Abstract #201  -  Depression among pregnant women testing for HIV in rural South Africa, Implications for VTC
Authors:   Presenting Author:   Ms Tamsen Rochat - University of KwaZulu Natal
Additional Authors:  Prof Mark Tomlinson, Prof Marie Louise Newell, Prof  Alan Stein,
Aim: In Southern Africa, women of child bearing age often learn their HIV status during antenatal screening. Developing our understanding of what it means to learn ones HIV status during pregnancy in African contexts, where fertility and child bearing is highly valued, is critical to developing effective prevention and support programmes for pregnant woman. Little is known about women�s personal experiences after HIV testing during pregnancy and how they construct meaning and anticipate their relationship with their unborn infant. This study aimed to explore experiences after learning HIV status during pregnancy.
Method / Issue: A sample of 60 pregnant women (30 HIV positive; 30 HIV negative) was recruited during routine PMTCT screening (including rapid testing for HIV) in a rural area of Northern Kwa-Zulu Natal. Semi structured interviews took place 2-3 weeks after receiving HIV results. Interviews explored experiences, thoughts and worries about HIV status, disclosure, social support and pregnancy. Interviews were transcribed and translated, once thematic analysis was completed data was coded, counted and categorized using NVIVO 7.
Results / Comments: Preliminary analysis indicated that more than two thirds (20/30) of HIV positive women had not disclosed their HIV status to anyone post testing. Reasons for non disclosure included fear of familial/social rejection; concern about partnership conflict/dissolution and subsequent loss of economic or emotional support; fear of discrimination within health services and a desire to cope by remaining secretive. Avoiding perceived risks outweighed possibilities of gained support through disclosure. Worry and guilt regarding their unborn infant, possible vertical infection, illness, death and abandonment featured strongly, impeding joyful anticipation of the coming birth. Likewise less than half (14/30) HIV negatives had disclosed status and a quarter of the negative women reported feeling anxious and reticent about their HIV negative status, citing concerns over the window period. Many HIV negative women reported low autonomy to reduce HIV risk behaviours and facing distressing scenarios related to an unplanned pregnancy with similar concerns to HIV positive women regarding rejection and loss of support. Concerns tended to cloud optimism gained by learning ones HIV negative status.
Discussion: Women, HIV positive and negative, experienced significant stress as a result of unplanned pregnancies and HIV status, rather than HIV alone. Disclosure among all women was low, reasons for non disclosure pragmatic, and support was often perceived to be compromised by disclosure. Similar evidence elsewhere in Africa suggests that woman tend not to disclose during pregnancy, while disclosure increases in the post partum period. Unfortunately, this leaves women vulnerable and without support during pregnancy and the early post partum period, a time when support is critical to achieving maternal and child health outcomes. The focus on disclosure by health care professionals distracted from woman�s more pressing and stressful concerns, and limited creative problem solving. Interventions for at risk women require understanding the complexity of women�s lives, including their perceptions of what is helpful for them in terms of dealing with HIV, health care services and risk behaviours.
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