Research from Uganda’s organisations

Started in 2001, the prevention of mother to child HIV transmission (PMTCT) programme is facing a serious challenge as a significant number of women are rejecting their HIV test results once they turn out positive.

This is according to research conducted by Heps-Uganda in western Uganda. Heps-Uganda is a Health Consumer’s Organisation advocating health rights and responsibilities.

Heps-Uganda’s findings followed its Community Empowerment and Participation in Maternal Health in Kamwenge District project, which resulted in more pregnant women seeking antenatal care services, although a big proportion still refused to consent to voluntary HIV counselling and testing (VCT) services.
 
Funded by the Regional Network on Equity in Health in East and Southern Africa (Equinet), Heps-Uganda’s project study aimed at facilitating the community to identify and try to solve barriers to PMTCT and other maternal health services.

“While PMTCT uptake has been known to be poor, in spite of policy guidelines that require all expectant mothers seeking antenatal care to be counselled and offered an HIV test, it has now emerged that health workers are having to contend with a significant number of rural women who reject positive results,” according to the findings published in Heps-Uganda’s current edition of the Medicine Access Digest quarterly publication.

The Uganda Aids Commission says rejecting test results cuts across the board. Responding to the survey findings, the Uganda Aids Commission’s Public Relations Officer Mr James Kigozi said refusal of results happens virtually in all testing centres.
 
“There are people who go for testing and for one reason or another, they don’t accept their results. It is not only in Kamwenge District where the Heps survey was conducted, but even in other health units all over the country,” said Kigozi.

“When you look at the percentages of people who come to test, there are some who refuse to accept their results and are living in denial. They think they can’t have HIV. But tests don’t lie. Sooner or later, they will come to accept their fate.”
 
However, once pregnant women reject the results, it means they cannot access preventive treatment to protect their children against catching HIV during the pregnancy, labour or during breastfeeding. Current statistics indicate that close to 30,000 children are born with HIV annually in Uganda. At 21 percent, mother to child transmission is the second biggest mode of HIV spread after sex.

Women who have reached the advanced stages of HIV infection require a daily lifelong combination of antiretroviral drugs for their own health. This treatment is also highly effective at preventing mother-to-child transmission. Women who require treatment will usually be advised to take it, beginning either immediately or after the first trimester.
 
And their newborn babies will usually be given a course of treatment for the first few days or weeks of life, to lower the risk even further. Pregnant women who do not yet need treatment for their own HIV infection can take a short course of drugs to help protect their unborn babies.

The Heps research authors argue that in the face of results being rejected, fingers should be directed at the quality of counselling. “The Ministry of Health needs to strengthen the standard of counselling at all PMTCT centres and take the programme to the community if the number of children catching HIV from their mothers is to reduce,” they wrote.

None-the-less, in addition to the rejection of HIV test results as noted earlier, other barriers identified during the project included expectant mothers not delivering in health facilities, bad attitude of health workers towards pregnant women and husbands not giving adequate support to their wives during pregnancy.