AIDS and Behavior

, Volume 17, Issue 7, pp 2528–2539

HIV-related Stigma as a Barrier to Achievement of Global PMTCT and Maternal Health Goals: A Review of the Evidence

Substantive Review

Abstract

The global community has set goals of virtual elimination of new child HIV infections and 50 percent reduction in HIV-related maternal mortality by the year 2015. Although much progress has been made in expanding prevention of mother-to-child transmission (PMTCT) services, there are serious challenges to these global goals, given low rates of utilization of PMTCT services in many settings. We reviewed the literature from low-income settings to examine how HIV-related stigma affects utilization of the series of steps that women must complete for successful PMTCT. We found that stigma negatively impacts service uptake and adherence at each step of this “PMTCT cascade”. Modeling exercises indicate that these effects are cumulative and therefore significantly affect rates of infant HIV infection. Alongside making clinical services more available, effective, and accessible for pregnant women, there is also a need to integrate stigma-reduction components into PMTCT, maternal, neonatal, and child health services.

Keywords

HIV/AIDS Stigma Discrimination Prevention of mother-to-child transmission 

Resumen

La comunidad internacional se ha fijado metas de eliminación virtual de las nuevas infecciones por el VIH infantil y una reducción de 50 por ciento en la mortalidad maternal relacionada con el VIH para el año 2015. Aunque se ha avanzado mucho en la expansión de la prevención de la transmisión materno-infantil (PTMI), existen serios desafíos para estos objetivos globales, dada las bajas tasas de utilización de los servicios de prevención en muchos lugares. Revisamos la literatura sobre estes temas en paises de bajos recursos para examinar cómo el estigma afecta a la utilización de una serie de pasos que las mujeres deben completar para una PTMI exitosa. Se encontró que el estigma afecta negativamente la aceptación del servicio y la adherencia en cada paso de la cascada de los servicios de PTMI. Los ejercicios de simulación indican que estos efectos sean acumulativos, y afectan significativamente las tasas de infección por VIH en infantes. Además de hacer que los servicios clínicos son más disponibles, efectivos y accesibles para las mujeres embarazadas, también se necesita integrar componentes de la reducción del estigma en los servicios de la salud maternal, neonatal, infantil, y de PTMI.

