title: Women's views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries.
abstract: BACKGROUND
  Ambitious UN goals to reduce the mother-to-child transmission of HIV have not been met in much of Sub-Saharan Africa. This paper focuses on the quality of information provision and counseling and disclosure patterns in Burkina Faso, Kenya, Malawi and Uganda to identify how services can be improved to enable better PMTCT outcomes.
  
  
  METHODS
  Our mixed-methods study draws on data obtained through: (1) the MATCH (Multi-country African Testing and Counseling for HIV) study's main survey, conducted in 2008-09 among clients (N = 408) and providers at health facilities offering HIV Testing and Counseling (HTC) services; 2) semi-structured interviews with a sub-set of 63 HIV-positive women on their experiences of stigma, disclosure, post-test counseling and access to follow-up psycho-social support; (3) in-depth interviews with key informants and PMTCT healthcare workers; and (4) document study of national PMTCT policies and guidelines. We quantitatively examined differences in the quality of counseling by country and by HIV status using Fisher's exact tests.
  
  
  RESULTS
  The majority of pregnant women attending antenatal care (80-90%) report that they were explained the meaning of the tests, explained how HIV can be transmitted, given advice on prevention, encouraged to refer their partners for testing, and given time to ask questions. Our qualitative findings reveal that some women found testing regimes to be coercive, while disclosure remains highly problematic. 79% of HIV-positive pregnant women reported that they generally keep their status secret; only 37% had disclosed to their husband.
  
  
  CONCLUSIONS
  To achieve better PMTCT outcomes, the strategy of testing women in antenatal care (perceived as an exclusively female domain) when they are already pregnant needs to be rethought. When scaling up HIV testing programs, it is particularly important that issues of partner disclosure are taken seriously.
authors.affiliation: Amsterdam Institute for Social Science Research, University of Amsterdam, Amsterdam, the Netherlands. A.P.Hardon@uva.nl
authors.forename: Anita
authors.initials: A
authors.lastname: Hardon
authors.forename: Eva
authors.initials: E
authors.lastname: Vernooij
authors.forename: Grace
authors.initials: G
authors.lastname: Bongololo-Mbera
authors.forename: Peter
authors.initials: P
authors.lastname: Cherutich
authors.forename: Alice
authors.initials: A
authors.lastname: Desclaux
authors.forename: David
authors.initials: D
authors.lastname: Kyaddondo
authors.forename: Odette
authors.initials: O
authors.lastname: Ky-Zerbo
authors.forename: Melissa
authors.initials: M
authors.lastname: Neuman
authors.forename: Rhoda
authors.initials: R
authors.lastname: Wanyenze
authors.forename: Carla
authors.initials: C
authors.lastname: Obermeyer
mesh_terms: D000293:Adolescent; D000328:Adult; D017954:Africa South of the Sahara; D003219:Confidentiality; D003376:Counseling; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000635:transmission; D006679:HIV Seropositivity; D019538:Health Care Surveys; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007407:Interviews as Topic; D008875:Middle Aged; D057240:Patient Preference; D011247:Pregnancy; D055815:Young Adult