Barcelona 2013
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| Abstract #463 - E-Posters English | ||||
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Session: 50.38: E-Posters English (Poster) on Sunday in Chaired by Authors: Presenting Author: Dr Blandine Bila - Centre National de recherche scientifique et technologique (CNRST), Burkina Faso |
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| Additional Authors: Dr. Jordi Casabona, Sra Cristina Sanclemente, Dra. Anna Esteve, Dra. Victoria Gonzalez, Grupo HIVITS TS, | ||||
| Aim: Within the EMTCT (Elimination of Mother-to-Child Transmission) policy, pregnant women are proposed HIV testing. If HIV-positive, PMTCT strategy is applied, and as part of post-test counselling some women are requested to disclose their HIV+ status to their partners.. The aim of this presentation is to confront the rationale of this intervention and its psychological and social effects on women, in order to discuss its relevance on the basis of evidence-based updated data. | ||||
| Method / Issue: The results of two studies on social aspects of PMTCT were gathered and underwent a specific analysis on the topic of PMTCT; these studies included: interviews with HIV-positive women about their experiences and relationships with health workers, with community counsellors for PMTCT and with key health workers in Senegal and Burkina Faso (PREMS/ANRS 12271); quantitative and qualitative data about disclosure to partner collected in a cohort study of PLWA in Senegal. | ||||
| Results / Comments: In both countries WHO and national strategies and guidelines strongly advise this intervention, based on three rationale: (1) disclosure to partner permits prevention of sexual transmission; (2) disclosure enable women to get support by partners particularly for applying prevention for HIV transmission to infant; (3) disclosure to partner gives men an opportunity to feel concerned by HIV testing, and to those HIV-positive to get early treatment. In 2013, reason (1) is no more relevant since EMTCT strategy, particularly B+ Option, provides ART to women. As for discordant couples taking TasP, their partners are then protected from HIV sexual transmission. Reason (2) is discussed by key informants who consider that expected psychological and social support is more easily obtained from PLWHA associations than from partners. Moreover some health workers consider that women do not get immediate support by partners and risk rejection. They do not reveal the women?s status to their partners for ethical reasons. Besides, other health workers insist on disclosure at every encounter with women, sometimes disclosing themselves to partners or co-spouses against the woman?s will. | ||||
| Discussion: Deleterious psychological and social effects on women of the pressure for early disclosure to partners have been documented. Concerned health workers consider that medical ethics does not allow them to disclose HIV-positive women?s status to their partners against their will, and that this act would jeopardize women?s care. Besides, they state that women should be supported and may disclose when they feel ready and when their social situation allows them to do so with reduced social risk. Laws that make disclosure compulsory in a short time span and health workers who apply this recommendation do not consider ethical dimensions and consequences for women. At the level of policies, exercising violence on women to help men access to HIV-test, rather than defining other opportunities for men to do their test, may be considered as a gender violence applied by the health system on HIV-positive women. | ||||
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