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

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.

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.

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Notes

  1. 1.

    Specific search terms used included stigma and PMTCT, discrimination and PMTCT, stigma and PMTCT adherence, PMTCT adherence and stigma and discrimination, maternal health and stigma and discrimination, PMTCT cascade, PMTCT adherence, PMTCT and loss to follow-up, antenatal HIV testing, antenatal HIV testing and PMTCT adherence, barriers to PMTCT, HIV testing and cascade, adherence and infant testing, adherence and infant testing and HIV, loss to follow-up and HIV and pregnant women, people living with HIV and pregnant women, AZT adherence, PMTCT uptake and stigma.

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Acknowledgments

The authors are grateful for the thoughtful comments of Ronald MacInnis and Beth Robinson of the Health Policy Project; and Benjamin Ryan Phelps, Michelle Wu Yoon, and Jose Gutierrez of the United States Agency for International Development (USAID). The authors also thank Philippe Monfiston, Ginny Gordon, Lori Merritt, Tasnim Shahjahan, and Modupe Durojaiye for their research, editorial, and graphic support. This paper was produced under the Health Policy Project (HPP) funded by USAID (under Cooperative Agreement No. AID-OAA-A-10-00067), which includes support from the President’s Emergency Plan for AIDS Relief (PEPFAR). HPP is implemented by Futures Group, in collaboration with CEDPA (CEDPA is now a part of plan International USA), Futures Institute, Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and the White Ribbon Alliance for Safe Motherhood (WRA). The views expressed are those of the authors and do not necessarily represent the views of USAID or the US government.

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Correspondence to Janet M. Turan.

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Turan, J.M., Nyblade, L. HIV-related Stigma as a Barrier to Achievement of Global PMTCT and Maternal Health Goals: A Review of the Evidence. AIDS Behav 17, 2528–2539 (2013). https://doi.org/10.1007/s10461-013-0446-8

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Keywords

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