Date Published: August 2, 2011
Publisher: BioMed Central
Author(s): Zahra P Theilgaard, Terese L Katzenstein, Mercy G Chiduo, Christiane Pahl, Ib C Bygbjerg, Jan Gerstoft, Martha M Lemnge, Britt P Tersbøl.
Highly Active Antiretroviral Therapy (HAART) has been available free of charge in Tanga, Tanzania since 2005. However we have found that a high percentage of women referred from prevention of mother-to-child transmission services to the Care and Treatment Clinics (CTC) for HAART never registered at the CTCs. Few studies have focused on the motivating and deterring factors to presenting for HAART particularly in relation to women. This study seeks to remedy this gap in knowledge.
A qualitative approach using in-depth interviews and focus group discussions was chosen to understand these issues as perceived and interpreted by HIV infected women themselves.
The main deterrent to presenting for treatment appears to be fear of stigmatization including fear of ostracism from the community, divorce and financial distress. Participants indicated that individual counselling and interaction with other people living with HIV encourages women, who are disinclined to present for HAART, to do so, and that placing the entrance to the CTC so as to provide discrete access increases the accessibility of the clinic.
Combating stigma in the community, although it is essential, will take time. Therefore necessary steps towards encouraging HIV infected women to seek treatment include reducing self-stigma, assisting them to form empowering relationships and to gain financial independence and emphasis by example of the beneficial effect of treatment for themselves and for their children. Furthermore ensuring a discrete location of the CTC can increase its perceived accessibility.
HAART has been available free of charge in Tanga, Tanzania since 2005. The treatment is provided and monitored at specialized HIV clinics called Care and Treatment Clinics (CTC). The CTCs also monitor and care for people living with HIV, who are not yet eligible for HAART. Prevention of mother-to-child transmission (PMTCT) of HIV is an integral part of antenatal care in Tanzania, and PMTCT services are centred at the Reproductive and Child Health (RCH) clinics. All pregnant women, who come to RCH clinics for care, are thus counselled about and tested for HIV, unless they opt out. HIV infected women, whose CD4 count is > 200 cells/μl, are provided with short-course ART for PMTCT. Those, whose CD4 count is < 200 cells/μl, are referred to the CTC to start life-long HAART . Successful referral of patients from RCH services to CTCs requires that the motivational factors outweigh the deterrents. The main deterrent from seeking treatment identified in this study was fear of stigmatization leading to rejection by family and community and the loss of income. This section will therefore focus on these aspects and discuss possible solutions. This study has shown that that stigmatization of HIV infected women is still widespread in Tanga and that fear of the consequences of stigma is a major threat to uptake of HAART by HIV infected women. The consequences feared by the participants were abandonment by their partner, loss of income and social degradation. The authors declare that they have no competing interests. The study was conceived and designed by ZPT, BPT, TLK and JG withparticipation from MGC, ICB and MML. Interviews were conducted by ZPT andCP. Focus group discussions were conducted by ZPT and MGC. Data-analysiswas done by ZPT with guidance from BPT. The manuscript was drafted by ZPT, TLK and BPT and underwent critical reading by MGC, CP, ICB, JG and MML. Allauthors have approved the final manuscript. Source: http://doi.org/10.1186/1742-6405-8-28