One of the projects that I work on at the Elizabeth Glaser Pediatric AIDS Foundation is a research study assessing the acceptability of option B+ among pregnant and lactating women in select sites in Malawi. In 2011, Malawi rolled out the Option B+ policy, which mandates health care workers (HCWs) to put every pregnant and lactating woman testing positive for HIV on antiretroviral therapy regardless of CD4 count and stage of pregnancy. The study excited me, and I was looking forward to learning about how the Option B+ policy has been working over the past two years.
During my second month working on the project, I saw this post on my friend’s (working in the private health sector) wall on Facebook:
“QUESTION: IN THIS DAY AND AGE ARE THERE WOMEN NOT ACCESSING PMTCT. I MEAN WHO CHOOSES NOT TO????”
This made me stop a bit to think. Prior to working on the Option B+ study, I wouldn’t have hesitated in agreeing with my friend’s post. Of course every woman should choose to access PMTCT services, why wouldn’t they? However, without preemptively sharing the findings of the study I am working on, I now consider more carefully how people in the health sector expect people to follow policies since it is for their own good, so we say. But how much publicity has the government of Malawi given to this issue I ask myself? Not only the government of Malawi, but how about the different organizations working in the field of health: have they taken the initiative to inform the public about this? I rarely hear Option B+ messages on the radio, let alone see a billboard for that around town. If these messages are scarce around town, then how about in our villages? I realized eventually that expecting women to access PMTCT in this day and age actually hinges on other factors, and these factors may force women not to actually access PMTCT.
I know Option B+ and PMTCT have advantages in promoting safe motherhood, maternal and neonatal health. I imagine myself pregnant and HIV positive and hearing a HCW tell me I have to initiate Option B+. Would l really do it I wonder? Since just by the thought I have a lot of questions in my mind still: How would my family react? How about my husband? How about my friends? What about the baby? Will it be a normal baby? Won’t it be affected negatively by the medicines? Well, I know if I had to meet a health practitioner they would explain very well and have answers to all my questions but the underlying fact is there are always questions and dilemmas that might force some women not to access PMTCT even in this day and age.
From the eyes of a person working to improve access to health I would be happy to see 100 percent PMTCT or Option B+ access, but I should also practically acknowledge that there are many questions and dilemmas surrounding these issues. I’ve learned that an individual’s health decisions can be complicated and not as straightforward as I once thought. This year, I hope to continue to listen to women’s stories, compassionately, and think twice before telling someone what I think is best for their health.
Well written Hazel. Indeed, the determinants of access to, and utilization of health care services are numerous. Just because a health service is available, it doesn’t mean it will be utilized by the target population group. It is not a very simplistic issue as we may sometimes imagine. Stigma and cultural factors are issues I think require to be addressed in the fight against HIV/AIDS, in as far as they influence the utilization of health services.
Hazel, I am not sure if you have heard the messages from Zodiak in Malawi about Option B+? I have been hearing these messages almost daily for over one and half months.
Richard,i have been talking to these women who are on Option B+ for more than 4 months now and none of them mentioned a radio station as a source of hearing messages about Option B+. i personally wouldn’t list a radio station as a source of getting these messages: am sure if i was talking to a group of men would have been a different issue (since men are known to listen to the radio, read newspapers e.t.c more than women: especially in the villages). The point i was making is we need to do more as a nation (using different mediums to sensitize the community about B+ and bearing factors of cultural beliefs and values, religious issues e.t,c, not only relying on the information given out at the hospital since usually its not enough and the HCW expects the woman just to accept the situation and start taking the medicine, even against her will-because to them that is what is supposed to be done and beneficial to the client (also, the health care is tired and the woman is tired and overwhelmed too and just accepts the medicine because they want to get done and go home).
Richard FYI, Option B+ was started in 2011, most hospitals started using it in the months of May/June 2011 so its over 2years now and you personally only started hearing messages about B+ on the radio 2 months ago, think about a woman in the village???