Desgrées-du-Loû Annabel, Brou Hermann, Traore Annick Tijou, Djohan Gerard, Becquet Renaud, Leroy Valeriane
IRD, CEPED, UMR Université Paris Descartes-INED-IRD, 221 Boulevard Davout, 75020, Paris, France.
Soc Sci Med. 2009 Sep;69(6):892-9. doi: 10.1016/j.socscimed.2009.05.045. Epub 2009 Jun 22.
The first step in preventing mother-to-child HIV transmission (PMTCT) programmes is offering HIV counselling and testing to pregnant women. In developing countries where HIV testing remains rare, it represents a unique opportunity for many women to learn their HIV status. This prenatal HIV testing is not only the entry point to prevention of mother-to-child HIV transmission, but also an occasion for women to sensitize their male partner to sexual risks. Here we explore if these women, HIV-tested as mothers, apply the prevention recommendations they also receive as women. In the Ditrame Plus PMTCT program in Abidjan, Côte d'Ivoire, two cohorts of women (475 HIV-infected women and 400 HIV-negative women) were followed up two years after the pregnancy when they were offered prenatal HIV testing. In each cohort, we compared the proportion of women who communicated with their regular partner on sexual risks, prior to and after prenatal HIV testing. We analysed socio-demographic factors related to this communication. We measured two potential conjugal outcomes of women HIV testing: the level of condom use at sex resumption after delivery and the risk of union break-up. Prenatal HIV testing increased conjugal communication regarding sexual risks, whatever the woman's serostatus. This communication was less frequent for women in a polygamous union or not residing with their partner. Around 30% of women systematically used condoms at sex resumption. Among HIV infected ones, conjugal talk on sexual risks was related to improved condom use. After HIV testing, more HIV-infected women separated from their partners than HIV-uninfected women, despite very few negative reactions from the notified partners. In conclusion, offering prenatal HIV counselling and testing is an efficient tool for sensitizing women and their partners to HIV prevention. But sexual prevention in a conjugal context remains difficult and need to be specifically addressed.
预防母婴传播艾滋病（PMTCT）项目的第一步是为孕妇提供艾滋病咨询与检测。在艾滋病检测仍不常见的发展中国家，这为许多女性提供了了解自身艾滋病感染状况的独特机会。这种产前艾滋病检测不仅是预防母婴传播艾滋病的切入点，也是女性让其男性伴侣认识到性风险的契机。在此，我们探讨这些作为母亲接受艾滋病检测的女性是否会采纳她们作为女性所收到的预防建议。在科特迪瓦阿比让的迪特拉姆 Plus 预防母婴传播艾滋病项目中，两组女性（475 名感染艾滋病病毒的女性和 400 名未感染艾滋病病毒的女性）在接受产前艾滋病检测后的两年孕期中接受了随访。在每组中，我们比较了产前艾滋病检测前后就性风险与固定伴侣交流的女性比例。我们分析了与这种交流相关的社会人口学因素。我们衡量了女性艾滋病检测的两个潜在婚姻结果：产后恢复性生活时使用避孕套的情况以及婚姻关系破裂的风险。无论女性的血清学状态如何，产前艾滋病检测都增加了关于性风险的夫妻间交流。对于处于一夫多妻制婚姻或未与伴侣同住的女性，这种交流频率较低。约 30%的女性在恢复性生活时会持续使用避孕套。在感染艾滋病病毒的女性中，关于性风险的夫妻间谈话与更好地使用避孕套有关。艾滋病检测后，与未感染艾滋病病毒的女性相比，更多感染艾滋病病毒的女性与伴侣分开，尽管告知伴侣后很少有负面反应。总之，提供产前艾滋病咨询与检测是提高女性及其伴侣对艾滋病预防意识的有效工具。但在婚姻关系中的性预防仍然困难，需要专门加以解决。
