilt, and Stress: Community Perceptions of Barriers to Engaging in Prevention of Mother to Child Transmission (PMTCT) Programs in Western Kenya
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Date
2014Author
Kohler, Pamela K.
Ondenge, Kenneth
Mills, Lisa A.
Okanda, John
Kinuthia, John
Olilo, George
Odhiambo, Frank
Zierler, Brenda
Voss, Joachim
John-Stewart, Grace
Language
enMetadata
Show full item recordAbstract
While global scale-up of prevention of mother-to-child transmission of HIV (PMTCT) services has been expansive, only half of HIV-infected pregnant women receive antiretroviral regimens for PMTCT in sub-Saharan Africa. To evaluate social factors influencing uptake of PMTCT in rural Kenya, we conducted a community-based, cross-sectional survey of mothers residing in the KEMRI/CDC Health and Demographic Surveillance System (HDSS) area. Factors included referrals and acceptability, HIV-related stigma, observed discrimination, and knowledge of violence. Chi-squared tests and multivariate regression analyses were used to detect stigma domains associated with uptake of PMTCT services. Most HIV-positive women (89%) reported blame or judgment of people with HIV, and 46% reported they would feel shame if they were associated with someone with HIV. In multivariate analyses, shame was significantly associated with decreased likelihood of maternal HIV testing (Prevalence Ratio 0.91, 95% Confidence Interval 0.84–0.99), a complete course of maternal antiretrovirals (ARVs) (PR 0.73, 95% CI 0.55–0.97), and infant HIV testing (PR 0.86, 95% CI 0.75–0.99). Community perceptions of why women may be unwilling to take ARVs included stigma, guilt, lack of knowledge, denial, stress, and despair or futility. Interventions that seek to decrease maternal depression and internalization of stigma may facilitate uptake of PMTCT.
Citation
Kohler, Pamela K., et al. "Shame, Guilt, and Stress: Community Perceptions of Barriers to Engaging in Prevention of Mother to Child Transmission (PMTCT) Programs in Western Kenya." AIDS patient care and STDs (2014).Publisher
University of Nairobi
Collections
- Faculty of Health Sciences (FHS) [10385]