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Bidirectional links between HIV and intimate partner violence in pregnancy: implications for prevention of mother-to-child transmission.
- Source :
-
Journal of the International AIDS Society [J Int AIDS Soc] 2014 Nov 03; Vol. 17, pp. 19233. Date of Electronic Publication: 2014 Nov 03 (Print Publication: 2014). - Publication Year :
- 2014
-
Abstract
- Introduction: Prevention of mother-to-child transmission (PMTCT) has the potential to eliminate new HIV infections among infants. Yet in many parts of sub-Saharan Africa, PMTCT coverage remains low, leading to unacceptably high rates of morbidity among mothers and new infections among infants. Intimate partner violence (IPV) may be a structural driver of poor PMTCT uptake, but has received little attention in the literature to date.<br />Methods: We conducted qualitative research in three Johannesburg antenatal clinics to understand the links between IPV and HIV-related health of pregnant women. We held focus group discussions with pregnant women (n=13) alongside qualitative interviews with health care providers (n=10), district health managers (n=10) and pregnant abused women (n=5). Data were analysed in Nvivo10 using a team-based approach to thematic coding.<br />Findings: We found qualitative evidence of strong bidirectional links between IPV and HIV among pregnant women. HIV diagnosis during pregnancy, and subsequent partner disclosure, were noted as a common trigger of IPV. Disclosure leads to violence because it causes relationship conflict, usually related to perceived infidelity and the notion that women are "bringing" the disease into the relationship. IPV worsened HIV-related health through poor PMTCT adherence, since taking medication or accessing health services might unintentionally alert male partners of the women's HIV status. IPV also impacted on HIV-related health via mental health, as women described feeling depressed and anxious due to the violence. IPV led to secondary HIV risk as women experienced forced sex, often with little power to negotiate condom use. Pregnant women described staying silent about condom negotiation in order to stay physically safe during pregnancy.<br />Conclusions: IPV is a crucial issue in the lives of pregnant women and has bidirectional links with HIV-related health. IPV may worsen access to PMTCT and secondary prevention behaviours, thereby posing a risk of secondary transmission. IPV should be urgently addressed in antenatal care settings to improve uptake of PMTCT and ensure that goals of maternal and child health are met in sub-Saharan African settings.
- Subjects :
- Female
HIV Infections prevention & control
HIV Infections therapy
Health Services Accessibility
Humans
Infant
Infant, Newborn
Interviews as Topic
Male
Pregnancy
South Africa
HIV Infections epidemiology
HIV Infections transmission
Infectious Disease Transmission, Vertical prevention & control
Pregnancy Complications, Infectious epidemiology
Sex Offenses
Subjects
Details
- Language :
- English
- ISSN :
- 1758-2652
- Volume :
- 17
- Database :
- MEDLINE
- Journal :
- Journal of the International AIDS Society
- Publication Type :
- Academic Journal
- Accession number :
- 25371218
- Full Text :
- https://doi.org/10.7448/IAS.17.1.19233