The Effects of HIV/AIDS Stigma on Use of Services by Pregnant Women in Kenya

Summary

Principal Investigator: Janet Turan
Affiliation: University of California
Country: USA
Abstract: My career goal is to conduct research that contributes to improvements in maternal health in low-resource settings through reduction of the adverse effects of HIV/AIDS on the physical and mental health of pregnant and childbearing women. For this K01 Award, I am proposing research and training on the role of HIV/AIDS stigma as a barrier to utilization of essential maternity and HIV services by pregnant women in Africa. This award will facilitate my transition from a background in maternal and reproductive health, to an independent investigator focusing on HIV/AIDS stigma and its effects on maternal health in Africa. My goals are to gain expertise in social science approaches to the study of stigma, advanced statistical methods for analyzing longitudinal and clustered data, the cultural context of HIV/AIDS in Africa, and intervention development. I propose to conduct a prospective study in Kenya using structured interviews and data from medical records, as well as a qualitative study using in-depth interviews. The aims are: 1) to identify the effects of anticipated stigma and perceived community stigma on acceptance of HIV testing among pregnant women who use ANC services, 2) to prospectively investigate the effects of anticipated stigma and perceived community stigma on pregnant women's subsequent use of ANC, delivery, and postpartum services, 3) to investigate whether stigma can shed light on the mechanisms through which ANC and HIV service integration may affect HIV-positive pregnant women's use of maternity and HIV services, and 4) to use qualitative research methods to elucidate the role of HIV/AIDS stigma as a barrier to health service use among women in the community who do not use facility-based maternity services. My research will be conducted in conjunction with a CDC-funded study to be carried out by the Kenya Medical Research Insititute-UCSF Collaborative Group and will take advantage of the resources of that larger study. The proposed program of training and research will prepare me to design and test an intervention for reducing HIV/AIDS stigma and discrimination experienced by pregnant women in Kenya. This research will contribute to public health efforts to improve the health of pregnant women in low-resource settings. HIV/AIDS stigma may constitute an important barrier to pregnant women's use of health services and efforts to understand and reduce HIV/AIDS stigma will have important implications for HIV prevention and treatment, as well as for maternal health and mortality.
Funding Period: 2007-08-11 - 2012-07-31
more information: NIH RePORT

Top Publications

  1. pmc HIV serostatus and disclosure: implications for infant feeding practice in rural south Nyanza, Kenya
    Maricianah A Onono
    Kenya Medical Research Institute KEMRI, Kisumu, Kenya
    BMC Public Health 14:390. 2014
  2. pmc Are there differences in the impact of partner violence on reproductive health between postpartum women and women who had an elective abortion?
    Vicenta Escriba-Aguir
    Centre for Public Health Research Inequality Health Area, Valencia, Spain
    J Urban Health 89:861-71. 2012
  3. pmc Factors associated with pregnant women's anticipations and experiences of HIV-related stigma in rural Kenya
    Yvette P Cuca
    Department of Social and Behavioral Sciences, University of California, San Francisco UCSF, San Francisco, CA, USA
    AIDS Care 24:1173-80. 2012
  4. pmc The role of HIV-related stigma in utilization of skilled childbirth services in rural Kenya: a prospective mixed-methods study
    Janet M Turan
    Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
    PLoS Med 9:e1001295. 2012
  5. pmc The study of HIV and antenatal care integration in pregnancy in Kenya: design, methods, and baseline results of a cluster-randomized controlled trial
    Janet M Turan
    Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
    PLoS ONE 7:e44181. 2012
  6. pmc How perceptions of HIV-related stigma affect decision-making regarding childbirth in rural Kenya
    José S Medema-Wijnveen
    University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
    PLoS ONE 7:e51492. 2012
  7. pmc Social context and drivers of intimate partner violence in rural Kenya: implications for the health of pregnant women
    Abigail M Hatcher
    School of Medicine, University of California, San Francisco, USA
    Cult Health Sex 15:404-19. 2013
  8. pmc Responses to and resources for intimate partner violence: qualitative findings from women, men, and service providers in rural Kenya
    Merab Odero
    Kenya Medical Research Institute, Nairobi, Kenya
    J Interpers Violence 29:783-805. 2014
  9. pmc Facilitating HIV status disclosure for pregnant women and partners in rural Kenya: a qualitative study
    Melonie M Walcott
    Department of Health Care Organization and Policy, University of Alabama at Birmingham, RPHB 330, 1530 3rd Ave S, Birmingham, AL 35294, USA
    BMC Public Health 13:1115. 2013
  10. pmc Patient satisfaction with integrated HIV and antenatal care services in rural Kenya
    Baotran N Vo
    Department of Family and Community Medicine, University of California, Davis, CA, USA
    AIDS Care 24:1442-7. 2012

