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HIV-related Shame among Women Giving Birth in Tanzania: A Mixed Methods Study

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Abstract

Women living with HIV (WLHIV) commonly experience HIV-related shame which can interfere with HIV care-seeking behavior and lead to poor clinical outcomes. HIV-related shame may be particularly heightened during the pregnancy and postpartum periods. This study aimed to describe HIV-related shame among WLHIV giving birth, identify associated factors, and qualitatively examine the impacts of HIV-related shame on the childbirth experience. Postpartum WLHIV (n = 103) were enrolled in the study between March and July 2022 at six clinics in the Kilimanjaro Region, Tanzania. Participants completed a survey within 48 h after birth, prior to being discharged. The survey included a 13-item measure of HIV-related shame, which assessed levels of HIV-related shame (Range: 0–52). Univariable and multivariable regression models examined factors associated with HIV-related shame. Qualitative in-depth interviews were conducted with pregnant WLHIV (n = 12) and postpartum WLHIV (n = 12). Thematic analysis, including memo writing, coding, and synthesis, was employed to analyze the qualitative data. The survey sample had a mean age of 29.1 (SD = 5.7), and 52% were diagnosed with HIV during the current pregnancy. Nearly all participants (98%) endorsed at least one item reflecting HIV-related shame, with an average endorsement of 9 items (IQR = 6). In the final multivariable model, HIV-related shame was significantly associated with being Muslim vs. Christian (ß = 6.80; 95%CI: 1.51, 12.09), attending less than four antenatal care appointments (ß = 5.30; 95%CI: 0.04, 10.55), and reporting experiences of HIV stigma in the health system (ß = 0.69; 95%CI: 0.27, 1.12). Qualitative discussions revealed three key themes regarding the impact of HIV-related shame on the childbirth experience: reluctance to disclose HIV status, suboptimal adherence to care, and the influence on social support networks. WLHIV giving birth experience high rates of HIV-related shame, and social determinants may contribute to feelings of shame. HIV-related shame impacts the childbirth experience for WLHIV, making the labor and delivery setting an important site for intervention and support.

The study is funded by the National Institutes of Health (R21 TW012001) and is registered on clinicaltrials.gov (NCT05271903).

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Acknowledgements

We would like to thank the research team, supervisors, hospital administrators, and staff for their willingness to give their time and information for this study. We would also like to thank the patients who shared their stories and the stakeholders who provided valuable input into study design.

Funding

The parent study was funded by the U.S. National Institutes of Health (R21 TW012001, MPI, Watt & Cohen).

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Author notes

  1. Olivia R. Hanson and Anya J. Weglarz are co-first author.

Authors and Affiliations

  1. Department of Population Health Sciences, Spencer Fox Eccles School of Medicine, University of Utah, Williams Building, Room 1N410, 295 Chipeta Way, Salt Lake City, UT, 84108, USA

    Olivia R. Hanson, Anya J. Weglarz, Maya J. Stephens & Melissa H. Watt

  2. Kilimanjaro Christian Medical University College, Moshi, Tanzania

    Mariam L. Barabara

  3. Department of Obstetrics and Gynecology, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, UT, USA

    Susanna R. Cohen

  4. Kilimanjaro Clinical Research Institute, Moshi, Tanzania

    Linda M. Minja, Janeth Mlay & Blandina T. Mmbaga

  5. Health Management Department, Kilimanjaro Regional Secretary’s Office, Moshi, Tanzania

    Gaudensia A. Olomi

  6. Department of Obstetrics and Gynecology, Kilimanjaro Christian Medical Center, Moshi, Tanzania

    Pendo S. Mlay

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  1. Olivia R. Hanson
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Correspondence to Olivia R. Hanson.

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The study is funded by the National Institutes of Health (R21 TW012001) and is registered on clinicaltrials.gov (NCT05271903).

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Hanson, O.R., Weglarz, A.J., Barabara, M.L. et al. HIV-related Shame among Women Giving Birth in Tanzania: A Mixed Methods Study. AIDS Behav (2024). https://doi.org/10.1007/s10461-024-04322-1

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