Abstract
Maternal and Child Health (MCH) units, where VCT/PMTCT/HAART have been integrated with traditional services, play a critical role in the connection between the massive HAART rollout and reproductive behavior. In this article, we use data from semi-structured interviews with MCH workers and ethnographic observations carried out in southern Mozambique to explore this role from the institutional perspective. We find that, along with logistical and workload problems, the de facto segregation of PMTCT/HAART clients within the “integrated” MCH system and the simplistic and uncompromising message discouraging further fertility and stressing condom-based contraception may pose serious challenges to a successful formulation and implementation of reproductive goals among seropositive clients. Although the recency of PMTCT/HAART services may partly explain these challenges, we argue that they are due largely to cultural miscommunication between providers and clients. We show how the cultural gap between the two is bridged by community activists and peer interactions among clients.
Similar content being viewed by others
Notes
To protect confidentially of study subjects, neither the district nor specific health facilities are identified in this article.
Our informants typically thought about “re-infection” in terms of increasing virus load rather than of its correct scientific meaning of infection with a different strain of HIV.
References
Aka-Dago-Akribi, H., Desgrées du Loû, A., Msellati, P., Dossou, R., Welffens-Ekra, C., et al. (1999). Issues surrounding reproductive choice for women living with HIV in Abidjan, Cote d’Ivoire. Reproductive Health Matters, 7, 20–29. doi:10.1016/S0968-8080(99)90108-8.
Askew, I., & Berer, M. (2003). The contribution of sexual and reproductive health services to the fight against HIV/AIDS: A review. Reproductive Health Matters, 11, 51–73. doi:10.1016/S0968-8080(03)22101-7.
Banda, M., Khudzani, Z. C., Noliwe, C. G., Mtike, V., et al. (2008). Nurses and what HIV positive mothers share with them during infant feeding counseling sessions. Presented at the XVIIth International AIDS Conference. Mexico-City, Mexico, 3–8 August.
Baylies, C. (2000). The impact of HIV on family size preference in Zambia. Reproductive Health Matters, 8, 77–86. doi:10.1016/S0968-8080(00)90008-9.
Betancourt, J. R., Green, A. R., Carrillo, J. E., & Park, E. R. (2005). Cultural competence and health care disparities: Key perspectives and trends. Health Affairs, 24, 499–505. doi:10.1377/hlthaff.24.2.499.
Blanc, A. K., Curtis, S. L., & Croft, T. N. (2002). Monitoring contraceptive continuation: Links to fertility outcomes and quality of care. Studies in Family Planning, 33, 127–140. doi:10.1111/j.1728-4465.2002.00127.x.
Buskens, I., & Jaffe, A. (2008). Demotivating infant feeding counselling encounters in southern Africa: Do counsellors need more or different training? AIDS Care, 20, 337–345. doi:10.1080/09540120701660346.
Buskens, I., Jaffe, A., & Mkhatshwa, H. (2007). Infant feeding practices: Realities and mindsets of mothers in southern Africa. AIDS Care, 19, 1101–1109. doi:10.1080/09540120701336400.
Caldwell, J. C., & Caldwell, P. (2002). Is integration the answer for Africa? International Family Planning Perspectives, 28, 108–111. doi:10.2307/3088243.
Chandisarewa, W., Chirapa, E., Maruva, M., Shetty, A., et al. (2008). Meaningful involvement and greater participation of PLWH within a PMTCT programme: Experience from urban Zimbabwe. Presented at the XVIIth International AIDS Conference. Mexico-City, Mexico, 3–8 August.
Cooper, D., Harries, J., Myer, L., Orner, P., Bracken, H., et al. (2007). ‘Life is still going on’: Reproductive intentions among HIV-positive women and men in South Africa. Social Science and Medicine, 65, 274–283. doi:10.1016/j.socscimed.2007.03.019.
de Paoli, M. M., Manongi, R., & Klepp, K. (2002). Counsellors’ perspectives on antenatal HIV testing and infant feeding dilemmas facing women with HIV in Northern Tanzania. Reproductive Health Matters, 10, 144–156. doi:10.1016/S0968-8080(02)00088-5.
Emneyonu, N., Maier, M., Andia-Biraro, I., Kaida, A., Hogg, R., & Bangsberg, D. R. (2008). ART, fertility desire and recent fertility history of HIV-positive Ugandan women”. Presented at conference “Switching Gears in HIV Research,” Johannesburg, South Africa.
Instituto Nacional de Estatística and Ministério da Saúde. (2005). Mozambique Demographic and Health Survey, 2003. Calverton, MD: ORC MACRO. (With technical assistance from MEASURE DHS +/ORC MACRO).
Feldman, R., & Maposhere, C. (2003). Safer sex and reproductive choice: Findings from ‘positive women: Voices and choices’ in Zimbabwe. Reproductive Health Matters, 11, 162–173. doi:10.1016/S0968-8080(03)02284-5.
Foreit, K. G. F., Hardee, K., & Agarwal, K. (2002). When does it make sense to consider integrating STI and HIV services with family planning services? International Family Planning Perspectives, 28, 105–107. doi:10.2307/3088242.
Gimbel-Sherr, S. O., Micek, M. A., Gimbel-Sherr, K. H., Koepsell, T., Hughes, J. P., Thomas, K. K., et al. (2007). Using nurses to identify HAART eligible patients in the Republic of Mozambique: Results of a time series analysis. Human Resources for Health, 5, 7. doi:10.1186/1478-4491-5-7.
Jamisse, L., Jacinto, E., Robertson, M., Mahotas, D., et al. (2008). The complete package: Providing a standardized toolkit for PMTCT mothers’ support groups in Mozambique. Presented at the XVIIth International AIDS Conference. Mexico-City, Mexico, 3–8 August.
