WOMEN’S ATTITUDES TOWARD THEIR PARTNERS’ INVOLVEMENT IN ANTE- NATAL CARE SERVICES AND PREVENTION OF MOTHER – TO – CHILD TRANSMISSION OF HIV IN QUTHING DISTRICT by Oluwasola Afolabi Abiodun Assignment presented in partial fulfillment of the requirements for the degree of Master of Philosophy (HIV/AIDS Management) in the Faculty of Economics and Management Science at Stellenbosch University Supervisor: Dr Thozamile Qubuda April 2014 Stellenbosch University http://scholar.sun.ac.za DECLARATION By submitting this assignment electronically, I declare that the entirety of the work contained therein is my own, original work, that I am the sole owner of the copyright thereof (save to the extent explicitly otherwise stated), that reproduction and publication thereof by Stellenbosch University will not infringe any third party rights and that I have not previously in its entirety or in part submitted it for obtaining any qualification. February 2014 Copyright © 2014 Stellenbosch University All rights reserved ii Stellenbosch University http://scholar.sun.ac.za ABSTRACT BACKGROUND: HIV and AIDS remains a public health challenge in Sub-Saharan Africa even though the epidemic has stabilized worldwide. The key strategy to prevention and control of HIV remains voluntary counselling and testing. Mother-to child transmission accounts for over 95% of all paediatric HIV infections worldwide. It is estimated that, in Sub-Saharan Africa, 76% of pregnant women have at least one antenatal care. In Quthing district, mother to child transmission of HIV accounts for 36% of all paediatric HIV infections in 2010 while HIV prevalence of women of child bearing age stands at 26%. Consequently, antenatal care is an avenue through which the women can have HIV testing, and, if she is infected, will be provided with care so as to prevent transmission of HIV from the mother to the child (PMTCT). The ministry of health, Lesotho in collaboration with Non-governmental organization have advocated increase in the number of men tested for HIV through partner testing in antenatal care. Health care practitioners are often required to care and treat these women when they present for antenatal care. It is essential to determine their knowledge and risks of transmission of HIV and their attitudes towards their patient and their partner involvement in antenatal care and PMTCT. Recent survey has shown that African women may not be willing to accommodate their partner’s involvement in antenatal care due to cultural and traditional factors. METHODS: The study surveyed women to identify their attitudes and beliefs concerning antenatal care, partners’ involvement in antenatal care and testing, PMTCT and to identify the attitude of MCH staffs to male partner involvement in antenatal care. This study elicited data from 25 pregnant women and nursing mothers and 10 staffs of maternal and child health of Quthing district hospital. Two types of data were collected namely: self-administered questionnaire with 25 women and semi-structured interview with 10 staffs of MCH. RESULTS: What came out clearly is that women viewed antenatal care as important to having good pregnancy result and they see it as an avenue to get tested. Majority of the women (68%) were in support of their partners’ involvement in antenatal care. The staffs of MCH were in total support of this. Cultural factors and gender based beliefs were found to be hindering male iii Stellenbosch University http://scholar.sun.ac.za involvement in PMTCT programme and getting tested for HIV. The results also show that the staffs of MCH have positive attitudes towards people living with HIV. DISCUSSIONS: Although, pregnancy has traditionally been viewed as a woman's affair, a good number of women expressed the desire to get their partners’ involved in antenatal care, including HIV counselling and testing. Majority of the women see antenatal care as a way to having a successful pregnancy and have identified male involvement down to individual beliefs. The researcher suggests improvement in antenatal care services and provision of a comprehensive approach to community mobilization of men. Further, ministry of health could assist in improving the knowledge of health professionals on HIV and AIDS related matters through the