Towle Megan, Lende Daniel H
Afr J AIDS Res. 2008 Jul;7(2):219-28. doi: 10.2989/AJAR.2008.7.2.7.524.
This paper examines the cultural and structural difficulties surrounding effective prevention of mother-to-child HIV transmission (PMTCT) in rural Lesotho. We argue for three strategies to improve PMTCT interventions: community-based research and outreach, addressing cultural and structural dynamics, and working with the relevant social groups that impact HIV prevention. These conclusions are based on interviews and participant observation conducted within the rural Mokhotlong district and capital city of Maseru, involving women and men of reproductive age, grandmothers serving as primary caretakers, HIV/AIDS programme staff, and medical professionals. Qualitative analysis focused on rural women's socio-medical experience with the four measures of PMTCT (educational outreach, voluntary counselling and testing, antiretroviral interventions, and safe infant feeding). Based on these results, we conclude that intervention models must move beyond a myopic biomedical 'best-practices' approach to address the social groups and contextual determinants impacting vertical HIV transmission. Given the complexities of effective PMTCT, our results show that it is necessary to consider the biomedical system, women and children, and the community as valuable partners in achieving positive health outcomes.
本文探讨了莱索托农村地区在有效预防母婴传播艾滋病毒（PMTCT）方面所面临的文化和结构难题。我们主张采取三种策略来改进预防母婴传播艾滋病毒的干预措施：基于社区的研究与宣传、应对文化和结构动态以及与影响艾滋病毒预防工作的相关社会群体合作。这些结论是基于在莱索托农村莫科托隆区和首都马塞卢进行的访谈及参与观察得出的，参与对象包括育龄男女、担任主要照料者的祖母、艾滋病毒/艾滋病项目工作人员以及医学专业人员。定性分析聚焦于农村妇女在预防母婴传播艾滋病毒的四项措施（教育宣传、自愿咨询检测、抗逆转录病毒干预措施以及安全婴儿喂养）方面的社会医疗经历。基于这些结果，我们得出结论，干预模式必须超越短视的生物医学“最佳实践”方法，以应对影响艾滋病毒垂直传播的社会群体和背景因素。鉴于有效预防母婴传播艾滋病毒的复杂性，我们的研究结果表明，有必要将生物医学系统、妇女和儿童以及社区视为实现积极健康成果的重要伙伴。
