Pregnancy and medical follow-up of women living with HIV/AIDS in Guadeloupe and Martinique (French West Indies): medical progress and social problems

Abstract

After sub-Saharan Africa, the Caribbean is the region of the world most affected by HIV/AIDS. Guadeloupe and Martinique (French West Indies) are located in the heart of this region. Although the AIDS incidence here is lower than in other Caribbean countries, it is much higher than in mainland France. Transmission is mostly heterosexual, and the proportion of women infected is high, almost half of all those infected. Moreover, in Guadeloupe a large proportion of them are foreigners (mainly from Haïti). This qualitative study was conducted in 2009 among health professionals, advocacy and support groups, and women living with HIV/AIDS. It analysed the characteristics of women's follow-up during and after their pregnancy. It also analysed the practices that health professionals have developed to provide follow-up for these women, despite various obstacles. Antiretroviral therapy makes it possible to health professionals to reduce the risk of mother-to-child transmission of HIV infection. They inform their patients of the possibilities for infected women to have a child with less risk of infection provided that she has a medical follow-up and that she is treated. But they note that the pregnancies are rarely planned in consultation with them: patients are generally already pregnant when they discuss the subject with their doctors. The pregnancy is nevertheless a special moment for medical monitoring: women are particularly compliant during their pregnancy, because their priority is the protection of the child's health. After the child's birth, however, the social and administrative difficulties of many of these women serve as obstacles to their continued medical care. Some women stop treatment and medical follow-up after delivery, even when they make sure the child has medical follow-up. To continue the follow-up of women and their children, or to contact women who have been lost to follow-up, professionals resort to various practices: compliance consultations, house calls, hospitalization... These practices are based on multidisciplinary collaboration, between medical departments (infectious diseases, obstetrics/gynaecology, and paediatrics), as well as with social services and support groups for persons living with HIV/AIDS.