Prevention of Mother-to-Child Transmission of HIV in Pregnant Malawian Adolescents

The HIV/AIDS epidemic is one of the most significant public health challenges of our times. Interventions have slowed the number of deaths from AIDS and allowed those infected to live longer than was previously possible. While most HIV infections continue to be transmitted via heterosexual sex, vertical transmission from mother to child remains the primary cause of pediatric HIV infections. Prevention of mother-to-child transmission (PMTCT) of HIV is a major focus, with rapid scale up of programs designed to initiate antiretroviral therapy (ART) in all pregnant women. One group of vulnerable pregnant females is adolescents; few studies have included pregnant HIV-infected adolescents. The purpose of this study was to determine HIV prevalence in a population of pregnant adolescents and elicit the barriers and facilitators of the uptake of PMTCT services in those who were HIV-infected. A mixed methods study was conducted in Blantyre, Malawi. A survey questionnaire sought demographic and reproductive health information; in-depth interviews were conducted with those who revealed their HIV infection. The interview questions sought to elicit the barriers and facilitators of adhering to PMTCT protocols faced by these participants. The survey questionnaire determined that the study population had an HIV prevalence of 7.8%, higher than in the general Malawian adolescent population. Those who were orphaned and had a history of forced sexual encounter(s) were more likely to be HIV-infected. The interviews with HIV-infected pregnant adolescents found that all had revealed their HIV status to at least one family member; two who were married had not told their husbands. All identified the support they received as important to their adherence to ART. Few barriers to adherence were identified: several mentioned the stigmatization of HIV, but such fears did not preclude their adhering to the PMTCT protocols. As children who were perinatally infected with HIV live into adolescence, pregnancy will become more common in this population. Identifying the characteristics of adolescent pregnancy complicated by HIV allows health care providers to capitalize on the strengths of this population to prevent HIV infection in their children