Factors Influencing Teen Mothers' Enrollment and Participation in Prevention of Mother-to-Child HIV Transmission Services in Limpopo Province,South Africa
Restricted accessResearch articleFirst published online June, 2008
Factors Influencing Teen Mothers' Enrollment and Participation in Prevention of Mother-to-Child HIV Transmission Services in Limpopo Province,South Africa
In this article, we examine barriers to HIV testing uptake and participation in prevention of mother-to-child HIV transmission (PMTCT) services among adolescent mothers aged 15 to 19 years in rural and urban Limpopo Province, South Africa. We used the narrative research method involving key informants constructing typical case studies of adolescent experiences with HIV testing and entry into PMTCT. Case studies formed the basis of a community-based questionnaire and focus group discussions with adolescent mothers. Client—counselor dynamics during pretest counseling were pivotal in determining uptake and participation, and counselor profile strongly influenced the nature of the interaction. Other factors found to influence adherence to PMTCT recommendations included HIV and early premarital pregnancy stigma, fear of a positive test result, and concerns over confidentiality and poor treatment by health care providers. Adolescents described elaborate strategies to avoid HIV disclosure to labor and delivery staff, despite knowing this would mean no antiretroviral therapy for their newborn infants. Theoretical, methodological, and programmatic implications of study findings are also discussed.
Bankole, A., Singh, S., & Woog, V. (2004). Risk and protection: Youth and HIV/AIDS in sub-Saharan Africa. New York: The Alan Guttmacher Institute.
2.
Bassett, M. (2002). Ensuring a public health impact of programs to reduce HIV transmission from mothers to infants: The place of voluntary counseling and testing. American Journal of Public Health, 92(3), 347-351.
3.
Cartoux, M., Meda, N., Van de Perre, P., Newell, M.L., De Vincenzi, I., & Dabis, F. (1998). Acceptability of voluntary HIV testing by pregnant women in developing countries: An international survey. AIDS , 12(2), 489-493.
4.
Chopra, M., Doherty, T., Jackson, D., & Ashworth, A. (2005). Preventing HIV transmission to children: Quality of counseling of mothers in South Africa. Acta Paediatrica , 94(3), 263-265.
5.
Dean, A.G., Dean, J.A., Coulombier, D., Brendel, K.A., Smith, D.C., Burton, A.H., et al. (1994). Epi info version 6.1: A word processing, database and statistics program for epidemiology on microcomputers. Atlanta: Centers for Disease Control and Prevention .
6.
De Paoli, M.M., Manongi, R., & Klepp, K.I. (2002). Counselors' perspectives on antenatal HIV testing and infant feeding dilemmas facing women with HIV in Northern Tanzania. Reproductive Health Matters, 10(20), 144-156.
7.
Department of Health. (1999). South Africa demographic and health survey 1998, full report. Pretoria, South Africa: Author.
8.
Department of Health. (2002). South Africa demographic and health survey 1998, full report. Pretoria, South Africa: Author.
9.
Department of Health. (2005). National HIV and syphilis antenatal sero-prevalence survey in South Africa, 2004. Pretoria, South Africa: Author .
10.
Department of Health. (2006). National HIV and Syphilis Antenatal Sero-Prevalence Survey in South Africa 2005. Pretoria, South Africa: Health Systems Research, Research Coordination and Epidemiology Directorate.
11.
Doherty, T., Besser, M., Donohue, S., Kamoga, N., Williamson, L., & Visser, R. (2003). An evaluation of prevention of mother to child HIV transmission (PMTCT) of HIV initiative in South Africa-Lessons and key recommendations. Durban, South Africa: Health Systems Trust.
12.
Doherty, T., McCoy, D., & Donohue, S. (2005). Health system constraints to optimal coverage of the prevention of mother-to-child HIV transmission programme in South Africa: Lessons from the implementation of the national pilot programme. African Health Sciences, 5(3), 213-218.
13.
Edwards, L.V. (2006). Perceived social support and HIV/AIDS medication adherence among AfricanAmerican women. Qualitative Health Research, 16, 679-691.
14.
Eide, M., Myhre, M., Lindbæk, M., Sundby, J., Arimi, P., & Ibou, T. (2006). Social consequences of HIV-positive women's participation in prevention of mother-to-child transmission programmes. Patient Education and Counseling, 60, 146-151.
15.
Family Health International. (2006). An assessment of services for adolescents in prevention of mother-to-child transmission programs (Youth Research Working Paper Series, No. 4.). Research Triangle Park, Arlington, VA: Author.
16.
Friedman, H.L. (1992). Changing patterns of adolescent sexual behavior: Consequences for health and development. Journal of Adolescent Health, 13, 345-350.
17.
Friedman, H.L. (1995). WHO's narrative research method: The study of young people's behaviour by young people themselves. Planned Parenthood Challenges, 1995(1), 46-48.
18.
Henry, R., & Carlson, L. (2005). Factors influencing women's uptake of PMTCT interventions in Georgetown, Guyana. Calverton, MD: ORC Macro.
19.
Horizons. (2001). HIV voluntary counseling and testing among youth ages 14 to 21: Results from an exploratory study in Nairobi, Kenya and Kampala and Masaka, Uganda. Washington, DC: International Center for Research on Women (ICRW)/ Population Council.
20.
