Surviving Surveillance: How Pregnant Women and Mothers Living With HIV Respond to Medical and Social Surveillance

2017 ◽  
Vol 27 (14) ◽  
pp. 2088-2099 ◽  
Author(s):  
Saara Greene ◽  
Allyson Ion ◽  
Gladys Kwaramba ◽  
Lisa Lazarus ◽  
Mona Loutfy
Keyword(s):  
Pregnant Women ◽  
Infant Feeding ◽  
Hiv Transmission ◽  
Service Providers ◽  
Negative Impact ◽  
Infant Feeding Practices ◽  
Women Living With Hiv ◽  
Related Stigma ◽  
Living With Hiv ◽  
The Relationship

Pregnant women and mothers living with HIV are under surveillance of service providers, family members, and the community at large. Surveillance occurs throughout the medical management of their HIV during pregnancy, preventing HIV transmission to their baby, infant feeding practices, and as part of assessments related to their ability to mother. Enacted and anticipatory HIV-related stigma can exacerbate the negative impact that being under surveillance has on mothers living with HIV as they move through their pregnancy, birthing, and mothering experiences. In response, women living with HIV find ways to manage their experiences of surveillance through engaging in acts of distancing, planning, and resisting at different points in time, and sometimes enacting all three practices at once. Positioning the narratives of pregnant women and mothers living with HIV in relation to their experiences of surveillance illuminates the relationship between the surveillance of mothers living with HIV and HIV-related stigma.

Antiretroviral Therapy in Pregnant Women

2019 ◽  
pp. 281-286
Author(s):  
William R. Short ◽  
Jason J. Schafer
Keyword(s):  
Clinical Trials ◽  
Pregnant Women ◽  
Hiv Transmission ◽  
Pediatric Aids ◽  
Women Living With Hiv ◽  
Pivotal Study ◽  
Aids Clinical Trials ◽  
Living With Hiv ◽  
Mother To Child ◽  
Over Time

Upon completion of this chapter, the reader should be able to describe the appropriate management of antiretrovirals for pregnant women living with HIV. Over time, research has demonstrated that proper prevention strategies and interventions during pregnancy, labor, and delivery can significantly reduce the rate of mother-to-child transmission (MTCT) of HIV. In 1994, a pivotal study in the field of HIV medicine, the Pediatric AIDS Clinical Trials Group 076, demonstrated that the use of zidovudine (ZDV) monotherapy during pregnancy substantially reduced the risk of HIV transmission to infants by 67% (...

scholarly journals Lack of HIV RNA test result is a barrier to breastfeeding among women living with HIV in Botswana

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Gloria Katuta Mayondi ◽  
Aamirah Mussa ◽  
Rebecca Zash ◽  
Sikhulile Moyo ◽  
Arielle Issacson ◽  
...  
Keyword(s):  
Infant Feeding ◽  
Hiv Transmission ◽  
Healthcare Providers ◽  
Feeding Method ◽  
Hiv Rna ◽  
Women Living With Hiv ◽  
Feeding Choice ◽  
Infant Feeding Decisions ◽  
Living With Hiv ◽  
Mother To Child

Abstract Background Botswana updated its antiretroviral treatment (ART) guidelines in May 2016 to support breastfeeding for women living with HIV (WLHIV) on ART who have documented HIV RNA suppression during pregnancy. Methods From September 2016 to March 2019, we evaluated feeding method at discharge among WLHIV at eight government maternity wards in Botswana within the Tsepamo Study. We validated the recorded feeding method on the obstetric record using the prevention of mother-to-child transmission of HIV (PMTCT) counsellor report, infant formula dispensing log or through direct observation. Available HIV RNA results were recorded from the obstetric record, and from outpatient HIV records (starting February 2018). In a subset of participants, we used electronic laboratory records to verify whether an HIV RNA test had occurred. Univariable and multivariable logistic regression analyses were performed to identify factors associated with infant feeding choice. Results Among 13,354 WLHIV who had a validated feeding method at discharge, 5303 (39.7%) chose to breastfeed and 8051 (60.3%) chose to formula feed. Women who had a documented HIV RNA result in the obstetric record available to healthcare providers at delivery were more likely to breastfeed (50.8%) compared to women who did not have a documented HIV RNA result (35.4%) (aOR 0.59; 95% CI 0.54, 0.65). Among women with documented HIV RNA, 2711 (94.6%) were virally suppressed (< 400 copies/mL). Breastfeeding occurred in a substantial proportion of women who did not meet criteria, including 46 (30.1%) of 153 women with HIV RNA > 400 copies/mL, and 134 (27.4%) of 489 women with no reported ART use. A sub-analysis of electronic laboratory records among 150 women without a recorded result on the obstetric record revealed that 93 (62%) women had an HIV RNA test during pregnancy. Conclusions In a setting of long-standing use of suppressive ART, with majority of WLHIV on ART from the time of conception, requiring documentation of HIV RNA suppression in the obstetric record to inform infant feeding decisions is a barrier to breastfeeding but unlikely to prevent a substantial amount of HIV transmission.

