Socio-cultural realities of following through with prevention of mother- to- child transmission of HIV programme in Chiota district Zimbabwe: Implications for elimination of paediatric infection

Abstract

The study assessed the social and cultural realities of following through with prevention of mother-to-child transmission of HIV during the postnatal and breastfeeding period in a rural community in Zimbabwe and its implications on elimination of paediatric infection. The assumption was that paediatric HIV infection was not only through mother to child transmission but other social and cultural practices. Following through with PMTCT was conceptualised as the mother’s ability to adhere to ART, exclusive breastfeeding for six months and protecting the baby from getting infected through having protected sex among other factors. The study was conducted in Chiota District, one of the districts with a pronounced HIV burden. A sequential model combining both qualitative and quantitative methods was used for the study. Qualitative data were obtained through in-depth interviews/narratives with mothers on the PMTCT programme from two rural health facilities, (n=15). Focus group discussions were conducted with community members (n=231), and key informant interviews with the health staff (n=8). Quantitative data were collected through a cross sectional survey of breastfeeding women (n=103) accessing PMTCT interventions. Qualitative data were analysed thematically whilst STATA version 11 was used for quantitative data analysis where descriptive statistics, bivariate and multivariate regression analyses were done.

Cultural practices, community, self and institutional stigma affected the effectiveness of the PMTCT programme. The prevalence of adherence to ART among the mothers was 82.5%. Only 6.8% of the mothers exclusively breastfed for the first six months. The major reasons for non-exclusive breastfeeding were the mother’s belief that the milk was unsafe (66%), inadequate (55%) and breastfeeding was not practical (67%). Risky traditional practices during PMTCT included ‘treatment’ of fontanelle by inserting the father’s male organ in the mouth of the child, toning of the girl child’s sexual libido through rubbing the father’s penis on the child’s vagina, improvement of eyesight and sense of hearing through use of mother’s milk among other practices. These practices exposed babies to bodily fluids like semen, precum, breastmilk and vaginal fluids, which are known to contain HIV.

Culturally embedded practices, self, community and institutional stigma compromised the ability of mothers to adhere to PMTCT. Evidence from this study suggests that culture plays a major role in following through with PMTCT. This calls for taking cognisance of culture in designing HIV programmes. There is a need for further research on PMTCT during the postnatal period. Programmes should be cognisant that a ‘onesize fits all’ approach does not work as women are different.