RESEARCH TRIANGLE PARK, N.C. – Concerns about HIV-related stigma can discourage pregnant women in low-income settings from seeking services for their own health and to prevent transmitting HIV to their children, according to a literature review conducted under the USAID-funded Health Policy project and authored by Janet Turan of the University of Alabama at Birmingham, and Laura Nyblade of RTI International and the Health Policy Project.
The authors reviewed 150 journal articles and reports to examine how HIV-related stigma affects usage of the series of steps that women must complete to prevent mother-to-child transmission of HIV. Their findings are published in the journal AIDS and Behavior.
To successfully prevent mother-to-child HIV transmission, women and infants must receive several interventions ranging from antenatal care services and HIV testing during pregnancy, to anti-retroviral treatment for pregnant women living with HIV, to safe childbirth practices followed by infant HIV testing, and other postnatal health services.
The review found strong evidence that HIV stigma inhibits the use of services at multiple steps of the prevention process. According to the authors, this incremental drop-off in use and retention across the process means that pregnant women with infants at risk of HIV infection may not take advantage of life-saving transmission-prevention programs when they are available.
“These studies, which explored pregnant women’s experiences from their own perspectives and those of their family members, revealed the important role that stigma plays in discouraging their use of both HIV and basic maternity services,” said Laura Nyblade, Ph.D., a senior technical advisor on stigma and discrimination at the Health Policy Project and RTI and co-author of the study. “These findings highlight a serious challenge to international goals to virtually eliminate mother-to-child HIV transmission and reduce HIV-related maternal mortality by 50 percent by 2015.”
The study found that some pregnant women may avoid antenatal care services altogether if they fear they will be forced to get tested for HIV. Those who do access antenatal care may refuse HIV testing, or may not be offered testing at all by health workers who have stigmatizing attitudes.
Among women who do reach later stages of transmission-prevention services, the review found that some who test HIV-positive may decide not to enroll in treatment and care programs for themselves or their infants for fear that their HIV status will become known to the larger community. Anticipated, perceived, or actual experiences of stigma, therefore, act as barriers to these services.
The authors recommend renewed attention to strategies to reduce HIV-related stigma, improve confidentiality, and increase acceptance of these services through community outreach, media campaigns and advocacy.
“Transmission-prevention and related maternal health services will not reach their full potential to save lives without addressing the context of women’s lives, and in particular the continuing threats of stigma associated with HIV-positive status in so many countries,” Nyblade said. “In addition to making clinical services more available, effective and accessible for pregnant women, there is also a need to integrate stigma-reduction components into maternal, neonatal, and child health services.”