TUPE335 - Poster Exhibition
Effects of anticipated stigma and subsequent disclosure on utilization of labor and delivery services in Nyanza province, Kenya
J. Turan1, M. Onono2, E.A. Bukusi3, S. Miller4, J. Medema-Wijnveen5, C.R. Cohen1
1University of California, San Francisco, Obstetrics, Gynecology and Reproductive Sciences, San Francisco, United States, 2Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research, Migori, Kenya, 3Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research, Nairobi, Kenya, 4University of California, San Francisco, Obstetrics, Gynecology, and Reproductive Sciences, San Francisco, United States, 5University of Groningen, Groningen, Netherlands
Background: Childbirth with a skilled attendant is important for prevention of maternal mortality and is an opportunity for prevention of mother-to-child transmission of HIV. The MAMAS Study is a prospective investigation of women attending nine antenatal care (ANC) clinics in rural Nyanza, Kenya, examining the effects of HIV/AIDS stigma on use of maternity and HIV services.
Methods: From 2007- 2009, 1,777 pregnant women with unknown HIV status participated in interviews before their first ANC visit, followed by an offer of HIV testing. All HIV-positive women, all HIV test refusers, and a random sample of HIV-negative women were selected for follow-up after delivery (N=614); 426 (70%) were located and interviewed 4-8 weeks postpartum. Effects of anticipated stigma and HIV status disclosure on health facility delivery were examined using logistic regression.
Results: Among the women interviewed postpartum, 156 (37%) were HIV-positive, 166 (39%) HIV-negative, and 104 (24%) had unknown HIV status. Among HIV-positive women, only 90 (58%) had disclosed their HIV status to anyone. Disclosure of HIV-positive status to the male partner was 42% among those who did not anticipate male partner stigma at baseline, compared to 16% among those who did anticipate such stigma (OR=4.5, 95% CI: 1.7-11.6). Overall, 35% of women delivered in a health facility. In analyses adjusted for other predictors, HIV-positive women who had not disclosed their HIV status were 5.6 times more likely to give birth outside of a health facility than HIV-positive women who had disclosed (95% CI: 2.4-13.3) and 2.8 times more likely than HIV-negative women (95% CI: 1.3-6.3).
Conclusion: Anticipated stigma from male partners and subsequent lack of disclosure of HIV status were associated with failure to utilize skilled maternity services by HIV-positive women in this study in rural Kenya. Interventions are needed to reduce stigma and to support safe disclosure of HIV status.
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