LANGUAGE, VIOLENCE AND STIGMA: BARRIERS TO CARE FOR HIV-POSITIVE PREGNANT WOMEN IN THE DOMENICAN REPUBLIC
Tesi di Dottorato
Data di Pubblicazione:
2014
Citazione:
LANGUAGE, VIOLENCE AND STIGMA: BARRIERS TO CARE FOR HIV-POSITIVE PREGNANT WOMEN IN THE DOMENICAN REPUBLIC / A. Staffa ; supervisor: A. Damonte. Università degli Studi di Milano, 2014 Oct 03. 26. ciclo, Anno Accademico 2013. [10.13130/staffa-annalisa_phd2014-10-03].
Abstract:
The Regional Initiative for the Elimination of Mother-to-Child Transmission of HIV goal is to reduce the prevalence of HIV in the newborn population respectively to 2% by the year 2015. This Initiative is promoted by the World Health Organization (WHO) and the United Nations Children's Fund (UNICEF). Governments from low and middle income countries have adopted and adapted the international directives of the Initiative to their national context in order to respond to international commitments, including the achievement of the Millennium Development Goals (MDGs) 5 and 6, related to maternal health and preventable diseases and infections, respectively.
Even though bio-medical innovations, mainly Anti Retroviral Drugs, and well-known best practices in public health implementation have made it feasible to prevent most of the Mother to Child transmission, approximately 2.5 million children worldwide are currently living with HIV and every day 1000 children are born with HIV (Marcos et al., 2012; UNAIDS, 2010).
In the Dominican Republic (DR), regardless a 98% coverage of antenatal services and institutional birth with skilled staff (MSP and UNICEF, 2011), there are lingering shortcomings that result in high maternal mortality and child mortality rates (150 per 100,000 and 36 per thousand, respectively) (UNICEF et al., 2013). If skilled attendance on birth is “the single most important factor in reducing maternal mortality” (WHO, 1999), how could anyone reconcile Dominican Republic’s quasi-universal skilled attendance with a maternal mortality rate that almost doubles the Latin American average? The answer to this paradox, according to UNDP, is the low quality and inequality of health care services (2010).
These systemic and institutional weaknesses also affect the Program for the Prevention of Mother to Child Transmission -PMTCT- where the current transmission rate has been estimated in 6% and the rate of full screening for HIV in pregnant women is only 19% (UNICEF, 2012). Consequently, the implementation of the PMTCT in Dominican Republic faces various challenges that range from the disempowerment and vulnerability of the target population (HIV positive pregnant women) to the weak incorporation of the initiative into mainstream prenatal care in order to avoid parallel programs (MSP and UNICEF, 2011).
Prevention of transmission from a HIV positive mother to her child requires the completion of a series of consecutive and necessary steps in a continuum of care, also known as the PMTCT cascade (Towle 2009, Marcos et al., 2012). One of the main problems identified in Low and Middle Income Countries (LMICs) is the poor retention and low adherence along this cascade. This phenomenon also called loss to follow-up (LFU) “has been recognized as a major hurdle by PMTCT programs in resource poor settings” (Panditrao et al., 2011). It affects 40% of women enrolled in India, up to 81% in Malawi, 84% in Cote d’Ivoire and more than 70% in South Africa and Zimbawe (Panditrao et al., 2011; Manzi et al., 2005; Painter et al., 2004).
Given such high rates of non-adherence to the PMTCT Cascade, the effectiveness of these programs is eroded “not only because the objective of reducing pediatric HIV transmissions is compromised but also because of the missed opportunity to link HIV-infected women and their partners to further care and support activities”. (Panditrao et al., 2011). This programmatic failure is compounded by the lack of information and academic literature about the institutional or social mechanisms that trigger a higher or lower adherence level and the risk-factors that influence drop-out in PMTCT (Towle, 2009; Panditrao et al., 2011).
According to Horne “nonadherence is often a hidden problem: undisclosed by pa
Tipologia IRIS:
Tesi di dottorato
Keywords:
Public Policies, HIV, LMICs, HIV, barriers, facilitators, adherence, PMTCT
Elenco autori:
A. Staffa
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