[procaare] Durban 2000: VCT - Attitudes among Pregnant Women in Uganda

[ProCAARE <procaare@usa.healthnet.org>]

Durban 2000: VCT Abstract (3)

'Attitudes to voluntary counselling and testing for HIV among pregnant women and maternity staff in
rural south west Uganda'
[TuPpB1159]

M. Gysels, R. Pool, S. Nyanzi
Uganda Virus Research Institute, PO Box 49, Entebbe, Uganda

Background:
Vertical transmission rates in Africa are 21-43%,  and most infants acquire HIV during the
peripartum period. A  recent trial of nevirapine in Uganda showed a reduced risk of  HIV
transmission of almost 50% during the first 14-16 weeks of  life. Although provision of nevirapine
to all pregnant women  may be potentially cost effective, ideally HIV positive pregnant  women
should be targeted in poor resource countries. This requires  voluntary counselling and testing
(VCT). The attitudes of women  and maternity staff to VCT are important to the success of such
interventions.

Methods:
24 focus group discussions (FGDs) were carried out with  208 women attending maternity clinics, 5
FGDs were held with  25 maternity staff, and in-depth interviews were held with 8  traditional birth
attendants and 26 women recognised by the community  as being knowledgeable about issues relating to
pregnancy in  3 sites in rural SW Uganda.

Results:
Almost all women were willing in principle to take an  HIV test in the event of pregnancy, and to
reveal their HIV status  to maternity staff. They were anxious, however, about confidentiality,  and
there was a widespread fear that maternity staff might refuse  to assist them when the time came to
deliver if their status  were known. This applied more to TBAs than to biomedical health  staff.
There were also rumours about medical staff intentionally  killing HIV positive patients in order to
stem the spread of  the epidemic. Maternity staff were adamant that they would treat  knowledge of a
patient's HIV status confidentially. Although  they claimed that they would treat HIV positive women
the same  as anyone else during delivery, they expressed much anxiety about  the possibility of
getting infected, especially due to lack of  proper clothing and gloves.

Conclusions:
Although VCT during pregnancy is acceptable in principle,  much will need to be done to ensure
confidentiality and allay  women's fears of stigmatisation and discrimination during delivery.
Maternity staff will also need to be trained and resources made  available for adequate protection.

Presenting author: M. Gysels, Uganda Virus Research  Institute, PO Box 49, Entebbe, Uganda, Tel.:
+256 41 320 042, Fax: +256 41 321  137, E-mail: mrc@starcom.co.ug

[We invite the authors of this abstract to share their views regarding testing in resource-poor
settings -Mod.]

 [*VCT = Voluntary Counselling and Testing]


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