Elwell Kristan
a Department of Anthropology , Michigan State University , East Lansing , MI , USA.
AIDS Care. 2016 Aug;28(8):971-5. doi: 10.1080/09540121.2016.1153586. Epub 2016 Mar 17.
In Malawi, an innovative prevention of mother-to-child transmission (PMTCT) of HIV program, Option B+, has greatly expanded access to antiretroviral treatment at no cost to women and their exposed infants. However, many women continue to experience social, cultural, and structural barriers impeding their ability to consistently access medical treatment. Understanding these women's perspectives may make programs more responsive to patients' needs. This qualitative study sought to explore factors influencing women's adherence within PMTCT programs in southern Malawi. Participants were current PMTCT patients (the first cohort following national implementation of Option B+), healthcare providers, community leaders, and patients who had dropped out of the program ("defaulters"). Qualitative interviews and focus groups were conducted to investigate barriers and facilitators to continued participation within PMTCT programs. Data were analyzed using content analysis. Barriers identified included fears of HIV disclosure to husbands, community-based HIV/AIDS stigma, and poor interactions with some health workers. Facilitators included the improved survival of PMTCT patients in recent years and the desire to remain healthy to care for one's children. This research highlights important sociocultural factors affecting adherence within HIV/AIDS treatment programs in Malawi. Recommendations to improve access to medical care for PMTCT patients include integrated services to increase attention to confidentiality and minimize stigma, shared HIV testing and counseling for couples to minimize conflict in gender-unequal relationships, and peer-led support groups to provide social support from other women with the shared experience of an HIV-positive serostatus.
在马拉维，一项创新的预防母婴传播艾滋病毒（PMTCT）项目——“方案B+”，极大地扩大了妇女及其受感染婴儿免费获得抗逆转录病毒治疗的机会。然而，许多妇女仍然面临社会、文化和结构障碍，阻碍她们持续获得医疗治疗。了解这些妇女的观点可能会使项目更能满足患者的需求。这项定性研究旨在探讨影响马拉维南部PMTCT项目中妇女坚持治疗的因素。参与者包括现有的PMTCT患者（全国实施“方案B+”后的第一批队列）、医疗服务提供者、社区领袖以及退出该项目的患者（“违约者”）。通过定性访谈和焦点小组来调查继续参与PMTCT项目的障碍和促进因素。使用内容分析法对数据进行分析。确定的障碍包括担心向丈夫披露感染艾滋病毒的情况、基于社区的艾滋病毒/艾滋病污名化以及与一些医护人员的不良互动。促进因素包括近年来PMTCT患者存活率的提高以及为了照顾孩子而保持健康的愿望。这项研究突出了影响马拉维艾滋病毒/艾滋病治疗项目中坚持治疗的重要社会文化因素。改善PMTCT患者获得医疗服务的建议包括提供综合服务，以加强对保密性的关注并尽量减少污名化；为夫妻提供共享的艾滋病毒检测和咨询，以尽量减少性别不平等关系中的冲突；以及由同伴主导的支持小组，为其他有艾滋病毒阳性血清状态共同经历的妇女提供社会支持。