implementation of continuous professional development courses. iv Stellenbosch University http://scholar.sun.ac.za OPSOMMING AGTERGROND: MIV en vigs is steeds ʼn uitdaging vir openbare gesondheid in Afrika suid van die Sahara, hoewel die epidemie wêreldwyd bestendig het. Die vernaamste strategie vir die voorkoming en beheer van MIV bly vrywillige berading en toetsing. Moeder-na-kind-oordrag verteenwoordig meer as 95% van alle gevalle van pediatriese MIV-infeksie wêreldwyd. Na beraming kry 76% van swanger vroue in Afrika suid van die Sahara minstens een keer voorgeboortelike sorg. In die Quthing-distrik van Lesotho het MIV-oordrag van moeder na kind 36% van alle gevalle van pediatriese MIV-infeksie in 2010 verteenwoordig, terwyl MIV onder 26% van vroue in hulle vrugbare jare voorkom. Gevolglik is voorgeboortelike sorg ʼn kanaal waardeur vroue vir MIV getoets kan word en, indien hulle geïnfekteer is, VMKO-behandeling kan ontvang (wat voorkom dat MIV van moeder na kind oorgedra word). Lesotho se minister van gesondheid, in samewerking met nieregeringsorganisasies, staan dit voor dat meer mans vir MIV getoets word deur die betrokke man ook tydens voorgeboortesorg te toets. Gesondheidspraktisyns moet dikwels vroue behandel wat vir voorgeboortesorg aanmeld. Dit is noodsaaklik om vas te stel wat sulke werkers weet van MIV-oordrag en hulle risiko van infektering, en wat hulle ingesteldheid is teenoor hulle pasiënte en die betrokkenheid van pasiënte se maats by voorgeboortesorg en VMKO. ʼn Onlangse opname het getoon dat swart vroue in Afrika weens kulturele en tradisionele faktore onwillig mag wees dat hulle maat by voorgeboortesorg betrokke raak. METODES: Die opname is onder vroue gedoen om te bepaal wat hulle ingesteldheid en oortuigings is rakende voorgeboortesorg, ʼn maat se betrokkenheid by voorgeboortesorg en toetsing, en VMKO; die opname wou ook bepaal wat MKG-personeel se ingesteldheid is teenoor manlike maats se betrokkenheid by voorgeboortesorg. In hierdie studie is data ingesamel van 25 swanger vroue en moeders wat borsvoed, en van 10 personeellede in die moeder-en-kind- gesondheid-afdeling van die Quthing-distrikshospitaal. Twee soorte data is verkry: ʼn selfdoenvraelys van die 25 vroue en semi-gestruktureerde onderhoude met die 10 MKG- personeellede. v Stellenbosch University http://scholar.sun.ac.za BEVINDINGS: Die navorsing het bevind dat vroue reken voorgeboortesorg is belangrik vir ʼn voorspoedige swangerskap, en hulle beskou dit as ʼn manier om getoets te word. Die meeste vroue (68%) was ten gunste daarvan dat hulle maats by voorgeboortesorg betrokke moet wees. Alle MKG-personeellede was ten gunste daarvan. Daar is bevind dat kulturele faktore en oortuigings wat op gender gegrond is mans verhinder om by die VMKO-program in te skakel en hulle vir MIV te laat toets. Die bevindings toon ook dat MKG-personeel positief ingestel is teenoor mense wat met MIV leef. GEVOLGTREKKINGS: Hoewel swangerskap tradisioneel as vrouesake beskou is, het heelwat vroue gesê dat hulle graag wil hê hulle maats moet by voorgeboortesorg betrokke wees, en ook MIV-berading en -toetsing ontvang. Die meeste vroue beskou voorgeboortesorg as ʼn manier om ʼn suksesvolle swangerskap te hê, en verbind die betrokkenheid van manlike maats met persoonlike oortuigings. Die navorser beveel aan dat voorgeboortesorgdienste verbeter word en dat ʼn omvattende benadering gevestig word om die mans in die gemeenskap te betrek. Verder sou die minister van gesondheid ook kon help om gesondheidswerkers se kennis van MIV- en vigsverwante sake te verbeter deur kursusse vir voortgesette professionele ontwikkeling in te stel. vi Stellenbosch University http://scholar.sun.ac.za TABLE OF ABBREVIATION AND ACRONYMS The abbreviations, acronyms and terms, are used throughout the dissertation. They are listed here for reference and clarity. ART - Antiretroviral treatment clinic ARVs - Antiretroviral CPDS – Continuous professional development seminars HIV – Human immune deficiency virus EGPAF – Elizabeth Glazer paediatric AIDS foundation ICAP – International centre for AIDS care and treatment MCH – Maternal and child health MTCT – Maternal to child transmission NGOs – Nongovernmental organizations PMTCT – Prevention of mother to child transmission STIs – Sexually