Variables are knowledge, stigma and discrimination with transplacental transmission of HIV/AIDS

(1)

Third International Seminar on Global Health (3^rd ISGH) Technology Transformation in Healthcare for a Better Life ISGH 3 | Vol 3. No. 1 | Oktober 2019 | ISSN: 2715-1948

School of Health Sciences Jenderal Achmad Yani Page 106

Jenderal Sudirman Canal Road – Cimahi 40533 Phone: +62-22-6631622 - 6631624

TRANSPLACENTAL TRANSMISSSION OF HIV/AIDS IN HOUSEWIVES WITH HIV POSITIVE

Dyan Kunthi Nugrahaeni^1*, Novie Elvinawaty Mauliku¹, Siti Nurendah Hendayani² [email protected]

1Department of Public Health, School of Health Sciences Jenderal Achmad Yani Cimahi, Indonesia

2Department of Midwifery, School of Health Sciences Jenderal Achmad Yani Cimahi, Indonesia ABSTRACT

Background: The rate transmission of HIV/AIDS among housewives have increased compared to female sex workers, which can lead to HIV transmission from mother who have HIV positive to the baby during pregnancy, childbirth or breastfeeding. Prevention of Mother to Child Transmission (PMTCT), is one of the HIV transmission prevention programs. The coverage of PMTCT services in Indonesia is 6%.

Objective: The purpose of this study was to determine the relationship between knowledge, stigma and discrimination with the occurrence of transplacental transmission among housewives who participated in the PMTCT program.

Method: The design research used cross-sectional study. Samples are housewives with HIV positive in district Bandung as much as 34 people. Variables are knowledge, stigma and discrimination with transplacental transmission of HIV/AIDS. Data collected through interviews using questions by peer outreach and Case Manager PMTCT in Clinic X District Bandung. The statistical analysis used chi-square (X²) test.

Result: The study showed that housewives who follow PMTCT and their children are infected with HIV/AIDS with less knowledge as much as 25%, negative stigma as much as 22.2%, negative discrimination as much as 53.8%. There is a relationship between stigma and transmission of HIV/AIDS from mother to child (p value=

0.043), while variables not significantly related to HIV/AIDS transmission from mother to child are knowledge (p value= 0.58) and discrimination (p value = 0.15)

Conclusion: Transmission of HIV / AIDS through mother to child can be prevented by increasing knowledge about transmitting HIV / AIDS, reducing stigma and eliminating discrimination for sufferers.

Keywords: HIV/AIDS, PMTCT, stigma, discrimination.

INTRODUCTION

HIV/AIDS (Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome) is a global health problem that needs to be treated seriously. Estimated report on the situation of HIV proliferation in Indonesia in 2017 amounted to 14,640 cases and the cumulative number was 280,623 cases, while AIDS was 4,725 with a cumulative number of 102,667 cases (Kementerian Kesehatan RI, 2017).

An increase in HIV transmission among female clients of sex workers has resulted in an increase in HIV among housewives. Data from 1987 - June 2014 the total number of housewives who suffer from AIDS as many as 14,721 people (Kementerian Kesehatan RI, 2017). Women who infected with HIV can be transmitted the virus to their children. UNICEF was found more than 160,000 children (0-9 years old) were new infection with HIV worldwide in 2018. Prevention of mother- to-child transmission HIV (PMTCT) Program has been available in Indonesia since 2005. PMTCT

program provide services to women of reproductive age (15 – 49 years) with HIV/AIDS, preventing pregnancies among women who have living with HIV/AIDS and prevent transmission of HIV during pregnancy, during childbirth, and breastfeeding period. The coverage of PMTCT implementation in 2010 achievement in Indonesia is very low as much as 6% (Kementerian Kesehatan RI, 2015). In 2012, there were 43,264 pregnant women carrying out HIV tests, and 1,329 people tested positive for HIV (3.04%). HIV/AIDS cases in West Java in 2015 amounted to 3,741 cases and 2016 of 5,466 cases.

Cases of HIV/AIDS in housewives in the city of Bandung in 2013 amounted to 324 people while the perinatal HIV/AIDS transmission in children as many as 86 cases with an average increase of 10 cases per year ((Dinas Kesehatan Kota Bandung, 2012)).

Several factors that influence housewives in using PMTCT program, such as insufficient of knowledge and attitudes of mothers about mode of

(2)

Transplacental Transmisssion of HIV/AIDS In Housewives With HIV Positive

Third International Seminar on Global Health (3^rd ISGH) Page 107

Vol 3 | No. 1 | October 2019 |

transmission HIV/AIDS, stigma and discrimination to those who are infected with HIV-AIDS. The impact HIV/AIDS infection for housewife are stigma and social discrimination, leading to negative health outcomes, working and family life, decreased welfare or quality of life and increased mortality. The impact of HIV/AIDS infection on children is social stigma and discrimination, influencing growth and development in children, life-long illness, and be an orphan (Nyamathi, Ekstrand, Zolt-gilburne, & Leake, 2013; Santos, Kruger, Mellors, Wolvaardt, & Ryst, 2014; United Nations Programme on HIV/AIDS, 2007).

