HIV disclosure to partners and family among women enrolled in prevention of mother to child transmission of HIV program: implications for infant feeding in poor resourced communities in South Africa.

Sphiwe Madiba,Rosemary Letsoalo

doi:10.5539/gjhs.v5n4p1

Abstract

The introduction of routine HIV counselling and testing (HCT) has increased the number of pregnant women being tested and receiving prevention of mother to child transmission of HIV (PMTCT) interventions in South Africa. While many women may enroll in PMTCT, there are barriers that hinder the success of PMTCT programmes. The success of the PMTCT is dependent on the optimal utilization of PMTCT interventions which require the support of the woman's partner, and other members of her family. We conducted focus groups interviews with 25 HIV-positive post-natal women enrolled in PMTCT, in the City of Tshwane, South Africa. The study explored HIV-positive status disclosure to partners and significant family members and assessed the effect of nondisclosure on exclusive infant feeding. Most women disclosed to partners while few disclosed to significant family members. Most women initiated mixed feeding practices as early as one month and reported that they were pressurized by the family to mix feed. Mixed feeding was common among women who had not disclosed their HIV-positive status to families, and women who had limited understanding of mother to child transmission of HIV. Women who disclosed to partners and family were supported to adhere to the feeding option of choice. Health providers have a critical role to play in developing interventions to support HIV pregnant women to disclose in order to avoid mixed feeding. Improving the quality of information provided to HIV-positive pregnant women during counselling will also reduce mixed feeding.

Highlights

South Africa initiated the National Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme in 2001 to prevent the baby from acquiring HIV
This study explored HIV disclosure to sexual partners and significant family members among post-natal women enrolled in a PMTCT programme in the City of Tshwane, South Africa
Ten of the women had disclosed their HIV-positive status to partners only, eight had disclosed to partners and close family members, two had disclosed to close family members only while 15 women had not disclosed their HIV-positive status to family members

Summary

Introduction

South Africa initiated the National Prevention of Mother-to-Child Transmission of HIV (PMTCT) programme in 2001 to prevent the baby from acquiring HIV. In line with the 2009 WHO guidelines, PMTCT interventions in South Africa were modified and include routine HIV testing and counselling (HCT) for pregnant women, dual therapy to prevent MTCT, Highly Active Anti Retroviral Therapy for pregnant women with CD4 cell count ≤350 cells/μl, postnatal infant prophylaxis for breastfeeding HIV-positive women, and counseling for safer infant feeding practices (NDOH/SANAC, 2010). In South Africa, the uptake of PMTCT services is high, with more than 98% of women getting HIV tested during pregnancy and 92% of HIV-positive mothers receiving antiretroviral treatment or prophylaxis (Goga et al, 2012). Consequent to the implementation of the new guidelines, the national HIV transmission rate from mother-to-child, measured in infants aged 4-8 weeks dropped from 8% in 2008 to 3.5% in 2010. A further drop to 2.7% in the transmission rate from mother-to-child was recorded in 2011 (Goga et al, 2012)

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Discussion

Conclusion