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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
The Role of HIV-Related Stigma in Utilization of Skilled Childbirth Services in Rural Kenya: A Prospective Mixed-Methods Study
PLoS Medicine, Volume 9, No. 8, Article e1001295, Year 2012
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Description
Background: Childbirth with a skilled attendant is crucial for preventing maternal mortality and is an important opportunity for prevention of mother-to-child transmission of HIV. The Maternity in Migori and AIDS Stigma Study (MAMAS Study) is a prospective mixed-methods investigation conducted in a high HIV prevalence area in rural Kenya, in which we examined the role of women's perceptions of HIV-related stigma during pregnancy in their subsequent utilization of maternity services. Methods and Findings: From 2007-2009, 1,777 pregnant women with unknown HIV status completed an interviewer-administered questionnaire assessing their perceptions of HIV-related stigma before being offered HIV testing during their first antenatal care visit. After the visit, a sub-sample of women was selected for follow-up (all women who tested HIV-positive or were not tested for HIV, and a random sample of HIV-negative women, n = 598); 411 (69%) were located and completed another questionnaire postpartum. Additional qualitative in-depth interviews with community health workers, childbearing women, and family members (n = 48) aided our interpretation of the quantitative findings and highlighted ways in which HIV-related stigma may influence birth decisions. Qualitative data revealed that health facility birth is commonly viewed as most appropriate for women with pregnancy complications, such as HIV. Thus, women delivering at health facilities face the risk of being labeled as HIV-positive in the community. Our quantitative data revealed that women with higher perceptions of HIV-related stigma (specifically those who held negative attitudes about persons living with HIV) at baseline were subsequently less likely to deliver in a health facility with a skilled attendant, even after adjusting for other known predictors of health facility delivery (adjusted odds ratio = 0.44, 95% CI 0.22-0.88). Conclusions: Our findings point to the urgent need for interventions to reduce HIV-related stigma, not only for improving quality of life among persons living with HIV, but also for better health outcomes among all childbearing women and their families. Please see later in the article for the Editors' Summary. © 2012 Turan et al.
Authors & Co-Authors
Turan, Janet M.
United States, Birmingham
The University of Alabama at Birmingham
Hatcher, Abigail M.
United States, San Francisco
University of California, San Francisco
Medema-Wijnveen, José S.
Netherlands, Groningen
Rijksuniversiteit Groningen
Onono, Maricianah Atieno
Kenya, Nairobi
Kenya Medical Research Institute
Miller, Suellen P.
United States, San Francisco
University of California, San Francisco
Bukusi, Elizabeth Anne
Kenya, Nairobi
Kenya Medical Research Institute
Turan, Bulent
United States, Birmingham
The University of Alabama at Birmingham
Cohen, Craig R.
United States, San Francisco
University of California, San Francisco
Statistics
Citations: 103
Authors: 8
Affiliations: 4
Identifiers
Doi:
10.1371/journal.pmed.1001295
ISSN:
15491277
e-ISSN:
15491676
Research Areas
Disability
Health System And Policy
Infectious Diseases
Maternal And Child Health
Sexual And Reproductive Health
Study Design
Cross Sectional Study
Cohort Study
Case-Control Study
Study Approach
Qualitative
Quantitative
Study Locations
Kenya
Participants Gender
Female