'The divorce program': gendered experiences of HIV positive mothers enrolled in PMTCT programs - the case of rural Malawi

John Njunga,Astrid Blystad

doi:10.1186/1746-4358-5-14

Abstract

BackgroundFor HIV infected mothers in developing countries, choosing to enroll in a prevention of mother to child transmission (PMTCT) of HIV program is supposed to represent the first step towards protecting their child from possible transmission of HIV from mother to child. Counseling and testing enable HIV infected mothers to learn about their status and to obtain the benefits of a PMTCT package. The study on which this article is based explored experiences of HIV positive women and their partners linked to Prevention of Mother to Child Transmission of HIV (PMTCT) programs in Chiradzulu district, Southern Malawi.MethodsA qualitative study using in-depth interviews (IDIs), focus group discussion (FGDs) and case studies was carried at two PMTCT sites. IDIs and FGDs were recorded and transcribed. The case studies involved a deeper inquiry into the past, present and situational factors of selected participants.ResultsIn a context of customary matrilineal kinship, matrilocal residence patterns and complete male absence from the PMTCT program, the demand by the PMTCT program for partner disclosure played up fears of rejection among men given accusations of infidelity by the wives' relatives. This situation led many men to abandon their families. Mothers enrolled in PMTCT programs hence faced not only the fear of transmitting the virus to their infants, but also the loss of income and support associated with a departed husband and the social disgrace of a ruined family. Community members referred to the PMTCT program as 'the divorce program'ConclusionsPMTCT programs may vary in effectiveness in different contexts unless they fundamentally respond to socio-cultural factors as lived out in communities they intend to serve. The PMTCT program in rural southern Malawi is a case in point.

Highlights

For HIV infected mothers in developing countries, choosing to enroll in a prevention of mother to child transmission (PMTCT) of HIV program is supposed to represent the first step towards protecting their child from possible transmission of HIV from mother to child
In the present study we explore HIV positive women and men’s experiences with partner disclosure in the ‘Prevention of Mother to Child Transmission of HIV’ (PMTCT) programs in Chiradzulu district, Southern Malawi
Health programs, in our case the PMTCT program, may not deliver results unless they fundamentally respond to the wide spectrum of socio-cultural factors that are present and lived out in community life

Summary

Introduction

For HIV infected mothers in developing countries, choosing to enroll in a prevention of mother to child transmission (PMTCT) of HIV program is supposed to represent the first step towards protecting their child from possible transmission of HIV from mother to child. In Sub-Saharan Africa alone 13.3 million HIV positive women of child bearing age live with HIV [1]. This figure represents 59 percent of the adult population living with HIV infection in the region. Such high HIV prevalence among women of child bearing age represents a huge latent risk for mother to child transmission of HIV [2].

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Conclusion