Concerns about starting antiretroviral treatment among pregnant women in Lesotho

ABSTRACT

The recommendation to start antiretroviral treatment independently of CD4 or viral load count is adopted as a strategy for reducing HIV/AIDS incidence rates in countries with a high prevalence rate, such as Lesotho. For example, the number of new HIV infections has lowered from 20,000 in 2010 to 11,000 in 2018 [UNAIDS Country Factsheets. (2019). https://www.unaids.org/en/regionscountries/countries/lesotho]. Lesotho introduced the ‘test and treat’ strategy in 2013 to address the HIV/AIDS pandemic, representing a shift from the provider-initiated HIV testing and counselling guidelines. The purpose of this paper was to understand pregnant women’s concerns about starting antiretroviral treatment to limit risks of mother-to-child HIV-transmission during the implementation of ‘test and treat’ protocol in Lesotho. The study used a qualitative research approach and collected information from Lesotho public antenatal clinics. In-depth interviews were conducted with eighteen pregnant women living with HIV/AIDS and data were analysed manually following the constructivist grounded theory. Findings reveal the sadness experienced at the diagnosis stage, concerns about accessing treatment and maintaining adherence, and concerns about disclosure. It was concluded that these factors stemmed from fears about triggering enacted stigma in the illness experience of pregnant women, which could hamper the implementation of the ‘test and treat’ protocol in Lesotho.

KEYWORDS:

• HIV-related stigma
• antiretroviral treatment
• test and treat protocol
• pregnant women
• Lesotho

Acknowledgements

I would like to thank the Editors of Global Public Health Journal for their support. I wish to acknowledge Asiimwe Fred Mugyenyi for editing earlier drafts of this paper, thank you. I also wish to acknowledge my committee members from Case Western Reserve University (CWRU), Professors Susan Hinze, Mary Erdmans, Gary Deimling, and Jennifer Furin, my enduring thanks to you.

Disclosure statement

No potential conflict of interest was reported by the author(s).