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Introduction
The Human Immunodeficiency Virus (HIV) is a virus that only infects human beings by
weakening the immune system, destroying important cells that fight disease and infection. It can
only reproduce itself by taking over a cell in the body of its host.
Unlike influenza or the common cold, the human immune system can't seem to get rid of
HIV. That means that once you have HIV, you have it for life. There is no cure for HIV. HIV can
hide for long periods of time in the body and that it attacks the T cells of your immune system,
which are necessary to fight infections and disease. HIV invades the T cells, uses them to make
more copies of itself, and then destroys them. Eventually, the loss and destruction of so many T
cells causes the body to lack the necessary resources to protect it. This causes Acquired
Immunodeficiency Syndrome (AIDS), the final stage of HIV infection. According to the Centers
for Disease Control and Prevention (2014), HIV can be transmitted through certain fluids—
blood, semen, pre-seminal fluid, rectal fluids, vaginal fluids, and breast milk—from an HIV-
infected person. These fluids must come in contact with a mucous membrane or damaged tissue
or be directly injected into the bloodstream (from a needle or syringe) for transmission to
possibly occur. Hence, HIV can be passed from mother to child during child birth.
This is worrisome for the Jamaican population. Even more so, since, in Jamaica, it is
estimated that 34,000 persons are living with HIV and as many as 50% are unaware of their
status (Ministry of Health, 2012). Of this number, the study showed, in 2012, for every one
thousand pregnant women attending public antenatal clinics, at least 9 were HIV infected. While
that in itself is a low statistic, it must be recognized that this number is only among women who
have volunteered to get tested before childbirth and it does not reflect the number of women
seeking antenatal care in private hospitals. Testing is voluntary, but there are still pregnant
women who do not take advantage of the opportunity and get tested.
Therefore, there needs to be an investigation into the factors that deter antenatal women
from getting tested for HIV, especially if the test has been offered to them. This is a big issue as
HIV transmission from mother to child could have been avoided with one test. Between 1989 and
1996 the HIV prevalence among antenatal women increased from 0.14% to 1.96%. It must be noted
however that the prevalence has declined over the last 15 years, with the 2011 and 2012 rates
remaining at 1% and below. However, as it is, one thousand five hundred and fifty one (1,551)
persons died from HIV in 2012 in Jamaica alone, Ministry of Health, 2012. A reduction in the
prevalence of HIV transmission from mother to child would equate to a better quality of life for
Jamaicans.
Literature Review
There have been studies investigating the attitudes of women seeking antenatal care, and
whether or not they get tested for HIV. A lot of studies highlight the trends of HIV in general.
These are usually done in first world countries such as the United Kingdom, The United States of
America, Canada and Sweden. The studies regarding the attitudes of antenatal women towards
getting tested for HIV are mostly from African states. While the Ministry of Health has a
National HIV/STI Program Jamaica which provides an annual HIV/AIDS Epidemic Update, the
studies are not specific to antenatal women and their prevalence to get tested for HIV. In an
ideal world, HIV testing would be done by all, especially expectant mothers; however, there are
various reasons why these women fail to make this crucial decision.
While it ideal to have expectant, antenatal mothers get tested for HIV, there are negative
schemas attached to a positive HIV status, leaving them in fear of finding out their status. De
Cock & Johnson (1998) state, “Negative consequences that may result from people discovering
their positive HIV status include, psychological disturbance, rejection, stigmatization, and social,
as well as financial discrimination”. They also highlight that HIV infected women in some
settings are at increased risk of domestic violence and discrimination; hence they struggle in their
Various studies have been carried out which highlight the relationship between the
attitudes of women seeking antenatal care and HIV. As such various factors affecting why
pregnant women do not get tested for HIV have been determined.
Age. Age plays a factor in whether or not expectant mothers will get tested for HIV. The
findings from a Ugandan study in 1998 by Pettifor, Rees, Kleinschmidt, Steffenson, MacPhail,
Hlongwa-Madikizela, Vermaak & Padian (2004) show that younger expectant mothers are more
likely to contract HIV. One third (1/3) of the Ugandan girls between ages fifteen and nineteen
(15-19) reported they were pregnant. Fifteen percent (15%) of them had HIV. They were the
highest recorded age cohort with pregnant women having HIV. In Brazil, a study took the
examination of age of expectant mothers and HIV prevalence one step further by examining the
prevalence of HIV testing among expectant mothers. It was found that younger girls, especially
those who had not finished receiving a primary or secondary education, had higher incidence of
failure to get tested for HIV. Authors of this study, Szwarcwald, Barbosa Júnior, Souza-Júnior,
Lemos, Frias, Luhm, Holcman, & Esteves (2008), found that pregnant women nineteen (19)
years and younger had a statistically higher failure rate to get tested for HIV compared to the
other age groups. Furthermore, pregnant women seeking antenatal care were found to be more
likely to get tested for HIV the older they became. This was seen as women thirty five (35) and
older had the lowest incidence of failure to get tested for HIV.
