Shame, Guilt, and Stress: Community Perceptions of Barriers to Engaging in Prevention of Mother to Child Transmission (PMTCT) Programs in Western Kenya
Shame, Guilt, and Stress: Community Perceptions of Barriers to Engaging in Prevention of Mother to Child Transmission (PMTCT) Programs in Western Kenya
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DOI：
10.1089/apc.2014.0171
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发表时间：
2014-12-01
影响因子：
4.9
通讯作者：
John-Stewart, Grace
中科院分区：
文献类型：
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作者：
Kohler, Pamela K.;Ondenge, Kenneth;John-Stewart, Grace
虽然全球扩大了预防艾滋病毒母婴传播(母婴传播)服务的规模，但在撒哈拉以南非洲，只有一半感染艾滋病毒的孕妇接受了预防母婴传播的抗逆转录病毒方案。为了评估影响肯尼亚农村地区母婴传播的社会因素，我们对居住在KEMRI/CDC卫生和人口监测系统(HDSS)地区的母亲进行了一项基于社区的横断面调查。因素包括转介和可接受性、与艾滋病毒有关的污名、观察到的歧视以及对暴力的了解。卡方检验和多元回归分析被用来检测与预防母婴传播服务的吸收相关的污名域。大多数艾滋病毒阳性妇女(89%)报告了对艾滋病毒携带者的指责或判断，46%的人报告说，如果她们与艾滋病毒携带者联系在一起，她们会感到羞愧。在多因素分析中，羞耻与母亲HIV检测(患病率0.91，95%可信区间0.84-0.99)、母亲全程抗逆转录病毒药物(PR 0.73，95%CI 0.55-0.97)和婴儿HIV检测(PR 0.86，95%CI 0.75-0.99)的降低显著相关。社区对女性为什么不愿服用抗逆转录病毒药物的看法包括耻辱、内疚、缺乏知识、否认、压力和绝望或徒劳。寻求减少产妇抑郁和耻辱内化的干预措施可能会促进预防母婴传播。
While global scale-up of prevention of mother-to-child transmission of HIV (PMTCT) services has been expansive, only half of HIV-infected pregnant women receive antiretroviral regimens for PMTCT in sub-Saharan Africa. To evaluate social factors influencing uptake of PMTCT in rural Kenya, we conducted a community-based, cross-sectional survey of mothers residing in the KEMRI/CDC Health and Demographic Surveillance System (HDSS) area. Factors included referrals and acceptability, HIV-related stigma, observed discrimination, and knowledge of violence. Chi-squared tests and multivariate regression analyses were used to detect stigma domains associated with uptake of PMTCT services. Most HIV-positive women (89%) reported blame or judgment of people with HIV, and 46% reported they would feel shame if they were associated with someone with HIV. In multivariate analyses, shame was significantly associated with decreased likelihood of maternal HIV testing (Prevalence Ratio 0.91, 95% Confidence Interval 0.84-0.99), a complete course of maternal antiretrovirals (ARVs) (PR 0.73, 95% CI 0.55-0.97), and infant HIV testing (PR 0.86, 95% CI 0.75-0.99). Community perceptions of why women may be unwilling to take ARVs included stigma, guilt, lack of knowledge, denial, stress, and despair or futility. Interventions that seek to decrease maternal depression and internalization of stigma may facilitate uptake of PMTCT.