Disrespect and abuse during childbirth in Tanzania: are women living with HIV more vulnerable?
Disrespect and abuse during childbirth in Tanzania: are women living with HIV more vulnerable?
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DOI：
10.1097/qai.0000000000000378
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发表时间：
2014-12-01
期刊：
影响因子：
--
通讯作者：
Langer A
中科院分区：
文献类型：
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作者：
Sando D;Kendall T;Lyatuu G;Ratcliffe H;McDonald K;Mwanyika-Sando M;Emil F;Chalamilla G;Langer A
与艾滋病毒有关的耻辱和歧视以及分娩期间的不尊重和虐待是使用基本的孕产妇和艾滋病毒保健服务的障碍。需要更多地了解艾滋病毒状况与分娩期间不尊重和虐待之间的关系，以设计促进妇女权利和增加对保健服务的接受和保留的干预措施；然而，关于艾滋病毒携带者妇女和艾滋病毒阴性妇女的比较研究很少。混合方法包括对产后妇女的访谈(n=2000)、分娩期间的直接观察(n=208)、结构化问卷(n=50)和与卫生保健提供者的深入访谈(n=18)。双变量和多变量回归分析了艾滋病毒状况与不尊重和虐待之间的关系，而问卷和深入访谈提供了对提供者态度和工作场所文化如何影响做法的洞察。在WLWH和HIV阴性的妇女中，分别有12.2%和15.0%的人报告在分娩期间经历过不尊重和虐待(P=0.37)。在调整后的分析中，WLWH和HIV阴性妇女在不同类型的不尊重和虐待方面的经历没有显著差异，但WLWH报告非同意护理的几率更高(P=0.03)。世界卫生组织没有报告侵犯艾滋病毒保密的行为，也没有人将不尊重和虐待归因于他们的艾滋病毒状况。提供者约谈表明，以预防艾滋病毒垂直传播为重点的培训和监督有助于改变机构文化，减少与艾滋病毒有关的侵权行为。总体而言，与艾滋病毒阴性的妇女相比，妇女妇女在分娩期间报告不尊重和虐待的可能性并不更大。然而，测量的不尊重和虐待的总体流行率很高，这表明问题很严重。与为减少分娩期间与艾滋病毒有关的歧视而进行的培训和监督所给予的机构优先事项类似，应侧重于确保所有妇女得到尊重的产妇护理。
HIV-related stigma and discrimination and disrespect and abuse during childbirth are barriers to use of essential maternal and HIV health services. Greater understanding of the relationship between HIV status and disrespect and abuse during childbirth is required to design interventions to promote women's rights and to increase uptake of and retention in health services; however, few comparative studies of women living with HIV (WLWH) and HIV-negative women exist. Mixed methods included interviews with postpartum women (n = 2000), direct observation during childbirth (n = 208), structured questionnaires (n = 50), and in-depth interviews (n = 18) with health care providers. Bivariate and multivariate regressions analyzed associations between HIV status and disrespect and abuse, whereas questionnaires and in-depth interviews provided insight into how provider attitudes and workplace culture influence practice. Of the WLWH and HIV-negative women, 12.2% and 15.0% reported experiencing disrespect and abuse during childbirth (P = 0.37), respectively. In adjusted analyses, no significant differences between WLWH and HIV-negative women's experiences of different types of disrespect and abuse were identified, with the exception of WLWH having greater odds of reporting non-consented care (P = 0.03). None of the WLWH reported violations of HIV confidentiality or attributed disrespect and abuse to their HIV status. Provider interviews indicated that training and supervision focused on prevention of vertical HIV transmission had contributed to changing the institutional culture and reducing HIV-related violations. In general, WLWH were not more likely to report disrespect and abuse during childbirth than HIV-negative women. However, the high overall prevalence of disrespect and abuse measured indicates a serious problem. Similar institutional priority as has been given to training and supervision to reduce HIV-related discrimination during childbirth should be focused on ensuring respectful maternity care for all women.