Effectiveness of services for Prevention of Mother to Child Transmission (PMTCT) of Human Immunodeficiency Virus (HIV) depends on viable and efficient health systems, adherence to and utilization of services. Despite strategies to provide access to PMTCT of HIV services, utilization of these services remain low in Nigeria thereby increasing child morbidity and mortality from HIV-related causes. Adherence to comprehensive HIV/AIDS care, for both the mother and baby, remain a challenge for HIV positive women. Utilizing the Health Belief Model and Social Support Theory, this qualitative study explores factors influencing utilization and adherence to PMTCT services by mothers living with HIV/AIDS in Rivers State, Nigeria. Purposive sampling procedures were used to select 40 study participants including 20 HIV positive mothers and 20 health care workers as key informants. Findings indicate that high self-perceived susceptibility to HIV influences utilization and adherence to PMTCT services among mothers living with HIV and AIDS in Rivers State. Although utilization and adherence to PMTCT were reported very high among this population, there were however challenges and barriers to optimal utilization of PMTCT. These include unavailability of test kits, antiretroviral medication stock-outs, and inadequate human resources for health. High transport, PMTCT and antenatal care costs were identified as the major socio-economic barriers to PMTCT administration as well as the high financial burden of formula feeding for women that preferred exclusive formula feeding. In addition to increased numbers of health care workers trained in PMTCT service delivery, recommendations for a public health approach to service delivery and a streamlined primary care strategy are proposed. These include social and community activities to address HIV/AIDS stigma, improving awareness of PMTCT facts, addressing gender relations and encouraging male participation. Inter-ministerial collaborations and targeted partnerships are also recommended for expanding coverage and ensuring optimal utilization of PMTCT services.

Magister Public Health - MPH / Sub Saharan Africa (SSA) single-handedly accounted for approximately two thirds (196 000) of the world maternal deaths. High maternal deaths have been attributed to high prevalence of HIV and low uptake of Antenatal Care (ANC). This made World Health Organization (WHO) to recommend integration of Prevention of Mother to Child Transmission of HIV (PMTCT) services into ANC to improve accessibility and utilization. According to Zambia Ministry of Health (MoH), every pregnant woman should have her ANC registration in the first trimester and achieve eight visits by delivery time. With the extra need of PMTCT services in the women living with HIV, early and regular ANC attendance is emphasized. However, in Zambia, there is limited information on ANC uptake and its associated factors among women living with HIV. / 2023

Philosophiae Doctor - PhD / Women living with HIV (WLHIV) desire to bear children. Safe conception (SC) education for informed decision-making to prevent peri-conception HIV infection is needed but not routinely available. Poor SC knowledge, attitude, skills in addition to the absence of a standardised training programme were challenges that limited delivery. This study therefore aimed at developing a training programme for healthcare workers to facilitate SC education among WLHIV. The study adopted the intervention research approach. Both qualitative and quantitative methods were employed.

Introduction: Postpartum women living with HIV (WLWHIV) on antiretroviral therapy (ART) are at high risk of viraemia. We examined the association between unintended pregnancy and HIV viral load (VL) at 24 months postpartum in Cape Town, South Africa. Methods: Data are from a randomised trial that compared different ART delivery modalities for postpartum women aged at least 18 years who had initiated ART during their most recent pregnancy, had a VL<400 copies/ml in the previous three months, and had no comorbidities necessitating regular clinical follow-up. Pregnancy intentions regarding the most recent pregnancy were self-reported at enrolment into the study. VL was measured at 24 months postpartum, with elevated VL defined as VL≥1000 copies/ml. Chi-squared tests and logistic regression were used to examine predictors of unintended pregnancy. The impact of unintended pregnancy on elevated VL was examined using Poisson regression models. Results: Among 411 women included in the analysis (mean age: 28.7 years, 42% married/cohabiting, 75% with a parity≥2, and 86% with a VL<50 copies/ml), 57% reported that their most recent pregnancy was unintended. Compared to women aged 18-24 years, older women had a lower relative odds of unintended pregnancy [25-28 years, adjusted odds ratio (AOR): 0.34; 95% confidence interval (CI): 0.17-0.70; 29-34 years, AOR: 0.18; CI: 0.08-0.37; and ≥35 years, AOR: 0.35; CI: 0.14-0.89]. Additionally, unintended pregnancy was associated with being unmarried/not cohabiting (AOR: 4.44; CI: 2.78-7.09) and with higher parity (compared to parity=1: parity=2, AOR: 3.47; 95% CI: 1.86-6.50; and parity≥3, AOR: 6.38; 95% CI: 3.06-13.28). VL data at 24 months postpartum were available for 89% (366/411) of participants of whom 24% had elevated VL≥1000 copies/ml. Unintended pregnancy was associated with elevated VL in unadjusted analyses [risk ratio (RR): 1.54; CI: 1.03-2.28; p=0.032]. After adjustment for maternal factors and trial allocation, the association persisted despite not reaching statistical significance (adjusted risk ratio (aRR): 1.36; CI: 0.88-2.08; p=0.158). Conclusion: Among postpartum WLWHIV in South Africa, unintended pregnancy is prevalent and could be a risk factor for elevated VL. Reproductive health counselling and support during routine care visits may reduce unintended pregnancies and its effects.