References

  1. 1.
    UNAIDS. Global plan towards the elimination of new HIV infections among children by, and keeping their mothers alive. Geneva: UNAIDS; 2015. p. 2011.Google Scholar
  2. 2.
    Lehman DA, John-Stewart GC, Overbaugh J. Antiretroviral strategies to prevent mother-to-child transmission of HIV: striking a balance between efficacy, feasibility, and resistance. PLoS Med. 2009;6(10):e1000169.PubMedCrossRefGoogle Scholar
  3. 3.
    Mofenson LM. Protecting the next generation—eliminating perinatal HIV-1 infection. N Engl J Med. 2010;362(24):2316–8.PubMedCrossRefGoogle Scholar
  4. 4.
    WHO, UNAIDS, UNICEF. Global HIV/AIDS response: epidemic update and health sector progress towards universal access: progress report. Geneva: WHO; 2011. p. 2011.Google Scholar
  5. 5.
    Stringer EM, Ekouevi DK, Coetzee D, Tih PM, Creek TL, Stinson K, et al. Coverage of nevirapine-based services to prevent mother-to-child HIV transmission in 4 African countries. JAMA. 2010;304(3):293–302.PubMedCrossRefGoogle Scholar
  6. 6.
    Sripipatana T, Spensley A, Miller A, McIntyre J, Sangiwa G, Sawe F, et al. Site-specific interventions to improve prevention of mother-to-child transmission of human immunodeficiency virus programs in less developed settings. Am J Obstet Gynecol. 2007;197(3 Suppl):S107–12.PubMedCrossRefGoogle Scholar
  7. 7.
    Padian NS, Holmes CB, McCoy SI, Lyerla R, Bouey PD, Goosby EP. Implementation science for the US President’s emergency plan for AIDS relief (PEPFAR). J Acquir Immune Defic Syndr. 2011;56(3):199–203.PubMedCrossRefGoogle Scholar
  8. 8.
    World Health Organization, UNAIDS, UNICEF. Towards universal access: scaling up priority HIV/AIDS interventions in the health sector: progress report. Geneva: World Health Organization; 2009. p. 2009.Google Scholar
  9. 9.
    Torpey K, Kabaso M, Kasonde P, Dirks R, Bweupe M, Thompson C, et al. Increasing the uptake of prevention of mother-to-child transmission of HIV services in a resource-limited setting. BMC Health Serv Res. 2010;10:29.PubMedCrossRefGoogle Scholar
  10. 10.
    Byamugisha R, Tumwine JK, Ndeezi G, Karamagi CA, Tylleskar T. Attitudes to routine HIV counselling and testing, and knowledge about prevention of mother to child transmission of HIV in eastern Uganda: a cross-sectional survey among antenatal attendees. J Int AIDS Soc. 2010;13:52.PubMedCrossRefGoogle Scholar
  11. 11.
    Stringer EM, Chi BH, Chintu N, Creek TL, Ekouevi DK, Coetzee D, et al. Monitoring effectiveness of programmes to prevent mother-to-child HIV transmission in lower-income countries. Bull World Health Organ. 2008;86(1):57–62.PubMedCrossRefGoogle Scholar
  12. 12.
    Manzi M, Zachariah R, Teck R, Buhendwa L, Kazima J, Bakali E, et al. High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: scaling-up requires a different way of acting. Tropical Med Int Health. 2005;10(12):1242–50.CrossRefGoogle Scholar
  13. 13.
    Ferguson L, Grant AD, Watson-Jones D, Kahawita T, Ong’ech JO, Ross DA. Linking women who test HIV-positive in pregnancy-related services to long-term HIV care and treatment services: a systematic review. Trop Med Int Health. 2012;17:564–80.PubMedCrossRefGoogle Scholar
  14. 14.
    Kirsten I, Sewangi J, Kunz A, Dugange F, Ziske J, Jordan-Harder B, et al. Adherence to combination prophylaxis for prevention of mother-to-child-transmission of HIV in Tanzania. PLoS One. 2011;6(6):e21020.PubMedCrossRefGoogle Scholar
  15. 15.
    Weiss MG, Ramakrishna J. Stigma interventions and research for international health. Lancet. 2006;367(9509):536–8.PubMedCrossRefGoogle Scholar
