HIV/AIDS and maternity care in Kenya: how fears of stigma and discrimination affect uptake and provision of labor and delivery services

Abstract

Although policies and programs exist to promote safe motherhood in sub-Saharan Africa, maternal health has not improved and may be deteriorating in some countries. Part of the explanation may be the adverse effects of HIV/AIDS on maternity care. We conducted a study in Kisumu, Kenya to explore how fears related to HIV/AIDS affect women's uptake and health workers’ provision of labor and delivery services. In-depth qualitative interviews with 17 maternity workers, 14 pregnant or postpartum women, four male partners and two traditional birth attendants; as well as structured observations of 22 births; were conducted at four health facilities. Participants reported that fears of HIV testing; fears of involuntary disclosure of HIV status to others, including spouses; and HIV/AIDS stigma are among the reasons that women avoid delivering in health facilities. Maternity workers now have to take into account the HIV status of the women they serve (as well as their own fears of becoming infected and stigmatized) but do not seem to be adequately prepared to handle issues related to consent, confidentiality and disclosure. Importantly, it appeared that women of unknown HIV status during labor and delivery were likely to be targets of stigma and discriminatory practices and that these women were not receiving needed counseling services. The findings suggest that increasing infection control precautions will not be enough to address the challenges faced by maternity care providers in caring for women in high-HIV-prevalence settings. Maternity workers need enhanced culturally sensitive training regarding consent, confidentiality and disclosure. Furthermore, this study points to the necessity of paying more attention to the care of women of unknown HIV-serostatus during labor and delivery. Such interventions may improve the quality of maternity care, increase utilization and contribute to overall improvements in maternal health, while also enhancing prevention of mother-to-child-transmission and HIV care.

Keywords:

• maternal health
• HIV/AIDS
• safe motherhood
• prevention of mother-to-child transmission
• Kenya

Acknowledgements

We thank the Kenyan women and men who participated in the study and shared their experiences with us. We acknowledge the important logistical support of the KEMRI-UCSF Collaborative Group and especially Kisumu FACES. We thank Gaudencia Mittow, Douglas Okelloh and Maria Jarkowiec for their diligent work in collecting and processing the data. We gratefully acknowledge Dr. Koech, the Director of KEMRI and Dr. Wamae, the Director of KEMRI's Centre for Microbiology, for their support in conducting this research. Training related to this study was carried out with financial assistance from the UC Berkeley/UCSF AIDS International Training and Research Program (Fogarty AITRP # 1 D43 TW00003). Janet Molzan Turan's work on this article was also supported, in part, by grant # T32 MH-19105-17 from the US National Institute of Mental Health.