A comprehensive approach for prevent HIV transmission from mother to her babies includes the following four elements: 1) Preventing HIV infection among women; 2) Preventing unwanted pregnancies among women who have HIV infection; 3) Preventing HIV transmission from women to their infants; 4) Providing caring, support and treatment to women who have living with HIV/AIDS and their children (Bello, Adebimpe, Osundina, & Abdulsalam, 2013; Kementerian Kesehatan RI, 2015). The purpose of this research is to know the relationship between knowledge, stigma and discrimination with transplacental transmission in housewives with HIV positive in district Bandung

METHODS

The design research used cross-sectional study.

A sample of the research is housewives with HIV positive in Clinic X, District Bandung as much as 34 people. Independent variables in this research are knowledge, stigma and discrimination, while variable dependent is transplacental transmission in housewives with HIV positive. Data collection through interviews using closed questions on respondents assisted by peer outreach and Case Manager from NGO (Non- Governmental Organization) that managed PMTCT program in Clinic X, District Bandung. Data from this research are presented using the frequency distribution of research variables, while to determine the relationship between variables using the Chi-Square (X2) test.

RESULTS

Figure 1. Distribution of respondent characteristics based on age

Distribution characteristic housewives with HIV positive in Clinic X of District Bandung who participated in PMTCT program, based on age group found that 85,3% were in the age range between 25 – 49 years old and based on level of education, most of them have junior high school education, which is 19 people (55.9%) and senior high school as much as 9 people (23.5%). Children infected with HIV/AIDS who came from transplacental transmission as much as 12 people (35.3%) (figure 2).

Figure 2. Percentage of a number transplacental transmission in housewives with HIV positive

Based on data from housewives participating in the PMTCT program, it was found that as many as 4 people (30.8%) of their children were infected with HIV through transplacental transmission, and did not know about the occurrence of HIV transmission. While respondents who did not know how to prevent transmission of Human Immunodeficiency virus (HIV) from mother to her babies and their children were infected with HIV through transplacental transmission as many as 3 people (50%) (table 1).

14.70%

85.30%

20 - 24 years old 25 - 49 years olds

35.30%

58.80%

5.90%

Transplacental transmission

Yes No No Answer

(3)

Vol 3 | No. 1 | October 2019 |

Table 1. Frequency distribution variable of knowledge about transplacental transmission of HIV/AIDS

Knowledge

Transplacental transmission of HIV/AIDS

Total

Yes No

n % n % n %

Mode of transmission

- No 4 30,8 9 69,2 13 100

- Yes 8 42,1 11 57,9 19 100

Prevention of transmission

- No 3 50 3 50 6 100

- Yes 9 34,6 17 65,4 26 100

Total 12 20 32 100

Table 2. The relationship between knowledge, stigma and discrimination with transplacental transmission of HIV/AIDS

Knowledge

Transplacental transmission of HIV/AIDS

P value

Yes No

n= 12 % n=20 %

1. Knowledge

- Less 1 25 3 75 0,581

- Well 11 39,3 17 60,7

2. Stigma

- Negative 4 22,2 14 77,8 0,043*

- Positive 8 57,1 6 42,9

3. Discrimination

- Negative 7 53,8 6 46,2 0,15

- Positive 5 26,3 14 73,7

Total 12 20

* = statistically significant

Housewives who participated in the PMTCT program with less knowledge and their children infected with HIV/AIDS were 1 person (25%). In this research was found that there was no relationship between knowledge with the occurrence of HIV/AIDS from mother to children through transplacental transmission (p value=

0.581).

Housewives who participated in the PMTCT program which had negative stigma and their children infected with HIV/AIDS as much as 4 people (22.2%), it was found there was a relationship between stigma and the occurrence of HIV/AIDS from mother to her children through transplacental transmission (p value= 0.043). HIV positive housewives who participated in the PMTCT program who experienced negative discrimination and their children infected with HIV/AIDS as many as 7 people (53.8%), in this study the results showed there was no relationship between discrimination with transmission of HIV/AIDS from mother to children (p value = 0.15).

DISCUSSIONS

The purpose of the PMTCT program for housewives is to prevent transmission from pregnant women who have been diagnosed with HIV positive to their babies and prevent

transmission after birth and during breastfeeding period. (Kementerian Kesehatan RI, 2015). More than 90% of HIV infections among children occur through transpacental transmission, several factor that influence it include labor, prematurity, and breastfeeding (Balogun & Odeyemi, 2010).

