Abstract:
Background: Women and children in sub-Saharan Africa bear a disproportionate burden of HIV/AIDS. Integration
of HIV with maternal and child services aims to reduce the impact of HIV/AIDS. To assess the potential gains and
risks of such integration, this paper considers pregnant women’s and providers’ perceptions about the effects of
integrated HIV testing and counselling on care seeking by pregnant women during antenatal care in Tanzania.
Methods: From a larger evaluation of an integrated maternal and newborn health care program in Morogoro,
Tanzania, this analysis included a subset of information from 203 observations of antenatal care and interviews
with 57 providers and 190 pregnant women from 18 public health centers in rural and peri-urban settings. Qualitative
data were analyzed manually and with Atlas.ti using a framework approach, and quantitative data of respondents’
demographic information were analyzed with Stata 12.0.
Results: Perceptions of integrating HIV testing with routine antenatal care from women and health providers were
generally positive. Respondents felt that integration increased coverage of HIV testing, particularly among difficult-toreach
populations, and improved convenience, efficiency, and confidentiality for women while reducing stigma.
Pregnant women believed that early detection of HIV protected their own health and that of their children. Despite
these positive views, challenges remained. Providers and women perceived opt out HIV testing and counselling during
antenatal services to be compulsory. A sense of powerlessness and anxiety pervaded some women’s responses,
reflecting the unequal relations, lack of supportive communications and breaches in confidentiality between
women and providers. Lastly, stigma surrounding HIV was reported to lead some women to discontinue services
or seek care through other access points in the health system.
Conclusion: While providers and pregnant women view program synergies from integrating HIV services into
antenatal care positively, lack of supportive provider-patient relationships, lack of trust resulting from harsh treatment or
breaches in confidentiality, and stigma still inhibit women’s care seeking. As countries continue rollout of Option B+,
social relations between patients and providers must be understood and addressed to ensure that integrated
delivery of HIV counselling and services encourages women’s care seeking in order to improve maternal and
child health.