Over 60% of those living with HIV/AIDS are women, the majority of them in their sexual and reproductive years (UNAIDS, 2006). With antiretroviral (ARV) drugs, most of them are living longer and healthier to engage in sexual and reproductive activities (WHO, 2006). This study explored the sexual and reproductive decisions and experiences of women living with HIV/AIDS (WLWHA) in Abuja, Nigeria. Only those who became pregnant and had a child after being diagnosed with HIV participated in the study. The study was an interview based qualitative research. The design of the interview guide was informed by the PEN-3 Model (Airhihenbuwa, 1995). A combination of purposive and snowball sampling technique was used to select 17 WLWHA aged between 26 and 41. Most of them had limited education, only the 3 of them with post secondary education had professional jobs; the rest are either housewives or petty traders. Most of the women had reduced sexual desire but felt compelled to acquiesce to their husband’s sexual demands out of cultural and religious sense of duty, fear that he would have sex outside marriage and/or beat them. While a few used condoms, most either did not use condom or used it inconsistently. Condoms were used mainly to prevent re-infection with another strain of HIV or to prevent infecting a negative partner. Reason for non use of condom includes reduced sexual pleasure with condoms, belief that condoms are used not for wives and that being on ARV precludes the need to use condom. Often, condom negotiation leads to violence. Most of the women still wanted more children and did not use contraceptives. Among the few who used contraceptives, condoms, hormone injections, intrauterine device (IUD) and tubal ligation are their methods of choice. The women chose to have babies to secure their marriage, fulfill maternal instinct and to “leave something behind”. Their decisions were informed by the belief that ARV would keep them alive, while Prevention of Mother to Child Transmission (PMCTC) programs would prevent infection to their babies. To conceive, they had unprotected sex during ovulation. Two serodiscordant couples used syringes to inseminate. Most of them had experienced obstetric challenges including infertility, miscarriages, preterm births, and infant deaths. Most of the women bottle-fed to prevent infecting their babies, however they were under tremendous pressure to breastfeed due to the cultural value attached to breastfeeding. Women living with HIV/AIDS in Abuja Nigeria, had unmet sexual and reproductive health needs. Their sexual and reproductive decisions were influenced by their individual circumstances, including their level of education, poverty, cultural and family influences, partner’s HIV status, stigma and discrimination, and access to PMTCT and ARV programs. To meet the sexual and reproductive health needs of WLWHA, program planners and policy makers should take these factors into consideration and ensure that programs are comprehensive and integrated.