Kaida, A., Andia, I., Maier, M., Strathdee, S. A., Bangsberg, D. R., et al. (2006). The potential impact of antiretroviral therapy on fertility in sub-Saharan Africa. Current HIV/AIDS Reports, 3, 187–194. doi:10.1007/s11904-006-0015-0.
Kaler, A., & Watkins, S. C. (2001). Disobedient distributors: Street-level bureaucrats and would-be patrons in community-based family planning programs in rural Kenya. Studies in Family Planning, 32, 254–269. doi:10.1111/j.1728-4465.2001.00254.x.
Koenig, M. A., Hossain, M. B., & Whittaker, M. (1997). The influence of quality of care upon contraceptive use in rural Bangladesh. Studies in Family Planning, 28, 278–289. doi:10.2307/2137859.
Lanktree, E., Alibhai, A., Ssebuko, A., Buregyeya, E., & Saunders, L. D. (2008). Qualitative insights of healthcare workers on breastfeeding education and practices of HIV-positive and HIV-negative women in Kabarole district, Uganda. Presented at the XVIIth International AIDS Conference. Mexico-City, Mexico, 3–8 August.
Lewis, J. J., Ronsmans, C., Ezeh, A., & Gregson, S. (2004). The population impact of HIV on fertility in sub-Saharan Africa. AIDS (London, England), 18(Suppl. 2), S35–S43. doi:10.1097/00002030-200406002-00005.
Maharaj, P., & Cleland, J. (2005). Integration of sexual and reproductive health services in KwaZulu-Natal, South Africa. Health Policy and Planning, 20, 310–318. doi:10.1093/heapol/czi038.
Mayhew, S. H. (2000). Integration of STI services into FP/MCH services: Health service and social contexts in rural Ghana. Reproductive Health Matters, 8, 112–124. doi:10.1016/S0968-8080(00)90193-9.
Medley, A., & Sweat, M. (2008). Provider challenges in implementing prevention of mother-to child HIV programs in Uganda. Presented at the XVIIth International AIDS Conference. Mexico-City, Mexico, 3–8 August.
Moore, A. M., Nakabiito, C., Mirembe, F., Prada, E., Bankole, A., Singh, S., et al. (2006). How HIV status impacts child-bearing decisions: Results from a qualitative study in Kampala, Uganda. Presented at the annual meetings of the Population Association of America, Los Angeles, California. 30 March–1 April.
Mozambique Ministry of Health (2008). Report on the Revision of the Data from HIV Epidemiological Surveillance, Round 2007. Maputo, Mozambique: Mozambique Ministry of Health.
Nakayiwa, S., Abang, B., Packel, L., Lifshay, J., Purcell, D. W., et al. (2006). Desire for children and pregnancy risk behavior among HIV-infected men and women in Uganda. AIDS and Behavior, 10, 95–104. doi:10.1007/s10461-006-9126-2.
Orner, P., Cooper, D., Myer, L., Zweigenthal, V., et al. (2008). Clients’ perspectives on HIV/AIDS care and treatment and reproductive health services in South Africa. AIDS Care, 20, 1–7. doi:10.1080/09540120701867008.
RamaRao, S., & Mohanam, R. (2003). The quality of family planning programs: Concepts, measurements, interventions, and effects. Studies in Family Planning, 34, 227–248. doi:10.1111/j.1728-4465.2003.00227.x.
Rutenberg, N., & Baek, C. (2005). Field experiences integrating family planning into programs to prevent mother-to-child transmission of HIV. Studies in Family Planning, 36, 235–245. doi:10.1111/j.1728-4465.2005.00064.x.
Rutenberg, N., Biddlecom, A. E., & Kaona, F. A. D. (2000). Reproductive decision-making in the context of HIV and AIDS: A qualitative study in Ndola, Zambia. International Family Planning Perspectives, 26, 124–130. doi:10.2307/2648301.
Shelton, J. D. (1999). Prevention first: A three-pronged strategy to integrate family planning program efforts against HIV and sexually transmitted infections. International Family Planning Perspectives, 25, 147–152. doi:10.2307/2991964.
Teasdale, C., Besser, M., Nolan, M., & Sonjica, N. (2008). PMTCT program task shifting to PLWHA peer educators. Presented at the XVIIth International AIDS Conference. Mexico-City, Mexico, 3–8 August.
UNICEF. (2003). Evaluation of United Nations-supported pilot projects for the prevention of mother-to-child transmission of HIV. New York: HIV/AIDS Working Paper Series.
Welch, T. R. (2001). Culture and the patient-physician relationship: Achieving cultural competency in health care. The Journal of Pediatrics, 136, 14–23.
WHO/UNAIDS/UNICEF/UNFPA. (2004). HIV and infant feeding: Guidelines for decision makers. Geneva: World Health Organization.
Wood, K., & Jewkes, R. (2006). Blood blockages and scolding nurses: Barriers to adolescent contraceptive use in South Africa. Reproductive Health Matters, 14, 109–118. doi:10.1016/S0968-8080(06)27231-8.
Zaba, B., & Gregson, S. (1998). Measuring the impact of HIV on fertility in Africa. AIDS (London, England), 12(Suppl. 1), S41–S50. doi:10.1097/00002030-199807000-00001.
Acknowledgments
The support of the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), USA, grant # R01HD058365, is gratefully acknowledged.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Agadjanian, V., Hayford, S.R. PMTCT, HAART, and Childbearing in Mozambique: An Institutional Perspective. AIDS Behav 13 (Suppl 1), 103–112 (2009). https://doi.org/10.1007/s10461-009-9535-0
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10461-009-9535-0