HIV/AIDS stigma is a common thread in the narratives of pregnant women affected by HIV/AIDS globally [8, 9]. Because a pregnant woman is often the first family member to be tested for HIV, she may be blamed for bringing the virus into the family and may suffer from adverse consequences of her HIV-positive status disclosure. Fears and experiences of stigma or discrimination from health workers, male partners, family, and community members have been identified as potential explanations for the facts that some pregnant women avoid maternity services altogether [10, 11], refuse antenatal HIV testing [12–14], or drop out of PMTCT programs once enrolled [15]. Theoretical frameworks and research on HIV/AIDS stigma also indicate that different dimensions of stigma—including anticipated stigma, perceived community stigma, enacted stigma, and self-stigma—adversely affect quality of life, healthcare access, and health outcomes [16–18]. Despite the consensus that HIV/AIDS stigma plays a significant role in deterring pregnant women from utilizing HIV services, few studies have attempted to quantitatively assess how these different dimensions of stigma affect uptake of HIV testing among pregnant women in high HIV prevalence settings.
Understanding women’s reasons for HIV test refusal is crucial for the development of interventions to increase antenatal HIV testing and extend the coverage of HIV services for pregnant women and their infants. We used data from the Maternity in Migori and AIDS Stigma Study (MAMAS Study) to examine how pregnant women’s perceptions of HIV/AIDS stigma influenced HIV testing uptake at ANC clinics in Nyanza Province, Kenya. Nyanza Province has the highest HIV prevalence in Kenya, with approximately 15% of adults 15–49 years of age testing HIV-positive [19]. Prevalence among pregnant women attending ANC clinics is higher, at an estimated 18% within districts included in this study (Family AIDS Care and Education Services program data [20]). In this manuscript we aim to a) describe the extent to which pregnant women who do not yet know their current HIV status perceive and fear HIV/AIDS stigma, and b) examine the relationships of quantitative measures of HIV/AIDS stigma to pregnant women’s refusal of HIV testing. In particular, we feel that it is important both theoretically and practically to understand the relative importance of different dimensions and sources of HIV/AIDS stigma—especially fears of stigma and negative consequences for self (anticipated stigma) versus general perceptions of stigma in the community (perceived community stigma)—for pregnant women’s uptake of HIV services.
HIV/AIDS stigma is a common thread in the narratives of pregnant women affected by HIV/AIDS globally [8, 9]. Because a pregnant woman is often the first family member to be tested for HIV, she may be blamed for bringing the virus into the family and may suffer from adverse consequences of her HIV-positive status disclosure. Fears and experiences of stigma or discrimination from health workers, male partners, family, and community members have been identified as potential explanations for the facts that some pregnant women avoid maternity services altogether [10, 11], refuse antenatal HIV testing [12–14], or drop out of PMTCT programs once enrolled [15]. Theoretical frameworks and research on HIV/AIDS stigma also indicate that different dimensions of stigma—including anticipated stigma, perceived community stigma, enacted stigma, and self-stigma—adversely affect quality of life, healthcare access, and health outcomes [16–18]. Despite the consensus that HIV/AIDS stigma plays a significant role in deterring pregnant women from utilizing HIV services, few studies have attempted to quantitatively assess how these different dimensions of stigma affect uptake of HIV testing among pregnant women in high HIV prevalence settings.
Understanding women’s reasons for HIV test refusal is crucial for the development of interventions to increase antenatal HIV testing and extend the coverage of HIV services for pregnant women and their infants. We used data from the Maternity in Migori and AIDS Stigma Study (MAMAS Study) to examine how pregnant women’s perceptions of HIV/AIDS stigma influenced HIV testing uptake at ANC clinics in Nyanza Province, Kenya. Nyanza Province has the highest HIV prevalence in Kenya, with approximately 15% of adults 15–49 years of age testing HIV-positive [19]. Prevalence among pregnant women attending ANC clinics is higher, at an estimated 18% within districts included in this study (Family AIDS Care and Education Services program data [20]). In this manuscript we aim to a) describe the extent to which pregnant women who do not yet know their current HIV status perceive and fear HIV/AIDS stigma, and b) examine the relationships of quantitative measures of HIV/AIDS stigma to pregnant women’s refusal of HIV testing. In particular, we feel that it is important both theoretically and practically to understand the relative importance of different dimensions and sources of HIV/AIDS stigma—especially fears of stigma and negative consequences for self (anticipated stigma) versus general perceptions of stigma in the community (perceived community stigma)—for pregnant women’s uptake of HIV services.
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