"If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing" : The influence of gender on Option B plus prevention of mother-to-child transmission participation in Malawi and Uganda
"If my husband leaves me, I will go home and suffer, so better cling to him and hide this thing" : The influence of gender on Option B plus prevention of mother-to-child transmission participation in Malawi and Uganda
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DOI：
10.1371/journal.pone.0178298
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发表时间：
2017-06-08
期刊：
影响因子：
3.7
通讯作者：
Munthali, Alister C.
中科院分区：
文献类型：
--
作者：
Flax, Valerie L.;Yourkavitch, Jennifer;Munthali, Alister C.
性别在方案B+下参与预防母婴传播方面的作用尚未得到充分研究，但这对于减少后续行动的损失至关重要。本研究采用定性方法来研究性别和个人，人际关系，卫生系统和社区因素，有助于防止母婴传播参与在马拉维和乌干达的相互作用。我们对预防母婴传播中的妇女、失访妇女、政府卫生工作者和支持预防母婴传播组织的利益相关者进行了深入访谈，并与男性进行了焦点小组讨论。我们使用主题内容分析法对数据进行了分析。我们发现，在受访者群体和两国之间的关键主题有许多相似之处。参与预防母婴传播的主要促进因素是了解ART的健康益处、社会支持和自我效能。主要障碍是害怕艾滋病毒的披露和耻辱，缺乏社会支持，男性参与，自我效能和机构。根据备选方案B+，妇女在有机会与丈夫或家人交谈之前，了解自己的艾滋病毒状况，并在同一天开始终身抗逆转录病毒治疗。受访者解释说，很少有丈夫陪妻子去诊所，因为他们觉得这是一个女性空间，担心别人会认为妻子在控制他们。许多答复者说，妇女害怕披露，因为她们害怕艾滋病毒的耻辱以及离婚和失去经济支持的风险。如果妇女不透露，她们就很难秘密参与防止母婴传播。如果她们确实透露，她们必须遵守丈夫关于她们参与防止母婴传播的决定，有些丈夫不支持或积极劝阻。为了提高预防母婴传播的参与度，卫生部应采用循证战略，解决艾滋病毒污名化、与披露有关的挑战、社会支持和男性参与不足以及潜在的性别不平等问题。
The role of gender in prevention of mother-to-child transmission (PMTCT) participation under Option B+ has not been adequately studied, but it is critical for reducing losses to follow-up. This study used qualitative methods to examine the interplay of gender and individual, interpersonal, health system, and community factors that contribute to PMTCT participation in Malawi and Uganda. We conducted in-depth interviews with women in PMTCT, women lost to follow-up, government health workers, and stakeholders at organizations supporting PMTCT as well as focus group discussions with men. We analyzed the data using thematic content analysis. We found many similarities in key themes across respondent groups and between the two countries. The main facilitators of PMTCT participation were knowledge of the health benefits of ART, social support, and self-efficacy. The main barriers were fear of HIV disclosure and stigma and lack of social support, male involvement, self-efficacy, and agency. Under Option B+, women learn about their HIV status and start lifelong ART on the same day, before they have a chance to talk to their husbands or families. Respondents explained that very few husbands accompanied their wives to the clinic, because they felt it was a female space and were worried that others would think their wives were controlling them. Many respondents said women fear disclosing, because they fear HIV stigma as well as the risk of divorce and loss of economic support. If women do not disclose, it is difficult for them to participate in PMTCT in secret. If they do disclose, they must abide by their husbands' decisions about their PMTCT participation, and some husbands are unsupportive or actively discouraging. To improve PMTCT participation, Ministries of Health should use evidence- based strategies to address HIV stigma, challenges related to disclosure, insufficient social support and male involvement, and underlying gender inequality.