  16. 16.
    Steward WT, Herek GM, Ramakrishna J, Bharat S, Chandy S, Wrubel J, et al. HIV-related stigma: adapting a theoretical framework for use in India. Soc Sci Med. 2008;67(8):1225–35.PubMedCrossRefGoogle Scholar
  17. 17.
    Earnshaw VA, Chaudoir SR. From conceptualizing to measuring HIV stigma: a review of HIV stigma mechanism measures. AIDS Behav. 2009;13(6):1160–77.PubMedCrossRefGoogle Scholar
  18. 18.
    Holzemer WL, Human S, Arudo J, Rosa ME, Hamilton MJ, Corless I, et al. Exploring HIV stigma and quality of life for persons living with HIV infection. J Assoc Nurses AIDS Care. 2009;20(3):161–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Brickley DB, Le Dung Hanh D, Nguyet LT, Mandel JS, Giang le T, Sohn AH. Community, family, and partner-related stigma experienced by pregnant and postpartum women with HIV in Ho Chi Minh City, Vietnam. AIDS Behav. 2009;13(6):1197–204.PubMedCrossRefGoogle Scholar
  20. 20.
    Turan JM, Bukusi EA, Onono M, Holzemer WL, Miller S, Cohen CR. HIV/AIDS stigma and refusal of HIV testing among pregnant women in Rural Kenya: results from the MAMAS Study. AIDS Behav. 2011;15(6):1111–20.PubMedCrossRefGoogle Scholar
  21. 21.
    Brown DC, Belue R, Airhihenbuwa CO. HIV and AIDS-related stigma in the context of family support and race in South Africa. Ethn Health. 2010;15(5):441–58.PubMedCrossRefGoogle Scholar
  22. 22.
    Kumar A, Hessini L, Mitchell EM. Conceptualising abortion stigma. Cult Health Sex. 2009;11(6):625–39.PubMedCrossRefGoogle Scholar
  23. 23.
    Bond V, Chase E, Aggleton P. Stigma, HIV/AIDS and prevention of mother-to-child transmission in Zambia. Eval Program Plan. 2002;25(4):347–56.CrossRefGoogle Scholar
  24. 24.
    Turan JM, Miller S, Bukusi EA, Sande J, Cohen CR. HIV/AIDS and maternity care in Kenya: how fears of stigma and discrimination affect uptake and provision of labor and delivery services. AIDS Care. 2008;20(8):938–45.PubMedCrossRefGoogle Scholar
  25. 25.
    Strebel A, Crawford M, Shefer T, Cloete A, Henda N, Kaufman M, et al. Social constructions of gender roles, gender-based violence and HIV/AIDS in two communities of the Western Cape, South Africa. Sahara J. 2006;3(3):516–28.PubMedCrossRefGoogle Scholar
  26. 26.
    Sandelowski M, Lambe C, Barroso J. Stigma in HIV-positive women. J Nurs Scholarsh. 2004;36(2):122–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Chase E, Aggleton P. Stigma, HIV/AIDS, and prevention of mother-to-child transmission. London: UNICEF and The Panos Institute; 2001.Google Scholar
  28. 28.
    Bunting SM. Sources of stigma associated with women with HIV. ANS Adv Nurs Sci. 1996;19(2):64–73.PubMedGoogle Scholar
  29. 29.
    Esplen E. Women and girls living with HIV/AIDS: overview and annotated bibliography. Brighton, UK: BRIDGE in collaboration with the International Community of Women Living with HIV and AIDS (ICW); 2007.Google Scholar
  30. 30.
    Nyblade LC. Measuring HIV stigma: existing knowledge and gaps. Psychol Health Med. 2006;11(3):335–45.PubMedCrossRefGoogle Scholar
  31. 31.
    Kendall T. Reproductive rights violations reported by Mexican women with HIV. Health Hum Rights. 2009;11(2):77–87.PubMedGoogle Scholar
  32. 32.
    Rahangdale L, Banandur P, Sreenivas A, Turan JM, Washington R, Cohen CR. Stigma as experienced by women accessing prevention of parent-to-child transmission of HIV services in Karnataka, India. AIDS Care. 2010;22(7):836–42.PubMedCrossRefGoogle Scholar
  33. 33.