scholarly journals The syndemic effects of mental ill health, household hunger, and intimate partner violence on adherence to antiretroviral therapy among pregnant women living with HIV in Yaoundé, Cameroon

PLoS ONE ◽  
2021 ◽  
Vol 16 (2) ◽  
pp. e0246467
Author(s):  
Evette Cordoba ◽  
Angela M. Parcesepe ◽  
John A. Gallis ◽  
Jennifer Headley ◽  
Claudian Soffo ◽  
...  
Keyword(s):  
Intimate Partner Violence ◽  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Partner Violence ◽  
Common Mental Disorders ◽  
Intimate Partner ◽  
Art Adherence ◽  
Women Living With Hiv ◽  
Living With Hiv ◽  
The Relationship

Background This research advances understanding of interrelationships among three barriers to adherence to antiretroviral therapy (ART) among pregnant women living with HIV (WLWH) in Cameroon: probable common mental disorders (CMD), intimate partner violence (IPV), and hunger. Methods The sample included 220 pregnant WLWH in Cameroon. Multivariable modified Poisson regression was conducted to assess the relationship between IPV, hunger, and CMD on ART adherence. Results Almost half (44%) of participants recently missed/mistimed an ART dose. Probable CMD was associated with greater risk of missed/mistimed ART dose (aRR 1.5 [95% CI 1.1, 1.9]). Hunger was associated with greater risk of missed/mistimed ART dose among those who reported IPV (aRR 1.9 [95% CI 1.2, 2.8]), but not among those who did not (aRR 0.8 [95% CI 0.2, 2.3]). Conclusion Suboptimal ART adherence, CMD, and IPV were common among pregnant WLWH in Cameroon. Pregnant WLWH experiencing IPV and hunger may be especially vulnerable to suboptimal ART adherence.

scholarly journals A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV

2021 ◽  
Vol 1 (10) ◽  
pp. e0000004
Author(s):  
John Humphrey ◽  
Marsha Alera ◽  
Bett Kipchumba ◽  
Elizabeth J. Pfeiffer ◽  
Julia Songok ◽  
...  
Keyword(s):  
Hiv Transmission ◽  
Male Partner ◽  
Retention In Care ◽  
Postpartum Women ◽  
Provider Attitudes ◽  
Women Living With Hiv ◽  
Motivational Support ◽  
Related Stigma ◽  
The Individual ◽  
Living With Hiv

Retention in care is a major challenge for pregnant and postpartum women living with HIV (PPHIV) in the prevention of mother-to-child HIV transmission (PMTCT) continuum. However, the factors influencing retention from the perspectives of women who have become lost to follow-up (LTFU) are not well described. We explored these factors within an enhanced sub-cohort of the East Africa International Epidemiology Databases to Evaluate AIDS Consortium. From 2018–2019, a purposeful sample of PPHIV ≥18 years of age were recruited from five maternal and child health clinics providing integrated PMTCT services in Kenya. Women retained in care were recruited at the facility; women who had become LTFU (last visit >90 days) were recruited through community tracking. Interview transcripts were analyzed thematically using a social-ecological framework. Forty-one PPHIV were interviewed. The median age was 27 years, 71% were pregnant, and 39% had become LTFU. In the individual domain, prior PMTCT experience and desires to safeguard infants’ health enhanced retention but were offset by perceived lack of value in PMTCT services following infants’ immunizations. In the peer/family domain, male-partner financial and motivational support enhanced retention. In the community/society domain, some women perceived social pressure to attend clinic while others perceived pressure to utilize traditional birth attendants. In the healthcare environment, long queues and negative provider attitudes were prominent barriers. HIV-related stigma and fear of disclosure crossed multiple domains, particularly for LTFU women, and were driven by perceptions of HIV as a fatal disease and fear of partner abandonment and abuse. Both retained and LTFU women perceived that integrated HIV services increased the risk of disclosure. Retention was influenced by multiple factors for PPHIV. Stigma and fear of disclosure were prominent barriers for LTFU women. Multicomponent interventions and refining the structure and efficiency of PMTCT services may enhance retention for PPHIV.