Lemeshow, S., & Robinson, D. (1985). Surveys to measure programme coverage and impact: A review of the methodology used by the Expanded Programme on Immunization . World Health Statistics Quarterly, 38, 65-75.
21.
Manzi, M., Zachariah, R., Teck, R., Buhendwa, L., Kazima, J., Bakali, E., et al. (2005). High acceptability of voluntary counselling and HIV-testing but unacceptable loss to follow up in a prevention of mother-to-child HIV transmission programme in rural Malawi: Scaling-up requires a different way of acting. Tropical Medicine and International Health , 10(12), 1242-1250.
22.
McCoy, D., Besser, M., Visser, R., & Doherty, T. (2002, February). Interim findings on the national PMTCT pilot sites: Lessons and recommendations. Durban, South Africa: Health Systems Trust.
23.
McCoy, L. (2005). HIV-positive patients and the doctor-patient relationship: Perspectives from the margins. Qualitative Health Research , 15, 791-806.
24.
Meyers, T.M., Moultrie, H., Sherman, G.G., Cotton, M.F., & Eley, B. (2006). Management of HIV-infected children. In P. Ijumba & A. Padarath (Eds.), South African Health Review 2006 (pp. 235-256). Durban, South Africa: Health Systems Trust.
25.
Nyblade, L., & Field, M. (2000). Community involvement in prevention of mother-to-child transmission (MTCT) initiatives: Women, communities and the prevention of mother-to-child transmission of HIV: Issues and findings from community research in Botswana and Zambia. Washington, DC: The International Center for Research on Women.
26.
Perez, F., Mukotekwa, T., Miller, A., Orne-Gliemann, J., Glenshaw, M., Chitsike, I., et al. (2004). Implementing a rural programme of prevention of mother-to-child transmission of HIV in Zimbabwe: First 18 months of experience . Tropical Medicine and International Health, 9(7), 774-783.
27.
Pool, R., Nyanzi, S., & Whitworth, J.A.G. (2001). Attitudes to voluntary counselling and testing for HIV among pregnant women in rural southwest Uganda . AIDS Care, 13, 605-615.
28.
Qsr Nud*Ist. (1997). QSR NUD*IST 4 Software for Qualitative Data Analysis (2nd ed). Melbourne, Australia: Qualitative Solutions and Research Pty, Ltd.
29.
Ransom, J.E., Siler, B., Peters, R.M., & Maurer, M.J. (2003). Worry: Women's experience of HIV testing. Qualitative Health Journal, 15(3), 382-393.
30.
Reynolds, H.W., & Kimani, Y. (2006). Services for prevention of mother-to-child transmission . YouthNet Briefs, 12, 1-2.
31.
Rutenberg, N., Baek, C., Kalibala, S., & Rosen, J. (2003, August). Evaluation of United Nations-supported pilot projects for the prevention of mother-to-child transmission of HIV: Overview of findings (HIV/AIDS Working Paper). New York : UNICEF.
32.
Seidel, G., Sewpaul, V., & Dano, B. (2000). Experiences of breast-feeding and vulnerability among a group of HIV-positive women in Durban, South Africa. Health Policy and Planning15(1), 24-33.
33.
Statistics South Africa. (1999). Limpopo provincial profile: October household survey, report #00-91-09. Pretoria, South Africa: Author.
34.
Strauss, A., & Corbin, J. (1998). Basics of qualitative research: Techniques and procedures for developing grounded theory (2nd ed.) Thousand Oaks, CA: Sage.
35.
Temmerman, M., Ndinya-Achola, J., Ambani, J., & Piot, P. (1995). The right to know HIV-test results. Lancet, 345, 969-970.
36.
Urban, M., & Chersich, M. (2004). Acceptability and utilisation of voluntary HIV testing and nevirapine to reduce mother-to-child transmission of HIV-1 integrated into routine clinical care. South African Medical Journal , 94, 362-366.
37.
Varga, C.A. (2000). Condom dilemmas: Dynamics of protected sex in high risk groups in South Africa. In J. C. Caldwell et al. (Eds.), Towards the containment of the AIDS epidemic: social and behavioural research. Canberra, Australia: Health Transition Centre, National Centre for Epidemiology and Population Health.
38.
Varga, C.A. (2002). Pregnancy termination among South African adolescents . Studies in Family Planning, 33(4), 283-298.
39.
Varga, C.A. (2003). How gender roles influence sexual and reprodutive health among South African Adolescents. Studies in Family Planning, 34(3), 160-172.
40.
Varga, C.A., & Brookes, H. (2008a). Preventing mother-to-child HIV transmission among South African adolescents. Journal of Adolescent Research , 3(2), 172-205.
41.
Varga, C.A., & Brookes H. (2008b). Social and community factors in the prevention of mother to child HIV transmission. Manuscript submitted for publication.
42.
Varga, C.A., Sherman, G.G., & Jones, S.A. (2006). HIV-disclosure in the context of vertical transmission: HIV-positive mothers in Johannesburg, South Africa. AIDS CARE18(8), 952-960.
43.
World Health Organization. (1993). The narrative research method: Studying behavioural patterns of young people-By young people. WHO/ADH/93.4. Geneva: Author.
44.
Worthington, C., & Myers, T. (2003). Factors underlying anxiety in HIV testing: Risk perceptions, stigma, and the patient-provider power dynamic. Qualitative Health Research, 13, 636-655.
