title: Shame, guilt, and stress: Community perceptions of barriers to engaging in prevention of mother to child transmission (PMTCT) programs in western Kenya.
abstract: 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.
authors.affiliation: 1 Department of Global Health, University of Washington , Seattle, Washington.
authors.forename: Pamela K
authors.initials: PK
authors.lastname: Kohler
authors.forename: Kenneth
authors.initials: K
authors.lastname: Ondenge
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Mills
authors.forename: John
authors.initials: J
authors.lastname: Okanda
authors.forename: John
authors.initials: J
authors.lastname: Kinuthia
authors.forename: George
authors.initials: G
authors.lastname: Olilo
authors.forename: Frank
authors.initials: F
authors.lastname: Odhiambo
authors.forename: Kayla F
authors.initials: KF
authors.lastname: Laserson
authors.forename: Brenda
authors.initials: B
authors.lastname: Zierler
authors.forename: Joachim
authors.initials: J
authors.lastname: Voss
authors.forename: Grace
authors.initials: G
authors.lastname: John-Stewart
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D055812:Community-Based Participatory Research; D003430:Cross-Sectional Studies; D005260:Female; D006167:Guilt; D015658:HIV Infections / Q000188:drug therapy / Q000517:prevention & control* / Q000523:psychology; D006297:Health Services Accessibility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007407:Interviews as Topic; D007630:Kenya; D009035:Mothers / Q000523:psychology*; D015999:Multivariate Analysis; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010465:Perception; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000453:epidemiology / Q000517:prevention & control*; D015397:Program Evaluation; D012044:Regression Analysis; D012424:Rural Population; D057545:Social Stigma; D013315:Stress, Psychological / Q000523:psychology*
chemical_list: D019380:Anti-HIV Agents