Relationship Status. Research has shown that the relationship status of women seeking
antenatal care affects whether or not they get tested for HIV. A Kenyan study by Turan, Bukusi,
Onono, Holzemer, Miller, & Cohen, C. R. (2011) showed pregnant women were less likely to
get tested for HIV because, in the event of being HIV positive, the women anticipated break ups
and violence from their male partners. Furthermore, pregnant women are usually the first in the
family to get tested for HIV, and if the woman is HIV positive, she is blamed for diseasing and
bringing discrimination on the family. Hence, pregnant women refuse testing, sometime
foregoing antenatal care all together. Turan, Bukusi, Onono, Holzemer, Miller, & Cohen (2011)
also found that a significant number expectant mothers who were married did not get tested is
because they were already aware of their husbands’ HIV positive status. Disclosure of this also
leads to discrimination and violence towards the woman. Pettifor et al (2004) also found that
pregnant women with more than one sexual partner had a significantly higher risk of being
infected with HIV. It can be inferred that pregnant women who are not in a stable relationship
are at risk of contracting HIV. Corbett, Dauya, Matambo, Cheung, Makamure, Bassett, & Hayes
(2006) found women in general who were married were less likely to get tested for HIV.
Employment Status. The employment status of women seeking antenatal care also
influences whether or not mothers seeking antenatal care will get tested for HIV. In a Tanzanian
study by de Paoli, Manongi & Klepp (2004), there a statistically significant relationship between
employment of expectant mothers and their attitude towards HIV. Majority of the women who
were unemployed and seeking antenatal care claimed they were economically dependent on their
husbands. Should they find out they were HIV positive, the women feared abuse and violence
from their spouses. Corbett et al (2006) found that women seeking antenatal care who were in
the work place were most get tested for HIV in a convenient place where they were less likely to
be seen by persons who could recognize them. They also found out that the cost of HIV testing
was also important to women seeking antenatal care, who were also employed.
Other Reasons. There are other reasons however that could explain why women seeking
antenatal care do not get tested for HIV. De Cock & Johnson (1998) propose another reason why
pregnant women do not seek voluntary HIV testing. They claim a major factor influencing rates
of testing is the attitude of attending midwives and obstetricians. Reticence to advocate testing is
often related to concerns about involuntary testing, stigmatization, and discrimination against
women seen to be at high risk, since the highest prevalence of HIV infection is in women of
African origin. Some women simply were not offered the test. Hence, they did not see it as an
Research Topic
This study is attempting to explore the possible relationship between the attitudes of
women seeking antenatal care and HIV testing, using age, relationship status and employment
status as variables. The research question is then, “Whether or not women seeking antenatal care,
who have been offered to receive an HIV test will agree to get tested for HIV, is dependent on
the woman’s age, relationship status and employment status.” This will be broken down into
three (3) hypotheses. The first hypothesis states, “As the age of women seeking antenatal care
increases, the likelihood that she will get tested for HIV, provided the test has been offered to her
also increases”. The second hypothesis proposes, “There is a relationship between a woman
seeking antenatal care’s relationship status and the likelihood that she will get tested for HIV,
provided the test has been offered to her. The final hypothesis purports that, “Women seeking
antenatal care who are married are less likely to get tested for HIV, compared to unmarried
women seeking antenatal care, provided the test has been offered to her.
References
Centers for Disease Control and Prevention. (2014). HIV Basics. Retrieved from
http://www.cdc.gov/hiv/basics/index.html
Corbett, E. L., Dauya, E., Matambo, R., Cheung, Y. B., Makamure, B., Bassett, M. T., ... &
of attitudes and practice around HIV testing. British Medical Journal, 316, 290-293
de Paoli, M. M., Manongi, R., & Klepp, K. I. (2004). Factors influencing acceptability of
Ministry of Health. (2012). National HIV/STI program Jamaica HIV/AIDS epidemic update.
Pettifor, A. E., Rees, H. V., Steffenson, A., Hlongwa-Madikizela, L., & MacPhail, C. (2004).
HIV and sexual behaviour among young South Africans: a national survey of 15-24 year
Szwarcwald, C. L., Barbosa Júnior, A., Souza-Júnior, P. R. B. D., Lemos, K. R. V. D., Frias, P.
G. D., Luhm, K. R., ... & Esteves, M. A. P. (2008). HIV testing during pregnancy: use of
secondary data to estimate 2006 test coverage and prevalence in Brazil. Brazilian Journal
Turan, J. M., Bukusi, E. A., Onono, M., Holzemer, W. L., Miller, S., & Cohen, C. R. (2011).
HIV/AIDS stigma and refusal of HIV testing among pregnant women in rural Kenya:
results from the MAMAS Study. AIDS and Behavior, 15(6), 1111-1120