Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA.
PLoS Med. 2012;9(8):e1001295. doi: 10.1371/journal.pmed.1001295. Epub 2012 Aug 21.
Childbirth with a skilled attendant is crucial for preventing maternal mortality and is an important opportunity for prevention of mother-to-child transmission of HIV. The Maternity in Migori and AIDS Stigma Study (MAMAS Study) is a prospective mixed-methods investigation conducted in a high HIV prevalence area in rural Kenya, in which we examined the role of women's perceptions of HIV-related stigma during pregnancy in their subsequent utilization of maternity services.
From 2007-2009, 1,777 pregnant women with unknown HIV status completed an interviewer-administered questionnaire assessing their perceptions of HIV-related stigma before being offered HIV testing during their first antenatal care visit. After the visit, a sub-sample of women was selected for follow-up (all women who tested HIV-positive or were not tested for HIV, and a random sample of HIV-negative women, n = 598); 411 (69%) were located and completed another questionnaire postpartum. Additional qualitative in-depth interviews with community health workers, childbearing women, and family members (n = 48) aided our interpretation of the quantitative findings and highlighted ways in which HIV-related stigma may influence birth decisions. Qualitative data revealed that health facility birth is commonly viewed as most appropriate for women with pregnancy complications, such as HIV. Thus, women delivering at health facilities face the risk of being labeled as HIV-positive in the community. Our quantitative data revealed that women with higher perceptions of HIV-related stigma (specifically those who held negative attitudes about persons living with HIV) at baseline were subsequently less likely to deliver in a health facility with a skilled attendant, even after adjusting for other known predictors of health facility delivery (adjusted odds ratio = 0.44, 95% CI 0.22-0.88).
Our findings point to the urgent need for interventions to reduce HIV-related stigma, not only for improving quality of life among persons living with HIV, but also for better health outcomes among all childbearing women and their families.
有熟练接生员的分娩对预防产妇死亡至关重要，也是预防艾滋病毒母婴传播的重要机会。米戈里母婴与艾滋病耻辱研究（MAMAS 研究）是在肯尼亚农村一个艾滋病毒高流行地区进行的前瞻性混合方法研究，我们在该研究中研究了孕妇在怀孕期间对艾滋病毒相关耻辱感的看法如何影响其随后对产妇服务的利用。
在 2007-2009 年期间，1777 名艾滋病毒状况未知的孕妇在首次产前护理就诊期间接受艾滋病毒检测前完成了一份由访谈员管理的问卷，评估了她们对艾滋病毒相关耻辱感的看法。就诊后，选择了一组女性进行随访（所有艾滋病毒检测阳性或未进行艾滋病毒检测的女性，以及随机抽取的艾滋病毒阴性女性，n=598）；411 名（69%）在产后完成了另一份问卷。对社区卫生工作者、产妇和家庭成员（n=48）进行了额外的定性深入访谈，以帮助我们解释定量研究结果，并强调了艾滋病毒相关耻辱感可能影响分娩决策的方式。定性数据显示，在社区中，在医疗机构分娩通常被视为最适合有妊娠并发症（如艾滋病毒）的女性。因此，在医疗机构分娩的女性面临着被贴上艾滋病毒阳性标签的风险。我们的定量数据显示，在基线时对艾滋病毒相关耻辱感有更高看法（特别是对艾滋病毒感染者持有负面态度的女性）的女性随后更不可能在有熟练接生员的医疗机构分娩，即使在调整了其他已知的医疗机构分娩预测因素后（调整后的优势比=0.44，95%置信区间 0.22-0.88）。
我们的研究结果表明，迫切需要采取干预措施来减少艾滋病毒相关耻辱感，不仅是为了提高艾滋病毒感染者的生活质量，也是为了改善所有产妇及其家庭的健康结果。
