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Faith, Courage, and Pray: Pregnant Women’s HIV/AIDS Experiences

Faith, Courage, and Pray: Pregnant Women’s HIV/AIDS Experiences. Purpose. This qualitative study described how knowledge, attitudes, beliefs, feelings, and abuse may influence decisions about participating in voluntary testing and counseling, treatment adherence; follow up

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Faith, Courage, and Pray: Pregnant Women’s HIV/AIDS Experiences

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  1. Faith, Courage, and Pray: Pregnant Women’s HIV/AIDS Experiences

  2. Purpose This qualitative study described how knowledge, attitudes, beliefs, feelings, and abuse may influence decisions about participating in voluntary testing and counseling, treatment adherence; follow up care, disclosing disease status to family and friends, and decisions related to parenting.

  3. Methods • In-depth interviews using open ended questions were used to ask about women’s: • Demographic characteristics • Pregnancy health history • Decision-making about HIV testing • Disclosure of test results • Behaviors and changes in their relationships related to test results and disclosure • Partner relationships

  4. Methods • The individual interviews: • Took 30-60 minutes • Were transcribed and analyzed informed by the descriptive phenomenological method (Koch, 1995; Lopez & Willis, 2004) to gain better insight into the experiences of the women • Were re-read multiple times to ensure methodological rigor and trustworthiness of data interpretation

  5. Results • Sample (N= 56) • 44 pregnant women • 12 parenting women • HIV/AIDS diagnosis at time of interview • 1 month to 9 years • Average was 2.5 years since diagnosis • 3 women acquired HIV through vertical transmission • 9 themes emerged from the interviews

  6. Themes • Women perceived themselves as vulnerable to get infected with HIV. • Decision to get tested was motivated by perceived benefits to the baby. • Decision to disclose their HIV status was determined by perceived risks. • Family members’ reactions to women disclosing their HIV status ranged from caring to being abusive. • Women’s behaviors included protecting themselves if they were HIV negative; and living healthy lifestyles and taking their medications if they were HIV positive to protect their baby and care for other children.

  7. Themes 6.Women musteredthe strength and took positive attitudes to deal with the devastation of HIV experiences. 7.Women felt that having babies was a way to be happy, have a sense of self-worth, and purpose. 8.Women were sexually assaulted at very young ages and subsequently got infected with HIV by their abuser. 9.Women found strength and resilience through HIV/AIDS experiences.

  8. Qualitative Analysis

  9. Qualitative Analysis

  10. Qualitative Analysis

  11. Limitations • Self report instruments were used, so women may have failed to divulge important information about their HIV status and abuse experiences • Convenience sampling limits external validity – women were already receiving health care and HIV testing was part of routine care • The sample size was small reducing, statistical power to find an effect, but the descriptive findings and summary statistics suggest that most women experienced lifetime abuse rather than abuse during pregnancy

  12. Conclusions • Perceived risks of disclosure, such as being ostracized and fear, prevented women from disclosing • Women infected with HIV were more willing to disclose if they had someone they trusted • Married women immediately disclosed their HIV status to their husbands. Results are similar with Peltzer & colleagues (2008), who found highest disclosure with partners (51.7%; n=116)

  13. Conclusions • Single women disclosed to a female relative – mother, aunt, or sister • Though abuse was not found to be significantly associated with HIV status, the percentage of lifetime abuse reported by the women is concerning and needs further investigation

  14. Conclusions • Women’s perception of benefits such as keeping their baby healthy motivated their decision to get tested. Same was found in other studies (Kirshenbaum & colleagues, 2004; Minnie & colleagues, 2008; Ransom, 2005) • When asked about their confidence in parenting, most women reported that taking their medications & caring for themselves will ensure that their baby stays healthy

  15. Conclusions • Of the 22 women who were HIV positive, only one (1) found out when she was pregnant and wanted to continue with the pregnancy. In contrast to a previous study (Suryavanshi & colleagues, 2008) • Women were knowledgeable about HIV transmission including vertical transmission; & preventive behaviors

  16. Implications • Need structured counseling & educational services to increase disclosure and subsequent HIV risk reduction behaviors • Need counseling related to decisions about pregnancy and plans for future pregnancies • Involve women who are interested in HIV & violence prevention initiatives

  17. Implications • Integrate HIV & violence prevention in school curricula • Implement the opt-out testing recommendation in mainstream health care in addition to prenatal clinics • Conduct a larger, experimental study using block design to ensure equal number of participants in each group and increase statistical power

  18. Acknowledgements We extend our heartfelt gratitude to the following for their contributions to this project: JHUSON • Mathew Hayat, PhD, Biostatistician • Amy Goh, RN, BSN, Research Assistant • Iye Kamara, RN, BSN, Research Assistant • Ayanna Johnson, RN, BSN, Research Assistant • Nadiyah Johnson, Academic Program Coordinator USVI • Tyra DeCastro, Administrative Assistant • Lorna Sutton, Program Administrator

  19. References • http://www.cdc.gov/hiv/topics/perinatal/1test2lives/about.htm. Retrieved July 22, 2009. • http://cdc.gov/hiv/topics/aa/index.htm. Retrieved July 11, 2009. • http://womenandaids.unaids.org/ Retrieved 2/16/06 • Kirshenbaum, S., Hirky, A., Correale, J., Johnson, M., et al., (2004). “Throwing the dice”: pregnancy decision- • making among HIV-positive women in four U.S. cities. Perspectives on Sexual and Reproductive Health, 36(3), 106 – 113. • Koch, T. (1995). Interpretive approaches in nursing research: the influence of Husserl and Heidegger. Journal of Advanced Nursing, 21, 827-836. • Lopez, K. A. & Willis, D. G. (2004). Descriptive versus interpretive phenomenology: their contributions to nursing knowledge. Qual.Health Res., 14, 726-735. • Minne, K., Klopper, H., & Walt, C. (2008). Factors contributing to the decision by pregnant women to be tested for HIV. Health Sa Gesondheid, 13(4) 50 – 65. • Peltzer, K., Chao, L., & Dana, P., (2008) Family planning among HIV positive and negative prevention of mother to child transmission (PMTCT) clients in a resource poor setting in South Africa. AIDS and Behavior. • Ransom, J., Siler, B., Peters, R. & Maurer, M. (2005). Worry: Women’s experience of HIV testing. Qualitative Health Research, 15(3), 382-393. • Suryavanshi, N., Erande, A., Pisal, H., Sastry, J., et al. (2008). Repeated pregnancy among women with known HIV status in Pune, India. AIDS Care, 20(9), 1111 – 1118.

  20. Contact Information • CERC - http://www.cercuvi.com/ • Phyllis Sharps – psharps@son.jhmi.edu • Veronica Njie-Carr – vnjie1@son.jhmi.edu • Doris Campbell – dwcampbe@aol.com

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