Abstract
BackgroundKenya has successfully expanded HIV treatment, but HIV-related stigma and discrimination, and unintended pregnancy remain issues for many Kenyan women living with HIV. While HIV-related stigma can influence the health seeking behaviors of those living with HIV, less is known about how reproductive health outcomes influence internalized stigma among women living with HIV.MethodsBaseline data only were used in this analysis and came from an implementation science study conducted in Kenya from 2015 to 2017. The analytic sample was limited to 1116 women who are living with HIV, between 18 to 44 years old, and have ever experienced a pregnancy. The outcome variable was constructed from 7 internalized stigma statements and agreement with at least 3 statements was categorized as medium/high levels of internalized stigma. Unintended pregnancy, categorized as unintended if the last pregnancy was mistimed or unwanted, was the key independent variable. Univariate and multivariate logistic regression models were used to assess the association between unintended pregnancy and internalized stigma. Associations between internalized stigma and HIV-related discrimination and violence/abuse were also explored.ResultsAbout 48% agreed with at least one internalized stigma statement and 19% agreed with at least three. Over half of women reported that their last pregnancy was unintended (59%). Within the year preceding the survey, 52% reported experiencing discrimination and 41% reported experiencing violence or abuse due to their HIV status. Women whose last pregnancy was unintended were 1.6 times (95% CI 1.2–2.3) more likely to have medium/high levels of internalized stigma compared to those whose pregnancy was wanted at the time, adjusting for respondents’ characteristics, experiences of discrimination, and experiences of violence and abuse. Women who experienced HIV-related discrimination in the past 12 months were 1.8 times (95% CI 1.3–2.6) more likely to have medium/high levels of internalized stigma compared to those who experienced no discrimination.ConclusionsResults suggest that unintended pregnancy is associated with internalized stigma. Integrated HIV and FP programs in Kenya should continue to address stigma and discrimination while increasing access to comprehensive voluntary family planning services for women living with HIV.
Highlights
Kenya has successfully expanded HIV treatment, but HIV-related stigma and discrimination, and unintended pregnancy remain issues for many Kenyan women living with HIV
As many Women living with HIV (WLHIV) prefer health facilities that provide specialized services for people living with HIV [8, 29, 30], these results suggest that WLHIV may not have the adequate access to reproductive health and family planning (FP) information and services, including FP counseling for themselves and their partners, that meets their needs
As this study found a significant association between unintended pregnancy and internalized stigma, further research is needed to understand how reproductive health and FP programs that assist WHLIV with planning and spacing their pregnancies can reduce internalized stigma for WLHIV
Summary
Kenya has successfully expanded HIV treatment, but HIV-related stigma and discrimination, and unintended pregnancy remain issues for many Kenyan women living with HIV. In Kenya, it is estimated that 1.6 million people (approximately 3% of Kenya’s population) are living with HIV as of 2018 and women ages 15 years and older account for about 57% of all individuals living with HIV [1]. This is slightly higher than the global average, where women account for 50% of those living with HIV [2]. Among Kenyan women living with HIV (WLHIV), about 75% are on antiretroviral therapy (ART) in 2018 compared to 29% in 2010 [1]. Some studies have found that individuals living with HIV may decide to have additional children as they begin to feel healthier with ARTs [10, 12]
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