scholarly journals The dynamics of the production of AIDS-related stigma among pregnant women living with HIV/AIDS in Rio de Janeiro, Brazil

2016 ◽  
Vol 32 (12) ◽  
Author(s):  
Simone Monteiro ◽  
Wilza Villela ◽  
Livia Fraga ◽  
Priscilla Soares ◽  
Adriana Pinho
Keyword(s):  
Pregnant Women ◽  
Rio De Janeiro ◽  
Gender Inequalities ◽  
Hiv Diagnosis ◽  
Life Trajectories ◽  
Women Living With Hiv ◽  
Related Stigma ◽  
And Gender ◽  
Living With Hiv ◽  
Hiv Aids

The study analyses the relationship between AIDS-related stigma and the processes of discrimination prior to diagnosis among pregnant women living with HIV/AIDS. The fieldwork involved interviews about the life trajectories of 29 pregnant women living with HIV/AIDS, recruited at two AIDS services in Rio de Janeiro, Brazil. The analysis revealed that before HIV diagnosis, social and gender inequalities experienced by these women reduced their access to material and symbolic goods that could have enhanced educational and career prospects and their ability and autonomy to exercise sexual and reproductive rights. Being diagnosed with HIV triggered fear of moral judgment and of breakdown in social and family support networks. Given these fears, pregnant women living with HIV/AIDS opt for concealment of the diagnosis. It is necessary for health services, NGOs and government agencies to work together to face the factors that fuel stigma, such as socioeconomic and gender inequalities, taboos and prejudices related to sexuality, and also develop actions to enable women to redefine the meaning of the disease.

scholarly journals HIV/AIDS Stigma Reduction as a Risk Factor for New HIV Infections: A Lived Experience Study of HIV Positive Young Women in a Rural Setting of Northern Uganda

2020 ◽  
Author(s):  
Amir Kabunga ◽  
Maxson Anyolitho Kenneth
Keyword(s):  
Young Women ◽  
Hiv Transmission ◽  
Unprotected Sex ◽  
Rural Setting ◽  
Hiv Positive ◽  
Stigma Reduction ◽  
Sexual Activities ◽  
Women Living With Hiv ◽  
Related Stigma ◽  
Living With Hiv

Abstract BackgroundHIV/AIDS-related stigma is a global problem among HIV patients with far-reaching implications. However, stigma reduction among HIV positive young women may be a catalyst to new HIV infections. This study aimed at exploring the coping strategies used and influence of HIV-related stigma on new infections among HIV positive young women in a rural setting. MethodsA cross-sectional exploratory research design was used. HIV positive young women in the catchment area of Aboke Health Center IV were part of the study. In-depth interviews were used to collect data and analysis was done using thematic approach. ResultsThe results from the data showed that acceptance of counseling and social support are some of the ways HIV-positive young women coped up with stigma. The results also showed that While HIV-related reduction has influenced positively for some HIV positive young mothers, to others as HIV-related stigma reduces, young women living with HIV are likely to get involved in risky sexual activities like having unprotected sex thus increasing HIV transmission. ConclusionsHIV-related reduction has influenced positively for some HIV positive young mothers. However, to others as HIV-related stigma reduces, young women living with HIV are likely to get involved in risky sexual activities like having unprotected sex thus increasing HIV transmission. Based on the results, there is need to understand the negative effects HIV-related stigma reduction as this may have implications for further transmission and control of HIV pandemic. Also, further research is needed to understand whether lessening HIV-related stigma encourages risky sexual behaviors among young women.