    Kalichman SC, Simbayi LC, Cloete A, Mthembu PP, Mkhonta RN, Ginindza T. Measuring AIDS stigmas in people living with HIV/AIDS: the internalized AIDS-related stigma scale. AIDS Care. 2009;21(1):87–93.PubMedCrossRefGoogle Scholar
  34. 34.
    Simbayi LC, Kalichman S, Strebel A, Cloete A, Henda N, Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Soc Sci Med. 2007;64(9):1823–31.PubMedCrossRefGoogle Scholar
  35. 35.
    Vyavaharkar M, Moneyham L, Corwin S, Saunders R, Annang L, Tavakoli A. Relationships between stigma, social support, and depression in HIV-infected African American women living in the rural Southeastern United States. J Assoc Nurs AIDS Care. 2010;21(2):144–52.CrossRefGoogle Scholar
  36. 36.
    Laher F, Cescon A, Lazarus E, Kaida A, Makongoza M, Hogg RS, et al. Conversations with mothers: exploring reasons for prevention of mother-to-child transmission (PMTCT) failures in the era of programmatic scale-up in Soweto, South Africa. AIDS Behav. 2012;16(1):91–8.Google Scholar
  37. 37.
    Nguyen TA, Oosterhoff P, Ngoc YP, Wright P, Hardon A. Barriers to access prevention of mother-to-child transmission for HIV positive women in a well-resourced setting in Vietnam. AIDS Res Therapy. 2008;5:7.CrossRefGoogle Scholar
  38. 38.
    Ujiji OA, Rubenson B, Ilako F, Marrone G, Wamalwa D, Wangalwa G, et al. Is ‘opt-out HIV testing’ a real option among pregnant women in rural districts in Kenya? BMC Public Health. 2011;11:151.PubMedCrossRefGoogle Scholar
  39. 39.
    Rakgoasi SD. HIV counselling and testing of pregnant women attending antenatal clinics in Botswana, 2001. J Health Popul Nutr. 2005;23(1):58–65.PubMedGoogle Scholar
  40. 40.
    Oosterhoff P, Hardon AP, Nguyen TA, Pham NY, Wright P. Dealing with a positive result: routine HIV testing of pregnant women in Vietnam. AIDS Care. 2008;20(6):654–9.PubMedCrossRefGoogle Scholar
  41. 41.
    Shetty AK, Marangwanda C, Stranix-Chibanda L, Chandisarewa W, Chirapa E, Mahomva A, et al. The feasibility of preventing mother-to-child transmission of HIV using peer counselors in Zimbabwe. AIDS Res Therapy. 2008;5:17.CrossRefGoogle Scholar
  42. 42.
    Peltzer K, Mlambo G, Phaweni K. Factors determining prenatal HIV testing for prevention of mother to child transmission of HIV in Mpumalanga, South Africa. AIDS Behav. 2010;14(5):1115–23.PubMedCrossRefGoogle Scholar
  43. 43.
    Balcha TT, Lecerof SS, Jeppsson AR. Strategic challenges of PMTCT program implementation in Ethiopia. J Int Assoc Phys AIDS Care (Chic). 2011;10(3):187–92.CrossRefGoogle Scholar
  44. 44.
    Kinuthia J, Kiarie JN, Farquhar C, Richardson BA, Nduati R, Mbori-Ngacha D, et al. Uptake of prevention of mother to child transmission interventions in Kenya: health systems are more influential than stigma. J Int AIDS Soc. 2011;14:61.PubMedCrossRefGoogle Scholar
  45. 45.
    Hardon A, Vernooij E, Bongololo-Mbera G, Cherutich P, Desclaux A, Kyaddondo D, et al. Women’s views on consent, counseling and confidentiality in PMTCT: a mixed-methods study in four African countries. BMC Public Health. 2012;12:26.PubMedCrossRefGoogle Scholar
  46. 46.
    Otieno PA, Kohler PK, Bosire RK, Brown ER, Macharia SW, John-Stewart GC. Determinants of failure to access care in mothers referred to HIV treatment programs in Nairobi, Kenya. AIDS Care. 2010;22(6):729–36.PubMedCrossRefGoogle Scholar
  47. 47.
    Turan JM, Onono M, Cohen CR, Bukusi EA. Stigma and lack of disclosure as barriers to use of maternity and HIV services by HIV-positive pregnant women in rural Kenya. In: APHA 140th annual meeting, October 27–31, San Francisco; 2012.Google Scholar
