Abstract
BackgroundMany factors contribute to an enhanced risk of infant HIV acquisition, two of which may include failure of a mother to disclose her HIV-positive status to her partner and exclusion of male partners in preventing mother-to-child transmission of HIV (PMTCT) interventions. To justify why HIV programmes need to integrate male partner involvement and partner disclosure, we need to establish an association between the two factors and infant HIV acquisition.ObjectiveTo determine whether failure to disclose an HIV-positive status to a male partner is associated with increased risk of infant HIV acquisition, and whether part of the association is explained by exclusion of male partner in PMTCT programmes.MethodsUsing a case–control study design, we identified a total of 180 mother–baby pairs with HIV-exposed infants. Thirty-six pairs with HIV-positive babies (cases) were compared to 144 pairs with HIV-negative babies (controls) on whether the mothers had disclosed their HIV status to their partner in order to determine whether a disclosure or lack of it contributed to increased risk of mother-to-child transmission of HIV (MTCT). Each case pair was matched to four control pairs from the same facility.ResultsOverall, 16.7% of mothers had not disclosed their HIV status to their partners, the proportion being significantly more among cases (52.8% vs. 7.6%, p < 0.001). Non-disclosure was significantly associated with infant HIV acquisition (aOR 9.8 (3.0–26.3); p < 0.001) and male partner involvement partially mediated the effect of non-disclosure on infant HIV acquisition (indirect coefficient = 0.17, p < 0.005).ConclusionsFailure of an HIV-positive woman to disclose her status to her male partner and exclusion of male partners in PMTCT programmes are two social factors that may curtail success of interventions towards the goal of eliminating MTCT.
Highlights
Transmission of HIV from the mother to the child can occur across the placenta during pregnancy, during the process of delivery and after birth through breast milk.[1]
Thirtysix pairs with HIV-positive babies were compared to 144 pairs with HIV-negative babies on whether the mothers had disclosed their HIV status to their partner in order to determine whether disclosure or lack of it contributed to increased risk of mother-to-child transmission of HIV (MTCT)
17% (n = 30) of mothers in the mother–baby pairs had not disclosed their HIV-positive status to their partners
Summary
Transmission of HIV from the mother to the child (vertical transmission) can occur across the placenta during pregnancy, during the process of delivery and after birth through breast milk.[1]. The risk of vertical transmission among mothers not on antiretroviral treatment (ART) in non-breastfeeding population ranges from 15% to 30%, with the risk being higher among breastfeeding women (20% – 45%).[2] In high-income countries, because of universal access to interventions aimed at preventing mother-to-child transmission of HIV (PMTCT), the risk of vertical transmission has been reduced to less than 1%.3. UNICEF4 estimates that approximately 6600 children in Kenya were infected with HIV in 2015, representing a mother-to-child transmission of HIV (MTCT) rate of 8%. Many factors contribute to an enhanced risk of infant HIV acquisition, two of which may include failure of a mother to disclose her HIV-positive status to her partner and exclusion of male partners in preventing mother-to-child transmission of HIV (PMTCT) interventions. To justify why HIV programmes need to integrate male partner involvement and partner disclosure, we need to establish an association between the two factors and infant HIV acquisition
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