Non-Uptake of HIV Testing in Children at Risk in Two Urban and Rural Settings in Zambia: A Mixed-Methods Study.

Sonja Merten,Harriet Ntalasha,Maurice Musheke,Janet Seeley

doi:10.1371/journal.pone.0155510

Abstract

This article investigates reasons why children who were considered at risk of HIV were not taken for HIV testing by their caregivers. Qualitative and quantitative data collected in Zambia from 2010–11 revealed that twelve percent of caregivers who stated that they had been suspecting an HIV infection in a child in their custody had not had the child tested. Fears of negative reactions from the family were the most often stated reason for not testing a child. Experience of pre-existing conflicts between the couple or within the family (aOR 1.35, 95% CI 1.00–1.82) and observed stigmatisation of seropositive children in one’s own neighbourhood (aOR 1.69, 95% CI1.20–2.39) showed significant associations for not testing a child perceived at risk of HIV. Although services for HIV testing and treatment of children have been made available through national policies and programmes, some women and children were denied access leading to delayed diagnosis and treatment–not on the side of the health system, but on the household level. Social norms, such as assigning the male household head the power to decide over the use of healthcare services by his wife and children, jeopardize women’s bargaining power to claim their rights to healthcare, especially in a conflict-affected relationship. Social norms and customary and statutory regulations that disadvantage women and their children must be addressed at every level–including the community and household–in order to effectively decrease barriers to HIV related care.

Highlights

Global estimates indicate that 3.2 million children 0–14 years of age were living with HIV at the end of 2013, most of them infected through mother-to-child transmission during pregnancy, labour and delivery [1]
Services for HIV testing and treatment of children have been made available through national policies and programmes, some women and children were denied access leading to delayed diagnosis and treatment–not on the side of the health system, but on the household level
Social norms and customary and statutory regulations that disadvantage women and their children must be addressed at every level–including the community and household–in order to effectively decrease barriers to HIV related care

Summary

Introduction

Global estimates indicate that 3.2 million children 0–14 years of age were living with HIV at the end of 2013, most of them infected through mother-to-child transmission during pregnancy, labour and delivery [1]. Despite evidence that early antiretroviral therapy can dramatically improve child survival [2,3,4,5,6,7], less than one quarter of all HIV infected children receive antiretroviral therapy [1]. According to the Zambia Consolidated Guidelines for Treatment and Prevention, all children living with HIV below 15 years of age are eligible for free antiretroviral therapy. Detection of an HIV infection in infants is important as without treatment; about half of the infected children die within the first two years of life, and 75–80% before the age of five [19]. In Zambia despite available testing opportunities, many of the infected children are identified after showing clinical symptoms which is considered late. [20, 21]

Methods

Results

Discussion

Conclusion