Awareness, attitudes and perceptions regarding HIV and PMTCT amongst pregnant women in Guinea-Bissau\u2013 a qualitative study

Noel Vieira,Morten Sodemann,Christian Wejse,Lucy Reynolds,Inês Oliveira,Peter Aaby,Dlama Nggida Rasmussen,Aureliano Gomes,Holger W Unger

doi:10.1186/s12905-017-0427-6

Abstract

BackgroundThe human immunodeficiency virus (HIV) continues to be a major cause of maternal and infant mortality and morbidity in sub-Saharan Africa. Prevention of mother-to-child transmission of HIV (PMTCT) strategies have proven effective in decreasing the number of children infected in utero, intrapartum and during the breastfeeding period. This qualitative study explores knowledge and perceptions of HIV amongst pregnant women, healthcare workers’ experiences of the national PMTCT services, and barriers to PMTCT, during a period of programme scale-up in urban Guinea-Bissau (2010–11).MethodsIn-depth interviews were undertaken amongst 27 women and 19 key informants at local antenatal clinics and the national maternity ward in Bissau, Guinea-Bissau.ResultsAmongst women who had been tested for HIV, awareness and knowledge of HIV and PMTCT remained low. Testing without informed consent was reported in some cases, in particular when the test was performed around the time of delivery. Possible drivers of inadequate counselling included lack of confidentiality, suboptimal healthcare worker training, lack of time, and perceived occupational risk. Demand-side barriers to PMTCT included lack of HIV and PMTCT knowledge, customary and cultural beliefs associated with HIV and ill-health, HIV stigma and discrimination, and fear of partnership dissolution.ConclusionsSocio-cultural and operational challenges, including HIV testing without informed consent, present significant barriers to the scale-up of PMTCT services in Bissau. Strengthening local capacity for effective counselling and testing in the antenatal setting is paramount. Further research into local customary beliefs relating to HIV is warranted.

Highlights

The human immunodeficiency virus (HIV) continues to be a major cause of maternal and infant mortality and morbidity in sub-Saharan Africa
The majority (25/27, 93%) of women were registered as having been tested for HIV in the current pregnancy and prior to the interview (Table 1)
Women’s knowledge of HIV/Acquired immune deficiency syndrome (AIDS) and Prevention of mother-to-child transmission of HIV (PMTCT) Interviews suggested that HIV-related knowledge was incomplete, despite participants having undergone testing in the current pregnancy

Summary

Introduction

The human immunodeficiency virus (HIV) continues to be a major cause of maternal and infant mortality and morbidity in sub-Saharan Africa. Prevention of mother-to-child transmission of HIV (PMTCT) strategies have proven effective in decreasing the number of children infected in utero, intrapartum and during the breastfeeding period. This qualitative study explores knowledge and perceptions of HIV amongst pregnant women, healthcare workers’ experiences of the national PMTCT services, and barriers to PMTCT, during a period of programme scale-up in urban Guinea-Bissau (2010–11). The human immunodeficiency virus (HIV) is a principal contributor to the high burden of maternal and infant mortality and morbidity in sub-Saharan Africa [1,2,3]. Eighty two percent of seropositive women, and 33% of their children, received antiretroviral therapy [23]

Methods

Results

Discussion

Conclusion