A dissertação inscreve-se nos campos dos Estudos de Gênero e dos Estudos Culturais pós-estruturalistas, em interface com a Saúde Coletiva. Nela, problematizo a feminização do HIV/aids no Rio Grande do Sul, tomando como foco o enfrentamento da doença em mulheres grávidas, e considerando o que está disposto nos textos normativos do Plano Integrado de Enfrentamento da Feminização da Epidemia de Aids e outras DST (BRASIL, 2009), da Linha de Cuidado para PVHA e outras DST do Estado do Rio Grande do Sul (2014a) e em alguns de seus desdobramentos. Os documentos foram examinados na perspectiva da análise cultural; para realizá-la, construí um jeito de olhar e de fazer, operando com alguns conceitos como ferramentas analíticas, entre eles: gênero, cultura, linguagem, educação, além de uma redefinição do termo vigilância epidemiológica. Por meio da realização de um exercício intensivo de multiplicação de sentidos dos termos centrais que nomeiam os dois principais documentos – cuidado e enfrentamento –, construí duas unidades analíticas: mulheres, gravidez e cuidados; e a feminização do HIV/aids e seus enfrentamentos. Através da descrição e análise das posições de sujeito corpo grávido e mãe responsável, foi possível problematizar os modos como a feminização do HIV/aids tem sido pautada nos programas de enfrentamento, quando se trata de mulheres grávidas, destacando-se aí os investimentos das biopolíticas sobre os corpos e a vida das mulheres, que incidem nas formas de cuidar, de enfrentar e de ser mulher em tempos de HIV/aids. / This dissertation is inserted in the fields of Gender Studies and post-structuralist Cultural Studies, approaching Public Health. It address the feminization of HIV/AIDS in Rio Grande do Sul, especially how pregnant women cope with the disease, considering what is provided in the normative texts in the Integrated Plan to Combat the Feminization of AIDS Epidemic and other STDs (BRASIL, 2009), in the Care Guidelines for PLWHA and other STDs of Rio Grande do Sul (2014a) and in some of its consequences. The documents were analyzed from the perspective of cultural analysis, through the conception of a way of looking and doing, considering some concepts as analytical tools, including gender: culture, language, education, and a redefinition of the term epidemiological surveillance. By conducting an intensive exercise of multiplying the meanings of central terms that name the two main documents - care and combat -, two analytical units were established: women, pregnancy and care; and the feminization of HIV/AIDS and how to combat it. Through the description and analysis from the positions of the subjects pregnant body and responsible mother, it was possible to discuss the ways how the feminization of HIV/AIDS has been addressed in the prevention programs of HIV infection, when it comes to pregnant women, highlighting the investments in biopolitics concerning the bodies and lives of women, that focus on ways of protecting, coping with and being a woman in HIV/AIDS times.

A dissertação inscreve-se nos campos dos Estudos de Gênero e dos Estudos Culturais pós-estruturalistas, em interface com a Saúde Coletiva. Nela, problematizo a feminização do HIV/aids no Rio Grande do Sul, tomando como foco o enfrentamento da doença em mulheres grávidas, e considerando o que está disposto nos textos normativos do Plano Integrado de Enfrentamento da Feminização da Epidemia de Aids e outras DST (BRASIL, 2009), da Linha de Cuidado para PVHA e outras DST do Estado do Rio Grande do Sul (2014a) e em alguns de seus desdobramentos. Os documentos foram examinados na perspectiva da análise cultural; para realizá-la, construí um jeito de olhar e de fazer, operando com alguns conceitos como ferramentas analíticas, entre eles: gênero, cultura, linguagem, educação, além de uma redefinição do termo vigilância epidemiológica. Por meio da realização de um exercício intensivo de multiplicação de sentidos dos termos centrais que nomeiam os dois principais documentos – cuidado e enfrentamento –, construí duas unidades analíticas: mulheres, gravidez e cuidados; e a feminização do HIV/aids e seus enfrentamentos. Através da descrição e análise das posições de sujeito corpo grávido e mãe responsável, foi possível problematizar os modos como a feminização do HIV/aids tem sido pautada nos programas de enfrentamento, quando se trata de mulheres grávidas, destacando-se aí os investimentos das biopolíticas sobre os corpos e a vida das mulheres, que incidem nas formas de cuidar, de enfrentar e de ser mulher em tempos de HIV/aids. / This dissertation is inserted in the fields of Gender Studies and post-structuralist Cultural Studies, approaching Public Health. It address the feminization of HIV/AIDS in Rio Grande do Sul, especially how pregnant women cope with the disease, considering what is provided in the normative texts in the Integrated Plan to Combat the Feminization of AIDS Epidemic and other STDs (BRASIL, 2009), in the Care Guidelines for PLWHA and other STDs of Rio Grande do Sul (2014a) and in some of its consequences. The documents were analyzed from the perspective of cultural analysis, through the conception of a way of looking and doing, considering some concepts as analytical tools, including gender: culture, language, education, and a redefinition of the term epidemiological surveillance. By conducting an intensive exercise of multiplying the meanings of central terms that name the two main documents - care and combat -, two analytical units were established: women, pregnancy and care; and the feminization of HIV/AIDS and how to combat it. Through the description and analysis from the positions of the subjects pregnant body and responsible mother, it was possible to discuss the ways how the feminization of HIV/AIDS has been addressed in the prevention programs of HIV infection, when it comes to pregnant women, highlighting the investments in biopolitics concerning the bodies and lives of women, that focus on ways of protecting, coping with and being a woman in HIV/AIDS times.