HIV/AIDS infection has a negative effects to the quality of maternal care, this is due to the fear of being stigmatized and getting discriminated in people living with HIV/AIDS from healthcare workers, their families and communities (Roosmalen, 2010).

Example of stigma and discrimination experienced by people with living HIV/AIDS such as verbal insults (28.3%), physical violence (16,1%) discrimination against the other household member (57.7%).

Stigma includes various forms of physical and social attributes that reduce a person's social identity, stigma will affect the quality of life of people living with HIV / AIDS. Stigma can affect the process of disease diagnosis, prevention and treatment of HIV/AIDS. Stigma is often enforced through discrimination, (discrimination can be defined as ill-treatment in various categories of people, especially in health status, race, age, or gender) (Santos et al., 2014).

(4)

Vol 3 | No. 1 | October 2019 |

Stigmatization related to HIV/AIDS is influenced several factors, such as low knowledge about the disease and how it is transmitted, lack of access to treatment, prejudice and fear related to sensitive issues such as illness and death (Santos et al., 2014). Knowledge is a factor influencing the transmission of HIV / AIDS through transplacental, where the low knowledge of housewives about how HIV is transmitted causes an increased risk of HIV- infected children in pregnant women suffering from HIV.

To reduce the impact of HIV / AIDS transmission from mother to their children, it is recommended that every housewife with a positive HIV infection be able to apply the knowledge they have about MTCT into daily practice. However, cultural factors, stigma and discrimination related to HIV and AIDS have limited efforts to prevent HIV transmission. In general, a low level of knowledge about PMTCT in housewives is a barrier to efforts to prevent transmission of HIV (Atwiine, Rukundo, Mutibwa, Sebikali, & Tumusiime, 2012). The efforts that can be made to reduce stigma and discrimination against people who living with HIV/AIDS (PLWH) including providing health education through communication media such as radio and television on HIV and AIDS issues (Bello et al., 2013). Exposure mass media communication such as radio and televise about HIV/AIDS issue was associated with reducing stigma and discrimination in people who living with HIV/AIDS

CONCLUSIONS

Prevention of transmission of HIV/AIDS from mother to child can be prevented by increasing knowledge in mothers suffering from HIV by providing accurate information during pregnancy, childbirth and breastfeeding about modes of transmitting HIV/AIDS as well as reducing stigma and discrimination for people who living with HIV/AIDS.

ACKNOWLEDGEMENTS

This research was funded by decentralization grant from The Indonesian Ministry of research and Technology. Our Thanks to Dean of School of Health Science Jenderal Achmad Yani Cimahi, who have facilitated this research, and say thanks to peer outreach and Case Manager that managed PMTCT program in Clinic X, District Bandung to contribution of this research.

REFERENCE

Atwiine, B. R., Rukundo, A., Mutibwa, D., Sebikali, J. M., & Tumusiime, D. (2012). Knowledge and Practices of Women Regarding PMTCT in Mwizi Sub-County. Uganda.

Balogun, M., & Odeyemi, K. (2010). Knowledge and practice of prevention of mother-to-child transmission of HIV among traditional birth attendants in Lagos State, Nigeria Mobolanle.

Pan African Medical Journal, 5(7), 1–13.

Bello, A. O., Adebimpe, W., Osundina, F., &

Abdulsalam, S. (2013). Perception on prevention of mother-to-child- transmission ( PMTCT ) of HIV among women of reproductive age group in Osogbo, Southwestern Nigeria, 399–405.

Dinas Kesehatan Kota Bandung. (2012). Laporan HIV/AIDS Kota Bandung tahun 2012.

Bandung.

Kementerian Kesehatan RI. (2015). Pedoman Manajemen Program Pencegahan Penularan HIV dan Sifilis dari Ibu dan Anak. Jakarta.

Kementerian Kesehatan RI. (2017). Laporan HIV/AIDS Tahun 2017. Jakarta.

Nyamathi, A., Ekstrand, M., Zolt-gilburne, J., &

Leake, B. (2013). Correlates of stigma among rural Indian women living with HIV/AIDS.

AIDS behavioral, 17 (1), 329–339.

https://doi.org/10.1007/s10461-011-0041- 9.Correlates

Roosmalen, J. Van. (2010). The impact of Prevention of Mother to Child Transmission (PMTCT) programs on maternal health care in resource-poor settings: looking beyond the PMTCT program — a systematic review, 1444–1450. https://doi.org/10.1111/j.1471- 0528.2010.02692.x

Santos, M. M. Dos, Kruger, P., Mellors, S. E., Wolvaardt, G., & Ryst, E. Van Der. (2014). An exploratory survey measuring stigma and discrimination experienced by people living with HIV / AIDS in South Africa: the People Living with HIV Stigma Index.

United Nations Program on HIV/AIDS. (2007).

Reducing HIV Stigma and Discrimination: a critical part of national AIDS program A resource for national stakeholders in the HIV response. Geneva.