Marseille 2007
| Abstract #60 - SOCIOCULTURAL FACTORS OF HIV TRANSMISSION DURING DELIVERY IN INDIA | ||||
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Session: 50.4: Transmission and social epidemiology (Parallel) on Wednesday @ 08.30-10.30 in PR Chaired by Brenda Spencer, Helene Sylvain Authors: Presenting Author: Mrs Pascale Hancart Petitet - Centre de Recherche Culture Sant Socit, France |
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| Additional Authors: Dr NM Samuel, Prof Alice Desclaux, Dr Pragathi Vellore, | ||||
| Aim: In India, programmes for Prevention of HIV Mother-to-Child Transmission (PMTCT) have been implemented in some public health structures since 2001. However, the majority of women do not access these programs since many deliveries occur at home, with the help of Traditional Birth Attendants, or in Maternity wards that do not develop MTC prevention. This is important not only for infants but also for womens health, since the context of pregnancy and delivery is the main opportunity in India for womens information on HIV and testing. The aim of this paper is to describe factors that favour or hinder mother-to-child transmission and iatrogenic transmission at field level and according to delivery settings. | ||||
| Method / Issue: The study is based on an ethnographical research conducted in four birth settings : at home with a Traditional Birth Attendant, in a district clinic without PMTCT program, in a public hospital with a PMTCT program, in a highly specialised HIV centre. In depth interviews have been conducted with women, healthcare providers and Traditional Birth Attendants. | ||||
| Results / Comments: The analysis of factors for transmission shows the intricacy between biological and social factors, such as the length of labour due to poor management of delivery in some health services for women from low social status. In each setting, some factors are specially related to HIV (such as womens low level of knowledge about AIDS or unavaibility of HIV testing), when others are not (such as high frequency of C-sections in hospitals and private clinics). Most factors are related to relationships between pregnant women and the health system, mainly through their interactions with health workers. | ||||
| Discussion: These data are relevant for the on-going debate about the involvement of Traditional Birth Attendants in decentralization of PMTCT, which meets the issue of changes in womens roles in the time of AIDS. They are also relevant when considering the consequences of delivery for womens health, including iatrogenic transmission and opportunities for HIV care, a topic that has often been neglected. | ||||
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