Intimate partner violence and HIV-positive women's non-adherence to antiretroviral medication for the purpose of prevention of mother-to-child transmission in Lusaka, Zambia

Abstract

Background: Prevention of mother-to-child transmission (PMTCT) depends critically on HIV-positive women's adherence to antiretroviral drugs during and after pregnancy. Adherence among pregnant and breastfeeding women remains a challenge across sub-Saharan Africa. Power dynamics within couples, such as intimate partner violence, has largely been neglected in research regarding PMTCT adherence.

Objective: This study aims to determine if there is a relationship between intimate partner violence and non-adherence to PMTCT.

Methods: In 2014, using a verbally administered cross-sectional survey at a large public health clinic in Lusaka, Zambia, 320 HIV-positive postpartum women, who were currently married or living with a man, provided information on their drug adherence during and after pregnancy, as well as relationship dynamics. Adherence was defined as the woman reporting she took or gave to the infant at least 80% of prescribed medication doses.

Results: Experiencing intimate partner violence was associated with decreased odds of adherence to PMTCT during and after pregnancy. Different forms of violence affected PMTCT adherence differentially. Physical violence had a less pronounced effect on non-adherence than emotional and sexual violence. A dose-response relationship between intimate partner violence and non-adherence was also observed.

Conclusions: Intimate partner violence is associated with non-adherence to PMTCT during and after pregnancy, which deserves increased attention in the effort to eliminate mother-to-child transmission of HIV.

Keywords: Antiretroviral adherence; HIV; Intimate partner violence; Prevention of mother-to-child transmission; Sub-Saharan Africa; Zambia.

Figure 1

Women’s Experiences with Intimate Partner Violence (n=320)