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HIV status disclosure linked to maternal prevention in rural Kenya

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Women living with HIV who had not disclosed their HIV-positive status to anyone had the lowest utilization levels of prevention of mother-to-child transmission (PMTCT) and maternal health services in rural Kenya, according to a new study.

Sydney A. Spangler, PhD, a researcher at the Nell Hodgson Woodruff School of Nursing at Emory University and colleagues, found that HIV-positive status disclosure is a significant predictor of the use of PMTCT and maternal health services. Women who had not disclosed their HIV-positive status to anyone used these services nearly six times less than those with a disclosed HIV-positive status and those who were HIV-negative.

Complete findings are available in the December 1, 2014 edition of the Journal of Acquired Immune Deficiency Syndrome.

“Given the high death and disability rates for childbearing women and children in this region, it is necessary that all women, especially those who are HIV-positive, receive these services to increase their chances of survival and the health of their children,” says Spangler, assistant professor of nursing and lead author of the study. “Often a social stigma is associated with an HIV-positive status. A better understanding of how to address this stigma is critically important for more effective prevention of HIV transmission and maternal and child health outcomes.”

Women living with HIV during pregnancy or postpartum are up to eight times more likely to die than women who are HIV negative. Women who are aware of their HIV-positive status and have not disclosed this status to anyone may face increased risks of poor health outcomes for themselves and their unborn and newborn children due to lack of utilization of available services such as antiretroviral drugs during and after pregnancy, pregnancy screening and monitoring, appropriate care during childbirth, and treatment of complications that can significantly improve maternal and child health outcomes.  

Using data from the Migori and AIDS Stigmas study (conducted in rural Kenya), Spangler and colleagues compared the use of PMTCT and maternal health services for all women by HIV status and disclosure category. Findings indicate that HIV-positive women with an undisclosed status had the lowest use of antiretroviral drugs and facility birth. HIV-positive women who had disclosed their status had the highest use of services. 

“Considerable advances have been made in global maternal and child health over the last few decades,” explains Spangler. “However, death and disability for childbearing women and children remain drastically high. Better understanding of HIV-related stigma, HIV status disclosure, and the impacts of these social processes on women’s health care seeking could prove essential for more effective prevention of HIV transmission and for improving maternal and child health outcomes in sub-Saharan Africa.”

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