A social ecological approach to developing behavioral change and preventing barriers of HIV intervention PMTCT
Introduction
Prevention of new human immunodeficiency virus (HIV) is an important public health challenge worldwide. There is a high HIV-infection and mortality rates due to mother-to-child transmission (MTCT) of HIV, need of antiretroviral drugs (ARVs) for HIV-infected, and prevention-of-mother-to child- transmission (PMTCT) intervention programs in clinics and medical centers (Hampanda, 2012). MTCT is the passing the virus from an HIV-positive mother to the fetus or infant (UNICEF, 2014). The transmission occurs during pregnancy, during labor or through breastfeeding. The World Health Organization (WHO) indicated that during pregnancy the HIV is transmitted from HIV-positive mother to the fetus through the placenta, during childbirth. The transmission of HIV from an infected mother to baby gets by the cervical secretion or blood, and post pregnancy transmission occurs during breastfeeding through milk or blood. The HIV transmission of HIV-positive mother to the baby during gestation, labor and breastfeeding is identified as the mother-to-child transmission. The Centers for Disease Control (CDC) reported that MTCT is the leading cause of morbidity and mortality for children under 5, and about 1000 HIV transmitted infants born every day worldwide. CDC (2014) indicated that without prevention about 15-30 % of children of HIV-positive mothers will become infected during gestational period or labor, and 5-20% of the newborns for HIV-positive mothers will get infected through breastfeeding. According to UN General Assembly (2010), the PMTCT is an effective intervention which target is to develop maternal and child health by reducing HIV transmission to infants by 50%. WHO (2014-2015) indicated that access to PMTCT within health services will facilitate the blocking of the virus transmission at any stage. WHO recommended the HIV-positive pregnant mothers to be on a triple- drug regimen of antiretroviral medication (ARVs) through pregnancy, delivery, breastfeeding, and post-pregnancy treatments for health maintenance? While MTCT of HIV is preventable with proper intervention, still, today, transmission of HIV/AIDS is a global priority in many low to middle- income countries. Only a small percent of women have access to prevention intervention due to major social and economic barriers and facilitators contributing to PMCTC program and interventions. This paper explores PMTCT perceived barriers addressed as health belief construct, and retention methods to accessing sexual and reproductive services in societal and community-based health system in low to middle income countries by using the social ecological model (SEM) as a foundation to successful outcomes by increasing awareness of HIV prevention, producing a culturally sensitive capacity to make an informed choice and care in pregnant and breastfeeding women.
Statement of the Problem
UNICEF (2014) indicated that “the HIV/AIDS epidemic is driven by a complex set of factors in developing countries, specifically in South Africa, including social, cultural, historical, political, economic and gendered factors” (p. 7). According to UNICEF (2014), “HIV/AIDS also touches on sensitive issues such as people’s sexuality and identity, challenges notions of morality and questions our accepted understandings of gender, disease and death” (p7). There are many obstacles and challenges facing the PMTCT today. According to WHO (2014) many countries don’t have PMTCT services and intervention centers due to poverty, poor structure health facilities, and no resources. According to WHO (2014), PMTCT barriers in the middle to low-income countries are questionable based on cultural and religious belief, gender issues, and psychological issues such as denial, fear, HIV testing and death. Busza et al. (2012) identifies risk perception, motivation/self-efficacy, health status,