Scientific Experts

  • P Romito
  • Lisa Rahangdale
  • Janet Turan
  • Elizabeth A Bukusi
  • Abigail M Hatcher
  • Maricianah Onono
  • Craig R Cohen
  • Merab Odero
  • Maricianah A Onono
  • Melonie M Walcott
  • José S Medema-Wijnveen
  • Yvette P Cuca
  • Vicenta Escriba-Aguir
  • Baotran N Vo
  • Lena E Winestone
  • M A Onono
  • Khaliah A Johnson
  • Mable Jerop
  • Chenoia Bryant
  • Zachary Kwena
  • Katie Schwartz
  • Janet Molzan Turan
  • Federica Scrimin
  • Elizabeth Bukusi
  • Sierra Washington
  • Rachel M Smith
  • Nicole C Schmidt
  • Daniel Kwaro
  • Suellen Miller
  • N Carraher
  • E A Bukusi
  • R C Cohen
  • Elsa Mengsteab
  • Mary Lake Polan
  • Dirk Jena
  • Letu Hailemariam

Detail Information

Publications21

  1. pmc HIV serostatus and disclosure: implications for infant feeding practice in rural south Nyanza, Kenya
    Maricianah A Onono
    Kenya Medical Research Institute KEMRI, Kisumu, Kenya
    BMC Public Health 14:390. 2014
    ..The aim of this study was to determine the effects of HIV/AIDS knowledge and other psychosocial factors on EBF practice among pregnant and postpartum women in rural Nyanza, Kenya, an area with a high prevalence of HIV...
  2. pmc Are there differences in the impact of partner violence on reproductive health between postpartum women and women who had an elective abortion?
    Vicenta Escriba-Aguir
    Centre for Public Health Research Inequality Health Area, Valencia, Spain
    J Urban Health 89:861-71. 2012
    ..This study reveals that IPV was associated with poor obstetrical history among both groups of women. But the associations of current IPV with previous EA and couple reproductive behaviours were stronger among PP women...
  3. pmc Factors associated with pregnant women's anticipations and experiences of HIV-related stigma in rural Kenya
    Yvette P Cuca
    Department of Social and Behavioral Sciences, University of California, San Francisco UCSF, San Francisco, CA, USA
    AIDS Care 24:1173-80. 2012
    ..Lack of women's empowerment, as well as depression, may be important risk factors for HIV-related stigma and discrimination...
  4. pmc The role of HIV-related stigma in utilization of skilled childbirth services in rural Kenya: a prospective mixed-methods study
    Janet M Turan
    Department of Health Care Organization and Policy, School of Public Health, University of Alabama at Birmingham, Birmingham, Alabama, USA
    PLoS Med 9:e1001295. 2012
    ....
  5. pmc The study of HIV and antenatal care integration in pregnancy in Kenya: design, methods, and baseline results of a cluster-randomized controlled trial
    Janet M Turan
    Department of Health Care Organization and Policy, University of Alabama at Birmingham, Birmingham, Alabama, United States of America
    PLoS ONE 7:e44181. 2012
    ..Integrating these services may result in better uptake of services, reduction of the time to treatment initiation, better adherence, and reduction of stigma...
  6. pmc How perceptions of HIV-related stigma affect decision-making regarding childbirth in rural Kenya
    José S Medema-Wijnveen
    University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands
    PLoS ONE 7:e51492. 2012
    ..We explored relationships between women's perceptions of HIV-related stigma and their attitudes and intentions regarding facility-based childbirth...
  7. pmc Social context and drivers of intimate partner violence in rural Kenya: implications for the health of pregnant women
    Abigail M Hatcher
    School of Medicine, University of California, San Francisco, USA
    Cult Health Sex 15:404-19. 2013
    ..These results resonate with global IPV research showing that factors beyond the individual - gender roles in intimate partnerships, family dynamics and community norms - shape high rates of violence...
  8. pmc Responses to and resources for intimate partner violence: qualitative findings from women, men, and service providers in rural Kenya
    Merab Odero
    Kenya Medical Research Institute, Nairobi, Kenya
    J Interpers Violence 29:783-805. 2014
    ..The results suggest that future IPV interventions should address community views around IPV and build upon locally available resources-including the health clinic-to address violence among women of childbearing age. ..
  9. pmc Facilitating HIV status disclosure for pregnant women and partners in rural Kenya: a qualitative study
    Melonie M Walcott
    Department of Health Care Organization and Policy, University of Alabama at Birmingham, RPHB 330, 1530 3rd Ave S, Birmingham, AL 35294, USA
    BMC Public Health 13:1115. 2013
    ..To lay the groundwork for developing an intervention, we conducted formative qualitative research to elicit feedback on three approaches for safe HIV disclosure for pregnant women and male partners in rural Kenya...
  10. pmc Patient satisfaction with integrated HIV and antenatal care services in rural Kenya
