HIV-related stigmatization: Experiences from women enrolled in a mother-to-child transmission of HIV prevention program in Malawi

Abstract

Abstract Title: HIV-related Stigmatization: Experiences from women enrolled in a Mother-to-child of HIV Prevention Program in Malawi

Researcher: Viva Combs Thorsen

Supervisors: Johanne Sundby, MD, MPH (Professor, University of Oslo) Francis Martinson, MD, PhD (Country Director, UNC Project)

Introduction: Despite two decades into the epidemic (first HIV diagnosis in Malawi in 1985) and its pervasiveness in Malawi, stigma insidiously continues to overshadow HIV, resulting in negative attitudes and reactions towards people living with HIV/AIDS (PLWHA). This has in turn impeded preventive efforts such as prevention of mother-to-child transmission (PMTCT). Fear of being stigmatized deter pregnant women from being tested, enrolling in PMTCT programs, and disclosing serostatus to significant others. The impetus for this study was HIV/AIDS-related stigma negatively impacts on the wellbeing of PLWHA, prevention efforts, and service delivery.

Overall Objective of the Study: The proposed study aims to broaden the understanding of HIV-related stigmatization in the context of prevention of mother-to-child transmission of HIV in Lilongwe, Malawi.

Specific Objectives were to: Identify and describe the forms of stigmatization HIV+ pregnant women and new mothers experience Investigate the context in which stigmatization is manifested Explore HIV+ pregnant women s responses to stigmatization Explore the dimensions of stigmatization that may influence HIV+ pregnant women s decisions to participate in efforts to prevent the transmission of HIV to their (unborn) child Investigate how healthcare workers may mitigate or perpetuate stigmatization in the MTCT prevention program

Study Design and Methods: Qualitative methods of interviews and non-participant observations were employed. Newspapers were also reviewed to assess socio-cultural and political tones of HIV/AIDS in Malawi.

Conclusion: Felt stigma influenced the women s decision to adhere to PMTCT recommendations. However, it was more an issue of how to comply without inadvertently disclosing their HIV status. Therefore, stigmatization was not the major contender; poverty and gender inequality were. They are most influential in the women s decision to adhere to PMTCT. Therefore, any anti-stigmatization campaigns must take these larger socio-cultural and political contextual factors into consideration.

Recommendations: The PMTCT should consider participating in the following seven activities: Increase number of anti-stigmatization activities Expand the scope of hospital staff training and counselling Reduce involuntary disclosure caused by incentives Integrate the PMTCT perspective into development initiatives Optimize infrastructure and supplies Modify PMTCT terminology