Studies Document HIV Stigma’s Effect on Use of PMTCT and Skilled Care at Delivery

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By: Sarah Blake, MHTF consultant

Two new studies reported on by The New York Times , document the role that stigma related to HIV/AIDS plays in dissuading women around the world from using health services during pregnancy and at delivery.

One study, ”HIV-related stigma as a barrier to achievement of global PMTCT and maternal health goals: A review of the evidence” published in AIDS and Behavior draws on literature from around the world in its analysis. It finds that stigma plays a major role in inhibiting women from taking up, continuing with and completing the complex series of interventions that are needed to successfully avoid transmission of HIV during pregnancy, deliver or infancy. They found that use of prevention of mother to child transmission (PMTCT) services fell of most steeply after HIV-tests were offered during antenatal care.

In the second study, “The role of HIV-related stigma  in utilization of childbirth services in rural Kenya: A prospective mixed-methods study,” published in PLOS-Medicine, researchers working in Nyanza Province, Kenya, where just 44 percent of women deliver in health facilities, and an estimated 15 percent of women of child-bearing age (15-49) are HIV-positive collected data on attitudes related to HIV and women’s use of health services during pregnancy and childbirth.

They found that:

Labor in a health facility is commonly viewed as being most appropriate for women with pregnancy complications such as HIV infection. Thus, women delivering in health facilities risk being labeled as HIV positive, a label that is associated with promiscuity. The quantitative data indicate that women with more negative attitudes about HIV-positive people (higher perceptions of HIV-related stigma) at baseline were about half as likely to deliver in a health facility with a skilled attendant as women with positive attitudes about people living with HIV.

The authors also noted that existing efforts to increase uptake of PMTCT services may be having the unintended effect of heightening the association between HIV and use of health facilities, thereby discouraging many women from seeking care. The authors warn that this sort of adverse unintended consequence may grow if efforts around the world seek to integrate PMTCT and maternal health services without also addressing HIV-related stigma.

On the other hand, as authors of both studies point out, successful efforts to reduce HIV stigma would have a positive impact not only on the health of people living with HIV and prevention of new infections among newborns, but also lead to increased use of skilled care at delivery by all women.