BARRIERS AND FACILITATORS TO CARE-SEEKING AMONG PREGNANT AND POSTNATAL HIV POSITIVE WOMEN IN RURAL NORTH WESTERN NIGERIA

Thesis (Master's)--University of Washington, 2019In Nigeria, the scale-up of free antiretroviral treatment (ART), proactive anti-discrimination laws, and social awareness campaigns have contributed to bringing Nigeria closer to ending AIDS by achieving “Zero new infections, Zero AIDS related deaths and Zero discrimination by 2021.” In the fight to end maternal and pediatric HIV/AIDS, however, multiple, intersecting stigmas have made stagnant any further gains in Prevention of Mother to Child Transmission of HIV (PMTCT) service delivery. As in the rest of Sub-Saharan Africa, Nigeria still carries a high overall burden of HIV. Maternal/pediatric HIV are troubling consequences of inadequate health services for HIV+ women in the region. We explored the interconnecting factors that perpetuate continued vertical transmission of HIV from mother to child in rural northwestern Nigeria. We conducted in-depth, semi-structured ethnographic interviews with 27 HIV+ pregnant women, aged 17 to 32 years, in four government-run rurally located secondary healthcare hospitals offering PMTCT services. Based on field notes and transcripts, we used grounded theory and thematic analysis and found that intersectional stigmas continue to create significant barriers to women living with HIV’s ante- and post-natal ART adherence. Key strategies women employed to access needed care by keeping appointments, collecting medications and taking medications on time included peer support groups, spousal disclosure, child survival and economic autonomy. For optimal maternal/pediatric HIV services, providers should support established models these women already employ. If an AIDS-free generation is to be realized by 2030, Nigeria must also strengthen and enforce anti-HIV stigma and discrimination laws