The Effects of HIV/AIDS Stigma on Use of Services by Pregnant Women in Kenya
Principal Investigator: Janet Turan
Affiliation: University of California
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
- HIV serostatus and disclosure: implications for infant feeding practice in rural south Nyanza, KenyaMaricianah 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...
- 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...
- Factors associated with pregnant women's anticipations and experiences of HIV-related stigma in rural KenyaYvette 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...
- The role of HIV-related stigma in utilization of skilled childbirth services in rural Kenya: a prospective mixed-methods studyJanet 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....
- The study of HIV and antenatal care integration in pregnancy in Kenya: design, methods, and baseline results of a cluster-randomized controlled trialJanet 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...
- How perceptions of HIV-related stigma affect decision-making regarding childbirth in rural KenyaJosé 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...
- Social context and drivers of intimate partner violence in rural Kenya: implications for the health of pregnant womenAbigail 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...
- Responses to and resources for intimate partner violence: qualitative findings from women, men, and service providers in rural KenyaMerab 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. ..
- Facilitating HIV status disclosure for pregnant women and partners in rural Kenya: a qualitative studyMelonie 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...
- Patient satisfaction with integrated HIV and antenatal care services in rural KenyaBaotran 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...
- Use of personal digital assistants for data collection in a multi-site AIDS stigma study in rural south Nyanza, KenyaM 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...
- The role of counseling for obstetric fistula patients: lessons learned from EritreaKhaliah 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...
- The relationships between physical violence, verbal abuse and women's psychological distress during the postpartum periodPatrizia 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...
- Acceptability and feasibility of integration of HIV care services into antenatal clinics in rural Kenya: a qualitative provider interview studyLena 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...
- Stigma as experienced by women accessing prevention of parent-to-child transmission of HIV services in Karnataka, IndiaLisa 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...
- HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya: results from the MAMAS StudyJanet 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....
- Positive effects of the non-pneumatic anti-shock garment on delays in accessing care for postpartum and postabortion hemorrhage in Egypt and NigeriaJanet Turan
University of California San Francisco, San Francisco, CA 94105, USA
J Womens Health (Larchmt) 20:91-8. 2011....
- Evaluation of a community intervention for promotion of safe motherhood in EritreaJanet 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...
- Violence in the lives of women in Italy who have an elective abortionPatrizia 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...
- Violence and women's psychological distress after birth: an exploratory study in ItalyPatrizia 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...
- Effects of HIV/AIDS on maternity care providers in KenyaJanet 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...