Fear of disclosure of HIV status as a cause of poor adherence in HIV positive pregnant women in a Caribbean Island
A. Quava- Jones, C. Bartholomew
Medical Research Centre, Port- of -Spain, Trinidad and Tobago
Background: This study was conducted during the years 2002-2009 to address adherence to antiretroviral drugs in HIV-positive pregnant women and the factors associated with non-adherence.
Methods: Adherence was assessed by self-report and rarely by pill counts. Between 2002 - 2006, HIV positive pregnant women with CD4 counts < 250 cells/mmᶟ were immediately started on HAART (combivir and nevirapine). Those with CD4 counts >250 cells/mmᶟ were treated with AZT mono-therapy from 36 weeks until delivery.
Results: Eight hundred and seventy-two (872) women were enrolled. They were mostly of the lower socio-economic classes. Eight hundred and nineteen (94%) reported perfect adherence during the short antepartum period and the desire to have an HIV negative baby was the main motivating factor. However in the postpartum period adherence rates were unsatisfactory in 662 (76%). The reason for poor adherence in 423 (64%) of mothers was a fear of disclosure of their HIV status to their sexual partners. Of these, 280 (66%) feared physical abuse from the fathers, 84 (20%) feared that the fathers would leave the relationship, and 50 (12%) feared the fathers would withdraw financial support of the mother and child. Of these women, 288 (68%) were single, 131 (31%) were in common-law unions and only 4 (1%) were married.
Conclusions: Four hundred and twenty-three (64%) mothers were secretive about their status and were non-adherent because of fear of disclosure of their infection to the fathers of the children. On the other hand, fear of giving birth to an HIV positive baby was the main motivating factor for adherence during the relatively short antepartum period. Only 4 (1%) of these mothers were married. The others were single or lived in common-law unions.
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