Biomedical and behavioral interventions can virtually eliminate the risk of vertical (i.e.,
mother-to-child) HIV transmission. Pregnant and breastfeeding women’s adherence to
prevention of mother-to-child transmission (PMTCT) interventions, however, remains a
challenge across sub-Saharan Africa. Using a concurrent mixed methods approach, including a
survey and semi-structured interviews, I test whether a relationship exists between women’s
low power within married couples (based on domains from the Theory of Gender and Power)
and adherence across the PMTCT cascade of care, including drug adherence during and after
pregnancy, safe infant feeding practices, and pediatric HIV testing. The results of this study
indicate that intimate partner violence is particularly detrimental to PMTCT adherence. Certain
PMTCT protocols are also affected by partner controlling behaviors, participation in household
decisions, and economic dependence, but not to the same extent as violence. Women with low
power cite a lack of partner support and an unwillingness to disclose their HIV status to the
husband due to fear of violence or abandonment as reasons for low PMTCT adherence.
Conversely, women with high power cite partner support and the ability to prioritize PMTCT,
sometimes even over the marriage, as enabling adherence. Based on these results, augmented
efforts to address gender power dynamics both in society and within the home are
recommended to promote the health of HIV-positive women and their families.