  48. 48.
    Muchedzi A, Chandisarewa W, Keatinge J, Stranix-Chibanda L, Woelk G, Mbizvo E, et al. Factors associated with access to HIV care and treatment in a prevention of mother to child transmission programme in urban Zimbabwe. J Int AIDS Soc. 2010;13(1):1–9.CrossRefGoogle Scholar
  49. 49.
    Kunihira NR, Nuwaha F, Mayanja R, Peterson S. Barriers to use of antiretroviral drugs in Rakai district of Uganda. Afr Health Sci. 2010;10(2):120–9.PubMedGoogle Scholar
  50. 50.
    Mepham S, Zondi Z, Mbuyazi A, Mkhwanazi N, Newell ML. Challenges in PMTCT antiretroviral adherence in northern KwaZulu-Natal, South Africa. AIDS Care. 2011;23(6):741–7.PubMedCrossRefGoogle Scholar
  51. 51.
    Peltzer K, Mlambo M, Phaswana-Mafuya N, Ladzani R. Determinants of adherence to a single-dose nevirapine regimen for the prevention of mother-to-child HIV transmission in Gert Sibande district in South Africa. Acta Paediatr. 2010;99(5):699–704.PubMedGoogle Scholar
  52. 52.
    Awiti Ujiji O, Ekstrom AM, Ilako F, Indalo D, Wamalwa D, Rubenson B. Reasoning and deciding PMTCT-adherence during pregnancy among women living with HIV in Kenya. Cult Health Sex. 2011;13(7):829–40.Google Scholar
  53. 53.
    Stanton C, Blanc AK, Croft T, Choi Y. Skilled care at birth in the developing world: progress to date and strategies for expanding coverage. J Biosoc Sci. 2006:1–12.Google Scholar
  54. 54.
    WHO. Global action for skilled attendants for pregnant women. Geneva: WHO, Family and Community Health, Department of Reproductive Health and Research, 2002.Google Scholar
  55. 55.
    Ndirangu J, Newell ML, Tanser F, Herbst AJ, Bland R. Decline in early life mortality in a high HIV prevalence rural area of South Africa: evidence of HIV prevention or treatment impact? AIDS. 2010;24(4):593–602.PubMedCrossRefGoogle Scholar
  56. 56.
    Turan JM, Hatcher AH, Medema-Wijnveen J, Onono M, Miller S, Bukusi EA, et al. The role of HIV-related stigma in utilization of skilled childbirth services in rural Kenya: a prospective mixed-methods study. PLoS Med. 2012;9(8):e1001295.PubMedCrossRefGoogle Scholar
  57. 57.
    Turan J, Onono M, Bukusi EA, Miller S, Medema-Winjveen J, Cohen CR, editors. Effects of anticipated stigma and subsequent disclosure on utilization of labor and delivery services in Nyanza Province, Kenya. In: 6th IAS conference on HIV pathogenesis, treatment and prevention 2011 17–20 July, Rome, Italy.Google Scholar
  58. 58.
    Buskens I, Jaffe A, Mkhatshwa H. Infant feeding practices: realities and mind sets of mothers in Southern Africa. AIDS Care. 2007;19(9):1101–9.PubMedCrossRefGoogle Scholar
  59. 59.
    Eide M, Myhre M, Lindbaek M, Sundby J, Arimi P, Thior I. Social consequences of HIV-positive women’s participation in prevention of mother-to-child transmission programmes. Patient Educ Couns. 2006;60(2):146–51.PubMedCrossRefGoogle Scholar
  60. 60.
    Morgan MC, Masaba RO, Nyikuri M, Thomas TK. Factors affecting breastfeeding cessation after discontinuation of antiretroviral therapy to prevent mother-to-child transmission of HIV. AIDS Care. 2010;22(7):866–73.PubMedCrossRefGoogle Scholar
  61. 61.
    Sibeko L, Coutsoudis A, Nzuza S, Gray-Donald K. Mothers’ infant feeding experiences: constraints and supports for optimal feeding in an HIV-impacted urban community in South Africa. Public Health Nutr. 2009;12(11):1983–90.PubMedCrossRefGoogle Scholar
  62. 62.
