Positive and pregnantin Asia

A peer-led study among women living with HIV in

Bangladesh, Cambodia, India, Indonesia, Nepal, Viet Nam

Susan Paxton PhD, Advisor, APN+Baby Rivona, Coordinator, IPPI Indonesia

Washington 2012

Study size

757 questionnaires: Bangladesh 33; Cambodia 200; India 172; Indonesia 109; Nepal 40; Viet Nam 203

10 FGDs: Bangladesh 2; Cambodia 2; Nepal 2; Viet Nam 4 (total 100 participants)

17 interviews: Cambodia 6; India 6; Indonesia 5

Inclusion criteria: HIV-positive, >16 years, pregnant within past 18 months

Study sample

Mean age: 29 years (range 17-47 yrs) Residence: 57% urban; 43% ruralMarital status: 77% married/live with partner, 21% no partner/widow, 2% never marriedMean number of children: 1.7 (range 0-8) Income: 53% dependent on familyTiming of HIV diagnosis: 56% before pregnancy, 27% during, 10% after delivery

Counselling

Over 70% of women received pre- and post-test counselling BUT:> 50% of Indian women tested in pregnancy did not get pre-test counselling Only 9% of women who said their test not voluntary received post-test counselling

Most women are strongly discouraged from becoming pregnant by health care workers

Women highlighted the importance of having trained HIV-positive female counsellors

Antiretrovirals

Majority (64%) were on ARVs: 41% started before pregnancy; 51% during; 8% after delivery

29% were still using Stavudine/d4T (Viet Nam 32%; Cambodia 31%; India 19%; Indonesia 15%)

Only 7% initiated ARVs at CD4 >350; majority started at CD4 <200

Cost of transport is the major barrier in accessing health care

Contraception

• Condoms are only contraception promoted among women with HIV - not used consistently; partners object

• 37% of women said pregnancy was unwanted • Women need methods they can control –

IUDs, pills, injectables, female condoms

Sterilisation

Of 426 deliveries, 37% via caesarean (Cambodia 7%, Nepal 33%, India 36%, Vietnam 41%, Bangladesh 57%, Indonesia 67%)

30% women encouraged to consider sterilisation, most commonly by gynaecologists

Strong correlation between caesarean sections and recommendations for sterilisation

Some women do not know whether they were sterilised during their caesarean

Discrimination

"During delivery the doctor wanted to put on two sets of gloves. He had put up on one set but the baby was already coming out and the doctor tried to push it back in so he could put on another set of gloves.“ (Saru, Nepal)

"When I was delivering the doctor left me alone and the baby came and just fell down.“ (Xuan, Viet Nam)

Some women avoid health care during pregnancy because of discrimination

Key recommendations

• Uphold sexual and reproductive rights of women with HIV

• Invest in positive women's organisations• Expand counselling by positive women• Improve sensitivity of maternal health workers • Ensure social security for women to access health

careFull report: “Positive and pregnant: How dare you”

available at www.apnplus.org/publications

Thank You