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“She Just Told Me Not To Cry”: A Qualitative Study of Experiences of HIV Testing and Counseling (HTC) Among Pregnant Women Living with HIV in Tanzania


HIV testing and counseling (HTC) in antenatal care is extremely effective at identifying women living with HIV and linking them to HIV care. However, retention is suboptimal in this population. We completed qualitative interviews with 24 pregnant women living with HIV in Tanzania to explore perceptions of HTC. Participants described intense shock and distress upon testing positive, including concerns about HIV stigma and disclosure; however, these concerns were rarely discussed in HTC. Nurses were generally kind, but relied on educational content and brief reassurances, leaving some participants feeling unsupported and unprepared to start HIV treatment. Several participants described gaps in HIV knowledge, including the purpose of antiretroviral therapy and the importance of medication adherence. Targeted nurse training related to HIV disclosure, stigma, and counseling skills may help nurses to more effectively communicate the importance of care engagement to prevent HIV transmission and support the long-term health of mother and child.


Las pruebas de VIH y la orientación (HTC) en el cuidado prenatal son métodos extremadamente efectivos para identificar a mujeres viviendo con VIH y referirlas al cuidado que necesitan. Sin embargo, la retención en los programas de cuidado es un obstáculo en esta población. Completamos entrevistas cualitativas en Tanzania con 24 mujeres embarazadas que viven con el VIH para identificar sus reacciones al HTC. Las participantes describieron un sentido de conmoción intensa y angustia al dar positivo, además de las preocupaciones sobre el estigma del VIH y el temor a divulgar ser positivas. Sin embargo, estas preocupaciones rara vez se discutieron durante el proceso de HTC. Por lo general, las enfermeras fueron amables, pero se dependían del material educativo y ofrecían pequeñas consolaciones, los cuales dejaban a algunas participantes sintiéndose sin apoyo y sin preparación para comenzar el tratamiento contra el VIH. Varias participantes describieron poco conocimiento del VIH, como el propósito de la terapia antirretroviral y la importancia de la adherencia terapéutica. Un entrenamiento específico para las enfermeras en relación a la divulgación, el estigma y la orientación sobre el VIH podrían ayudar a las enfermeras a comunicar de manera más efectiva la importancia de la participación en el cuidado de la condición para así prevenir la transmisión del VIH y fomentar la salud a largo plazo del la madre y la criatura.

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This study was funded by a grant from the NIH National Institute of Allergies and Infectious Diseases (NIAID), Grant R21 AI124344. We also acknowledge support received from the Fogarty International Center (R21 TW011053; D43 TW009595; D43 TW009337), the Duke Center for AIDS Research (P30 AI064518), and the NIH Office of Behavioral and Social Science Research (OBSSR).

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Correspondence to Brandon A. Knettel.

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Oshosen, M., Knettel, B.A., Knippler, E. et al. “She Just Told Me Not To Cry”: A Qualitative Study of Experiences of HIV Testing and Counseling (HTC) Among Pregnant Women Living with HIV in Tanzania. AIDS Behav 25, 104–112 (2021).

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  • HIV testing and counseling (HTC)
  • Low- and middle-income countries (LMICs)
  • Option B+
  • Prevention of mother-to-child transmission of HIV (PMTCT)
  • HIV stigma