The “work” of women when considering and using interventions to reduce mother-to-child transmission (MTCT) of HIV

Abstract

This paper explores HIV-infected women's experiences of considering and using recommended interventions during pregnancy and postpartum to reduce mother-to-child transmission of HIV. Data were collected from 45 HIV-infected women aged 18–44 years living in Melbourne, Australia. A semi-structured interview was used to collect qualitative information on women's reproductive experience and intentions. The 15 women who had their children after their HIV diagnosis engaged in significant work including surveillance and safety work to minimise stigma and infection, information work to inform decisions and actions, accounting work to calculate risk and benefit, hope and worry work concerning a child's infection status and impact of interventions, work to redefine an acceptable maternal identity, work to prepare an alternative story to counter the disclosure effect of the intervention and emotional work to reconcile guilt when considering these interventions. This study provides a framework to help clinicians understand the real and on-going “work” that women engage in when they are considering interventions recommended by their physicians to reduce transmission of HIV. Even in circumstances where access to and acceptance of interventions are high, women continue to engage in this work even after they have a made a decision about a particular intervention.

Keywords:

• HIV
• pregnancy
• antiretroviral therapy
• cesarean section
• breast feeding

Acknowledgements

Dr Michelle Giles is supported by a National Health and Medical Research Council Postgraduate Fellowship. Professor Sharon Lewin is supported by a National Health and Medical Research Council Practitioner Fellowship and the Alfred Foundation. Associate Professor Margaret Hellard is a National Health and Medical Research Council Career Development Fellow and Senior VicHealth Fellow. Mary O'Brien is supported by an Australian Research Council (ARC) Postdoctoral Fellowship and an ARC Discovery Project grant.

We also wish to acknowledge and thank the women who participated in interviews and the clinical staff who assisted in recruitment for this project.