Missed opportunities for human immunodeficiency virus prevention of mother-to-child transmission: A case study in southern India
Résumé
In India, human immunodeficiency virus (HIV) prevention of mother-to-child transmission (PMTCT) programmes are available at tertiary hospital level and numerous women, particularly when living in remote areas, do not have access to those services. Others, living in cities, are not receiving correct information about PMTCT, or are not able to follow the entire protocol required by caregivers. For various reasons some women are lost to follow-up. The aim of this paper is to describe the various social factors that contribute to missed opportunities for PMTCT. The study is based on ethnographic research conducted in rural areas with women and in a public hospital where PMTCT and highly active antiretroviral therapy (HAART) programmes have been set up. In-depth interviews were conducted with women attending antenatal care, involved in PMTCT activities or receiving HAART treatment. Interviews were also held with health-care providers. Analysis of the factors for transmission shows the intricacy of various social factors that limit women's access to PMTCT. For example: the social categorization of patients conducted by health caregivers when deciding whom to test or not; economic factors that limit the possibility of women to follow the rules required by protocols; social factors that shape discrimination and stigma of HIV-infected people; and inadequacy of ethical norms edited by international health institutions that in some contexts are sometimes difficult to implement. Some factors relate to the poor living conditions of women in rural areas, others relate to relationships between pregnant women and the health system, mainly through their interactions with health workers. These data are relevant to identify missed opportunities for PMTCT regarding the integration of a continuum of surveillance and control of PMTCT. The paper will describe and analyse factors that enhance the continuum of care regarding PMTCT and identify factors that facilitate and hinder efforts to prevent and treat HIV-related diseases in mothers and children in India.