    Desclaux A, Alfieri C. Counseling and choosing between infant-feeding options: overall limits and local interpretations by health care providers and women living with HIV in resource-poor countries (Burkina Faso, Cambodia, Cameroon). Soc Sci Med. 2009;69(6):821–9.PubMedCrossRefGoogle Scholar
  63. 63.
    Onono MA, Bukusi EA, Cohen CR, Turan JM. HIV serostatus and disclosure: implications on infant feeding practice in rural South Nyanza, Kenya. In: 16th international conference on AIDS & STIs in Africa, December 4–8, Addis Ababa, Ethiopia, 2011.Google Scholar
  64. 64.
    Kiragu K, Schenk K, Murugi J, Sarna A. “If you build it, will they come?” Kenya healthy start pediatric HIV study: a diagnostic study investigating barriers to HIV treatment and care among children. Washington, DC: The Population Council; 2008.Google Scholar
  65. 65.
    Peltzer K, Mlambo G. Factors determining HIV viral testing of infants in the context of mother-to-child transmission. Acta Paediatr. 2010;99(4):590–6.PubMedCrossRefGoogle Scholar
  66. 66.
    Cook RE, Ciampa PJ, Sidat M, Blevins M, Burlison J, Davidson MA, et al. Predictors of successful early infant diagnosis of HIV in a rural district hospital in Zambezia, Mozambique. J Acquir Immune Defic Syndr. 2011;56(4):e104–9.PubMedCrossRefGoogle Scholar
  67. 67.
    Delvaux T, Elul B, Ndagije F, Munyana E, Roberfroid D, Asiimwe A. Determinants of nonadherence to a single-dose nevirapine regimen for the prevention of mother-to-child HIV transmission in Rwanda. J Acquir Immune Defic Syndr. 2009;50(2):223–30.PubMedCrossRefGoogle Scholar
  68. 68.
    Alcorn K. Malawi plans ‘test and treat’ approach for pregnant women to cut mother-to-child HIV transmission. http://www.aidsmap.com/Malawi-plans-test-and-treat-approach-for-pregnant-women-to-cut-mother-to-child-HIV-transmission/page/1494940/ (2010). Accessed Nov 4 2011.
  69. 69.
    Jani IV, Sitoe NE, Alfai ER, Chongo PL, Quevedo JI, Rocha BM, et al. Effect of point-of-care CD4 cell count tests on retention of patients and rates of antiretroviral therapy initiation in primary health clinics: an observational cohort study. Lancet. 2011;378(9802):1572–9.PubMedCrossRefGoogle Scholar
  70. 70.
    Thorsen VC, Sundby J, Martinson F. Potential initiators of HIV-related stigmatization: ethical and programmatic challenges for PMTCT programs. Dev World Bioeth. 2008;8(1):43–50.PubMedCrossRefGoogle Scholar
  71. 71.
    Greene K, Derlega VJ, Yep GA, Petronio S. Privacy and disclosure of HIV in interpersonal relationships: a sourcebook for researchers and practitioners. Mahwah: Lawrence Erlbaum Associates, Publishers; 2003.Google Scholar
  72. 72.
    Desgrées-du-Loû A, Brou H, Traore AT, Djohan G, Becquet R, Leroy V. From prenatal HIV testing of the mother to prevention of sexual HIV transmission within the couple. Soc Sci Med. 2009;69(6):892–9.PubMedCrossRefGoogle Scholar
  73. 73.
    Orne-Gliemann J, Desgrees-Du-Lou A. The involvement of men within prenatal HIV counselling and testing. Facts, constraints and hopes. AIDS. 2008;22(18):2555–7.PubMedCrossRefGoogle Scholar
  74. 74.
    Katz DA, Kiarie JN, John-Stewart GC, Richardson BA, John FN, Farquhar C. HIV testing men in the antenatal setting: understanding male non-disclosure. Int J STD AIDS. 2009;20(11):765–7.PubMedCrossRefGoogle Scholar
  75. 75.
    Bond VA. “It is not an easy decision on HIV, especially in Zambia”: opting for silence, limited disclosure and implicit understanding to retain a wider identity. AIDS Care. 2010;22(Suppl 1):6–13.PubMedCrossRefGoogle Scholar
  76. 76.
    Medley A, Garcia-Moreno C, McGill S, Maman S. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ. 2004;82(4):299–307.PubMedGoogle Scholar
