Postnatal care utilization and local understandings of contagion among HIV-infected and uninfected women in rural, southern Zambia

ABSTRACT

Postnatal care is essential for ensuring the optimal health of newborns and necessary for the prevention of maternal-to-child human immunodeficiency virus (HIV) transmission as well as the early diagnosis and treatment of HIV-infected infants. However, coverage of postnatal care is low in many rural areas of sub-Saharan Africa. We examined women’s experiences of accessing formal postnatal care for their HIV-exposed newborns, comparing reports of HIV-infected and uninfected women in an HIV-endemic area of rural southern Zambia. We conducted 24 qualitative in-depth interviews with recently delivered women in a rural region of southern Zambia, including 8 with women who were willing to disclose their HIV infection status and answer additional questions. Data were transcribed, coded and analyzed using thematic analysis techniques. HIV-infected women identified more disincentives and reported more negative experiences accessing postnatal care than HIV-uninfected women. A local notion of contagion holds that healthy infants may become sick with chibele, a fatal, febrile illness, if exposed to another infant who is taking “strong medicine”, such as antiretroviral drugs. Thus, HIV-uninfected women expressed objections to sharing clinics with women and infants who were presumed to be under treatment. Additionally, women reported receiving better treatment from staff at HIV clinics compared to general pediatric clinics. Due to these tensions, HIV-infected women were less likely to visit a clinic for newborn care if the clinic or waiting area was a common space used by HIV-uninfected women and their children. When integrating programs for HIV with maternal and child health care, these nuanced tensions between groups of patients must be recognized and resolved.

KEYWORDS:

• Neonatal health
• postnatal care
• contagion
• stigma
• PMTCT
• HIV
• Zambia
• Africa

Acknowledgements

The authors wish to thank Nelly Chikwikwi, Tendai Mapani Muleya and Joyce Hamabwa. Thanks to Felix Mayani and the late Abraham Mhango at Macha Hospital, the directors and staff at the Macha Research Trust and the students at the Ubuntu Leadership Academy. Thanks to Tsitsi Masvawure, Lindsey Reynolds, Morgan Philbin and Caitlin Kennedy for comments and insight on HIV scholarship in Africa, and thanks to the Association for Social Sciences and Humanities in HIV/AIDS for opportunities to present working data.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

Funding was provided by the Health Systems Department and the Wendy Klag Scholarship in Child Health at Johns Hopkins University.