scholarly journals Common mental disorders and intimate partner violence against pregnant women living with HIV in Cameroon: a cross-sectional analysis

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Angela M. Parcesepe ◽  
Evette Cordoba ◽  
John A. Gallis ◽  
Jennifer Headley ◽  
Berenger Tchatchou ◽  
...  
Keyword(s):  
Mental Health ◽  
Pregnant Women ◽  
Partner Violence ◽  
Common Mental Disorders ◽  
Mental Health Disorders ◽  
Intimate Partner ◽  
Women Living With Hiv ◽  
Health Disorders ◽  
Living With Hiv ◽  
The Relationship

Abstract Background Women living with HIV are at increased risk of poor mental health and intimate partner violence (IPV). Mental health disorders have been consistently associated with suboptimal HIV-related outcomes. Little is known about the prevalence or correlates of mental health disorders among pregnant women living with HIV in sub-Saharan Africa. Methods This study assessed the prevalence of probable common mental disorders (CMD), i.e., depressive or anxiety disorders, and the relationship between probable CMD and recent IPV among pregnant women living with HIV in Cameroon. The sample included 230 pregnant women living with HIV aged > 18 enrolled in care at 10 HIV clinics in Cameroon. Probable CMD was assessed with the WHO Self Reporting Questionnaire (SRQ-20). Multivariable logistic regression was conducted to assess the relationship between IPV and probable CMD. Results Almost half (42%) of participants had probable CMD using a 7/8 cut-off of the SRQ-20. Emotional, physical, and sexual IPV were reported by 44, 37, and 31% of respondents, respectively. In multivariable regression analyses, all forms of IPV assessed were significantly associated with greater odds of probable CMD. Conclusions Pregnant women living with HIV in Cameroon had a high prevalence of probable CMD and IPV. Screening and services to address IPV and mental health are urgently needed for this population. Integrated interventions to both prevent and screen and address IPV and probable CMD should be developed, implemented, and evaluated.

Social Vulnerability among Foreign-Born Pregnant Women and Maternal Virologic Control of HIV

2020 ◽  
Author(s):  
Ashish Premkumar ◽  
Lynn M. Yee ◽  
Lia Benes ◽  
Emily S. Miller
Keyword(s):  
Antiretroviral Therapy ◽  
Pregnant Women ◽  
Median Time ◽  
Social Vulnerability ◽  
Viral Suppression ◽  
Foreign Born ◽  
Women Living With Hiv ◽  
Virologic Control ◽  
Clinical Records ◽  
Living With Hiv

Objective The aim of this study was to assess whether social vulnerability among foreign-born pregnant women living with HIV is associated with maternal viremia during pregnancy. Study Design This retrospective cohort study included all foreign-born pregnant women living with HIV who received prenatal care in a multidisciplinary prenatal clinic between 2009 and 2018. A licensed clinical social worker evaluated all women and kept detailed clinical records on immigration status and social support. Social vulnerability was defined as both living in the United States for less than 5 years and reporting no family or friends for support. The primary outcome was evidence of viral non-suppression after achievement of initial suppression. Secondary outcomes were the proportion of women who required > 12 weeks after starting antiretroviral therapy to achieve viral suppression, median time to first viral suppression (in weeks) after initiation of antiretroviral therapy, and the proportion who missed ≥ 5 doses of antiretroviral therapy. Bivariable analyses were performed. Results A total of 111 foreign-born women were eligible for analysis, of whom 25 (23%) were classified as socially vulnerable. Social and clinical characteristics of women diverged by social vulnerability categorization but no differences reached statistical significance. On bivariable analysis, socially-vulnerable women were at increased risk for needing > 12 weeks to achieve viral suppression (relative risk: 1.78, 95% confidence interval: 1.18–2.67), though there was no association with missing ≥ 5 doses of antiretroviral therapy or median time to viral suppression after initiation of antiretroviral therapy. Conclusion Among foreign-born, pregnant women living with HIV, markers of virologic control during pregnancy were noted to be worse among socially-vulnerable women. Insofar as maternal viremia is the predominant driver of perinatal transmission, closer clinical surveillance and support may be indicated in this population. Key Points

Sign in / Sign up

Export Citation Format

Share Document