HIV infection has become one of the greatest complications of pregnancy in some
developing countries. Namibia, with a population of only 1,8 million people, is ranked
among the top five countries in the world, in terms of HIV/AIDS infections. In 2004, the
National HIV prevalence ration among pregnant women was 19,8% (MOHSS, 2004). In
the absence of ARV medicine intervention, transmission could vary between 30-45%.
The identification of infection through voluntary counseling and testing (VCT),
especially during pregnancy, is critical not just for guiding treatment but for future
prevention as well. Namibia is experiencing a low uptake of VCT by pregnant women in
all hospitals, which are implementing the Prevention of HIV from mother-to -child
(PMTCT) strategy. Out of 5220 pregnant women who attended antenatal services in two
pilot hospitals, only 10% of them agreed to be counseled and tested between March 2002
– March 2003 (MOHSS, 2003:7). This research was conducted in Oshakati Hospital,
which is one of the first pilot hospitals for PMTCT.
The study focused on perceptions and experiences of pregnant women who opted in
against those who opted out of voluntary antenatal HIV counseling and testing. The
pregnant women’s perceptions and experiences were assessed in order to gain insight into
their views towards voluntary antenatal counseling and testing.
A qualitative, descriptive and comparative study was used regarding participants who
opted in and opted out. A purposive random sampling was used to collect data from the
participants. The study sample comprised six focus group discussions (FGD) of pregnant
women who were attending antenatal services at this hospital. Each FGD consists of six
pregnant women. Three FGD were women who opted in and other three FGD were for
those who opted out. The semi-structure FGD guide was used to guide the discussions.
The discussions were audio recorded, transcribed and analyzed, using thematic content
analysis.
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Based on the findings of the study, the knowledge of pregnant women who opted in was
relatively good comparing with those who opted out. Despite the recognition of the
benefits of VCT, it was evident that women were reluctant to use the VCT service
because of reasons that include fear of being stigmatized, abandoned and discriminated
against. The women’s participation in the existing services of voluntary antenatal
counseling and testing was influenced by their partners. The women are often being
blamed for spreading the disease in the family. Due to stigma and discrimination women
were afraid to disclose their status in order to avoid rejections by their partners, family
and society.
It was also found that there were misconceptions surrounding the knowledge of the
causes and prevention of vertical transmission. These misconceptions should be talked
about. The distance was another factor, which hampered the participation of pregnant
women in the programme. Other reasons for non-attendance given by the participants
included dissatisfaction with some of the nurses’ attitudes, ignorance about the service as
well as reluctance to be tested.
Participants appreciated some aspects of VCT rendered, but suggested improvement in
areas they felt were lacking. Areas of concern included partner involvement, community
education, improving confidentiality and extension of services to the rural places / clinics.
The study makes number recommendations, among others improved partner
communication on the issues of HIV/AIDS as it will encourage sharing of confidentiality
and responsibility.