A dissertação inscreve-se nos campos dos Estudos de Gênero e dos Estudos Culturais pós-estruturalistas, em interface com a Saúde Coletiva. Nela, problematizo a feminização do HIV/aids no Rio Grande do Sul, tomando como foco o enfrentamento da doença em mulheres grávidas, e considerando o que está disposto nos textos normativos do Plano Integrado de Enfrentamento da Feminização da Epidemia de Aids e outras DST (BRASIL, 2009), da Linha de Cuidado para PVHA e outras DST do Estado do Rio Grande do Sul (2014a) e em alguns de seus desdobramentos. Os documentos foram examinados na perspectiva da análise cultural; para realizá-la, construí um jeito de olhar e de fazer, operando com alguns conceitos como ferramentas analíticas, entre eles: gênero, cultura, linguagem, educação, além de uma redefinição do termo vigilância epidemiológica. Por meio da realização de um exercício intensivo de multiplicação de sentidos dos termos centrais que nomeiam os dois principais documentos – cuidado e enfrentamento –, construí duas unidades analíticas: mulheres, gravidez e cuidados; e a feminização do HIV/aids e seus enfrentamentos. Através da descrição e análise das posições de sujeito corpo grávido e mãe responsável, foi possível problematizar os modos como a feminização do HIV/aids tem sido pautada nos programas de enfrentamento, quando se trata de mulheres grávidas, destacando-se aí os investimentos das biopolíticas sobre os corpos e a vida das mulheres, que incidem nas formas de cuidar, de enfrentar e de ser mulher em tempos de HIV/aids. / This dissertation is inserted in the fields of Gender Studies and post-structuralist Cultural Studies, approaching Public Health. It address the feminization of HIV/AIDS in Rio Grande do Sul, especially how pregnant women cope with the disease, considering what is provided in the normative texts in the Integrated Plan to Combat the Feminization of AIDS Epidemic and other STDs (BRASIL, 2009), in the Care Guidelines for PLWHA and other STDs of Rio Grande do Sul (2014a) and in some of its consequences. The documents were analyzed from the perspective of cultural analysis, through the conception of a way of looking and doing, considering some concepts as analytical tools, including gender: culture, language, education, and a redefinition of the term epidemiological surveillance. By conducting an intensive exercise of multiplying the meanings of central terms that name the two main documents - care and combat -, two analytical units were established: women, pregnancy and care; and the feminization of HIV/AIDS and how to combat it. Through the description and analysis from the positions of the subjects pregnant body and responsible mother, it was possible to discuss the ways how the feminization of HIV/AIDS has been addressed in the prevention programs of HIV infection, when it comes to pregnant women, highlighting the investments in biopolitics concerning the bodies and lives of women, that focus on ways of protecting, coping with and being a woman in HIV/AIDS times.

This qualitative study aimed to explore and describe the experiences of women living with HIV and Aids in Centurion, Gauteng Province. The study was conducted at Lyttleton clinic and 12 women living with HIV and Aids were selected for the study using a non-probability, purposive sampling technique. In-depth, individual semi-structured interviews were used during data collection. A thematic content approach in data analysis yielded the following main themes: experience of being diagnosed HIV positive, disclosure of an HIV positive status, physical signs and symptoms of HIV and Aids, stigma/ emotional stress well experiences in services rendered. The study highlighted the need for a well-established health system, assisting women living with HIV and Aids on how to cope and to raise awareness on HIV and Aids. / Health Studies / M. A. (Public Health)

A qualitative study was undertaken in Pietermaritzburg to unveil the experiences and challenges of WLWHIV as perceived by social workers as well as to explore and describe the experiences of social workers in rendering services to these women. Explorative, descriptive and contextual research designs were employed for the research process. Purposive and snowball sampling techniques were utilised to recruit participants who met the set criteria. Face-to-face semi-structured interviews were conducted with thirteen participants. Data obtained were transcribed and analysed applying Tesch‘s eight steps (Creswell, 2009). Data verification was guided by Guba‘s model (Krefting, 1991). The findings revealed the existence of strained relationships between WLWHIV and their partners and ineffective delivery of social work services to WLWHIV. Based on the findings, it is recommended that specialised training for social workers on issues related to death and dying and services for children of WLWHIV be incorporated in the guidelines for social work practice / Social Work / M.A. (social Work)