Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA.
Community and Youth Development Initiatives, Owerri, Imo State, Nigeria.
Soc Sci Med. 2018 Aug;211:234-242. doi: 10.1016/j.socscimed.2018.06.006. Epub 2018 Jun 19.
International recommendations related to the prevention of mother-to-child transmission (PMTCT) of HIV have evolved rapidly over time; recommendations have also varied contextually in line with local constraints and national policies. This study examines how young Africans made sense of mother-to-child transmission (MTCT) and PMTCT and related barriers and facilitators between 1997 and 2014 in the context of these complex and changing recommendations. It uses a distinctive data source: 1343 creative narratives submitted to HIV-themed scriptwriting competitions by young people aged 10-24 from 5 African countries (Senegal, Burkina Faso, Nigeria, Kenya, and Swaziland) between 1997 and 2014. The study triangulates between analysis of quantifiable characteristics of the narratives, thematic qualitative analysis, and narrative-based approaches. MTCT occurs in 8% of the narratives (108), while it is prevented in 5% (65). Narratives differ according to whether they depict MTCT or PMTCT (or, rarely, both), evolve over time, and show cross-national thematic variation. In the aggregate, representations shift in line with increased access to testing and antiretroviral medications, with PMTCT narratives becoming more frequent and MTCT narratives becoming more hopeful as diagnosis becomes the gateway to ART access. However, storylines of intergenerational tragedy in which MTCT is depicted as inevitable persist through 2014. Alongside cross-national differences in theme and tone, narratives from higher prevalence Swaziland and Kenya situate MTCT/PMTCT more centrally within descriptions of life with HIV. Findings illustrate the need to improve communication about PMTCT, reframing negative cultural narratives to reflect the full promise of developments of the past decade and a half.
国际上有关预防母婴传播（PMTCT）艾滋病毒的建议随着时间的推移迅速发展；这些建议也因当地限制和国家政策的不同而有所不同。本研究考察了年轻的非洲人如何理解母婴传播（MTCT）和 PMTCT 以及在这些复杂和不断变化的建议背景下相关的障碍和促进因素。它使用了一个独特的数据源：1997 年至 2014 年间，来自 5 个非洲国家（塞内加尔、布基纳法索、尼日利亚、肯尼亚和斯威士兰）的 10-24 岁的年轻人提交的 1343 篇以艾滋病毒为主题的剧本创作比赛的创意叙事。该研究在叙事的可量化特征、主题定性分析和基于叙事的方法之间进行了三角分析。8%的叙事中发生了 MTCT（108 例），而 5%的叙事中 MTCT 得到了预防（65 例）。叙事因是否描述 MTCT 或 PMTCT（或很少同时描述两者）而有所不同，随着时间的推移而演变，并表现出跨国家的主题差异。总体而言，随着检测和抗逆转录病毒药物的可及性增加，MTCT 越来越频繁，PMTCT 越来越有希望，因为诊断成为获得抗逆转录病毒治疗的途径，MTCT 的代表性逐渐发生变化。然而，2014 年仍有描绘 MTCT 不可避免的代际悲剧的故事情节。除了主题和基调的跨国差异外，来自高流行率的斯威士兰和肯尼亚的叙事将 MTCT/PMTCT 更集中地置于艾滋病毒生活的描述中。研究结果表明，需要改进有关 PMTCT 的沟通，重新构建负面的文化叙事，以反映过去十年半的发展所带来的全部希望。