  77. 77.
    Medley AM, Kennedy CE, Lunyolo S, Sweat MD. Disclosure outcomes, coping strategies, and life changes among women living with HIV in Uganda. Qual Health Res. 2009;19(12):1744–54.PubMedCrossRefGoogle Scholar
  78. 78.
    Obermeyer CM, Baijal P, Pegurri E. Facilitating HIV disclosure across diverse settings: a review. Am J Public Health. 2011;101(6):1011–23.PubMedCrossRefGoogle Scholar
  79. 79.
    Dlamini PS, Kohi TW, Uys LR, Phetlhu RD, Chirwa ML, Naidoo JR, et al. Verbal and physical abuse and neglect as manifestations of HIV/AIDS stigma in five African countries. Public Health Nurs. 2007;24(5):389–99.PubMedCrossRefGoogle Scholar
  80. 80.
    Watts C, Zimmerman C, Eckhaus T, Nyblade L. Modelling the impact of stigma on HIV and AIDS programmes: preliminary projections for mother-to-child transmission. Washington, DC: International Center for Research on Women (ICRW) and London School of Hygiene and Tropical Medicine; 2010.Google Scholar
  81. 81.
    Prudden H, Nyblade L, Dzialowy N, Foss A, Black V, Wallace N, et al. Modelling the impact of stigma on the prevention of mother-to-child HIV transmission for a setting in South Africa. Washington, DC: Health Policy Project and London School of Hygiene and Tropical Medicine; 2013 (forthcoming).Google Scholar
  82. 82.
    Welty TK, Bulterys M, Welty ER, Tih PM, Ndikintum G, Nkuoh G, et al. Integrating prevention of mother-to-child HIV transmission into routine antenatal care: the key to program expansion in Cameroon. J Acquir Immune Defic Syndr. 2005;40(4):486–93.PubMedCrossRefGoogle Scholar
  83. 83.
    Sherr L. Literature review on program strategies and models of continuity of HIV/maternal, newborn, and child health care for HIV-positive mothers and their HIV-positive/-exposed children. Arlington, VA: USAID’s AIDS Support and Technical Assistance Resources, AIDSTAR-One, Task Order 1; 2012.Google Scholar
  84. 84.
    Winestone LE, Bukusi EA, Cohen CR, Kwaro D, Schmidt NC, Turan JM. Acceptability and feasibility of integration of HIV care services into antenatal clinics in rural Kenya: a qualitative provider interview study. Glob Public Health. 2012;7(2):149–63.PubMedCrossRefGoogle Scholar
  85. 85.
    Pulerwitz J, Michaelis A, Weiss E, Brown L, Mahendra V. Reducing HIV-related stigma: lessons learned from horizons research and programs. Public Health Rep. 2010;125(2):272–81.PubMedGoogle Scholar
  86. 86.
    Carr D, Eckhaus T, Brady L, Watts C, Zimmerman C, Nyblade L. Scaling up the response to HIV stigma and discrimination. Washington, DC: International Center for Research on Women; 2010.Google Scholar
  87. 87.
    Nyblade L, Stangl A, Weiss E, Ashburn K. Combating HIV stigma in health care settings: what works? J Int AIDS Soc. 2009;12:15.PubMedCrossRefGoogle Scholar
  88. 88.
    Sengupta S, Banks B, Jonas D, Miles MS, Smith GC. HIV interventions to reduce HIV/AIDS stigma: a systematic review. AIDS Behav. 2011;15(6):1075–87.PubMedCrossRefGoogle Scholar
  89. 89.
    mothers2mothers. Where we work. 2012. http://www.m2m.org/what-we-do/where-we-work.html. Accessed 13 April 2012.

Copyright information

© Springer Science+Business Media New York 2013

Authors and Affiliations

  1. 1.Department of Health Care Organization and PolicySchool of Public Health, University of Alabama at BirminghamBirminghamUSA
  2. 2.Health Policy Project and Global Health Division, International Development GroupRTI InternationalWashingtonUSA

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