    Baotran N Vo
    Department of Family and Community Medicine, University of California, Davis, CA, USA
    AIDS Care 24:1442-7. 2012
    ..Full integration of HIV care into antenatal clinics can significantly increase overall satisfaction with care for HIV-infected women, with no significant decrease in satisfaction for HIV-uninfected women served in the same clinics...
  11. pmc Use of personal digital assistants for data collection in a multi-site AIDS stigma study in rural south Nyanza, Kenya
    M A Onono
    Family Aids Care and Education Services, Kenya Medical Research Institute, Kenya
    Afr Health Sci 11:464-73. 2011
    ..To describe the development, cost effectiveness and implementation of a PDA based electronic system to collect, verify and manage data from a multi-site study on HIV/AIDS stigma and pregnancy in a rural, resource-poor area...
  12. pmc The role of counseling for obstetric fistula patients: lessons learned from Eritrea
    Khaliah A Johnson
    Stanford University School of Medicine, Stanford, CA, USA
    Patient Educ Couns 80:262-5. 2010
    ..The goal of this study was to evaluate the first formal counseling program for obstetric fistula patients in Eritrea...
  13. pmc The relationships between physical violence, verbal abuse and women's psychological distress during the postpartum period
    Patrizia Romito
    Department of Psychology, University of Trieste, Trieste, Italy
    J Psychosom Obstet Gynaecol 30:115-21. 2009
    ..To analyse the relationship between violence in the post-partum period and mothers' psychological distress...
  14. pmc Acceptability and feasibility of integration of HIV care services into antenatal clinics in rural Kenya: a qualitative provider interview study
    Lena E Winestone
    Department of Pediatrics, Stanford University School of Medicine, Palo Alto, CA, USA
    Glob Public Health 7:149-63. 2012
    ..However, integration efforts need to take into account potential negative effects on ANC provider workload, disclosure and the quality of care...
  15. pmc Stigma as experienced by women accessing prevention of parent-to-child transmission of HIV services in Karnataka, India
    Lisa Rahangdale
    Department of Obstetrics and Gynecology, University of North Carolina, Chapel Hill, NC, USA
    AIDS Care 22:836-42. 2010
    ..Based on these formative data, PPTCT program planners should consider further research and interventions aimed at diminishing institutional and interpersonal HIV-associated stigma experienced by pregnant women...
  16. pmc HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS Study
    Janet M Turan
    Department of Obstetrics, Gynecology, and Reproductive Sciences and Center for AIDS Prevention Studies, University of California San Francisco, 50 Beale St, Suite 1200, San Francisco, CA 94105, USA
    AIDS Behav 15:1111-20. 2011
    ....
  17. pmc Positive effects of the non-pneumatic anti-shock garment on delays in accessing care for postpartum and postabortion hemorrhage in Egypt and Nigeria
    Janet Turan
    University of California San Francisco, San Francisco, CA 94105, USA
    J Womens Health (Larchmt) 20:91-8. 2011
    ....
  18. pmc Evaluation of a community intervention for promotion of safe motherhood in Eritrea
    Janet Molzan Turan
    Department of Obstetrics, Gynecology, and Reproductive Sciences, Bixby Center for Global Reproductive Health, University of California, San Francisco, 50 Beale St, Suite 1200, San Francisco, CA 94105, USA
    J Midwifery Womens Health 56:8-17. 2011
    ..The intervention aimed to increase women's birth preparedness, knowledge of birth danger signs, use of antenatal care services, and birth at a health care facility...
  19. pmc Violence in the lives of women in Italy who have an elective abortion
    Patrizia Romito
    Department of Psychology, University of Trieste, Trieste, Italy
    Womens Health Issues 19:335-43. 2009
    ..Many women who seek an elective abortion (EA) live in difficult personal and social circumstances, in which violence often has a central role, yet few studies have analyzed the relationships between violence and having an EA...
  20. pmc Violence and women's psychological distress after birth: an exploratory study in Italy
    Patrizia Romito
    Department of Psychology, University of Trieste, Via S Anastasio 12, Trieste, Italy
    Health Care Women Int 30:160-80. 2009
    ..74 for women experiencing violence. We believe that these results provide support for the important role of violence in postpartum maternal psychological distress...
  21. pmc Effects of HIV/AIDS on maternity care providers in Kenya
    Janet M Turan
    Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco, CA, USA
    J Obstet Gynecol Neonatal Nurs 37:588-95. 2008
    ..To explore the impact of HIV/AIDS on maternity care providers in labor and delivery in a high HIV-prevalence setting in sub-Saharan Africa...