transmitted infections TB – Tuberculosis UNAIDS – The joint United Nations programme on HIV and AIDS vii Stellenbosch University http://scholar.sun.ac.za DEFINITION OF TERMS HIV (Human Immuno-deficiency Virus) is the virus that destroys the immune system and renders the person susceptible to infections (Whiteside & Sunter, 2000). AIDS (Acquired Immunodeficiency Syndrome) is “the presence of a reliably diagnosed “opportunistic” disease and of the underlying defect in cell mediated immunity in the absence of known causes of immune defects such as immunosuppressive therapy or malignancies” (Onin, 2002). Knowledge “is the ability to acquire, retain and use information; a mixture of comprehension, experience, discernment and skill” (Badran, 1995). Attitude refers to inclinations to react in a certain way to certain situations, to see and interpret events according to certain predispositions or to organize opinions into coherent and interrelated structures (Badran, 1995). The risk factor is the harm that is caused by some particular danger or threat. These factors exist before a problem arises or continue over time. A community or the general environment can contribute towards the problem (Skolbekken, 1995). PMTCT refers to the prevention of mother to child transmission of HIV during pregnancy, at birth and throughout the developmental milestone of the child viii Stellenbosch University http://scholar.sun.ac.za TABLE OF CONTENTS CANDIDATE'S DECLARATION………………………………………………………………ii ABSTRACT………………………………………………………………………...……………iii OPSOMMING……………………………………………………………………………………v TABLE OF ABBREVIATION AND ACRONYMS……………………………………………vii DEFINITION OF TERMS……………………………………………………………………...viii Chapter 1…………………….…………………………………………………………………..1 1.1 Introduction……………………………………………………………………..…………….….1 1.2 Problem statement………………………………………………………………………….….…3 1.3 Research question…………………………………………………………………………….….3 1.4 Significance of the study………………………………………………………………….……..4 1.5 Aims and objectives…………………………………………………………………….……….4 1.6 Definition of terms………………………………………………………………………….…..5 1.7 Research design and methodology…………………………………………………..…..….…..6 1.8 Structure of the study……………………………………………………………….….….……7 Chapter 2: Critical literature review 2.1 Introduction……………………………………………………………………………..…9 2.2 Overview…………………………………………………………………………….…..…9 2.3 Conceptual framework…………………………………………………………………....10 2.4 Antenatal care and prevention of Mother to Child Transmission of HIV………………..11 2.5 Voluntary testing and counselling………………………………………………………...11 2.6 Prevention of Mother to Child Transmission of HIV Interventions………………..….…12 2.7 Barriers to male partner involvement in PMTCT………………………….……….…….13 2.8 Facilitator of male involvement………………………………………………….…..…...14 2.9 Health care workers knowledge of HIV/AIDS…………………………….………..…...16 2.10 Health care workers attitudes towards HIV/AIDS patients………………………..…...18 ix Stellenbosch University http://scholar.sun.ac.za 2.11 Conclusion…………………………………………………………………..………..21 Chapter 3: Research methodology……………………………………………………….22 3.1 Introduction………………………………………………………...…………………22 3.2 Research design…………………………………………….………..………………..22 3.3 Sampling……………………………………………………………………………….22 3.4 Qualitative and quantitative research…………………………………..……………..25 3.5 Data collection…………………………………………………………..…………….25 3.6 Pilot study………………………………………………………….…………………26 3.7 Reliability and validity………………. …………………………….……………...27 3.8 Data analysis…………………………………………………………….……………28 3.9 Ethical consideration…………………………………………………………………28 Chapter 4: Data analysis and findings 4.1 Introduction………………………………………………………………..…..…....29 4.2 Analysis of data from questionnaires 4.3 Discussion 4.4 Analysis of data from Interviews……………………………………………………..42 4.5 Treatment…………………………………………………………….………….……51 4.6 Self-assessment Knowledge………………………………………………….………52 4.7 Respondent’s fear and risk of infection………………………………………...……54 4.8. Source of information……………………………………………………….………56 4.9 Discussion…………………………………………………………………………….57 Chapter 5: Conclusion and recommendations……………………………………………62 5.1 Conclusions………………………………………………………………….………...62 5.2 Recommendations……………………………………………………………………..63 5.3 Areas for further research……………………………………………………………..64 5.4 Limitations of the study……………………………………………………….……….64 x