Health Policy Project

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Research Shows Stigma Inhibits Uptake of PMTCT and Maternal Health Services

Posted March 21, 2013


Image of Army Reserve Nurse Delivers Baby in Rural Uganda. Photo by United States Army Africa.
A medic in northern Uganda hands a newborn to his mother.
Photo by Maj. Corey Schultz, Army Reserve Communications, US Army Africa

WASHINGTON, DC—A new literature review published in the journal AIDS and Behavior finds that concerns about HIV-related stigma can discourage pregnant women in low-income settings from seeking services for their own health and to prevent mother-to-child transmission (PMTCT) of HIV. These findings highlight a serious challenge to international goals to virtually eliminate mother-to-child HIV transmission and reduce HIV-related maternal mortality by 50 percent by 2015.

In their review of 150 journal articles and reports, authors Janet M. Turan (University of Alabama at Birmingham) and Laura Nyblade (Health Policy Project and RTI, International) found strong evidence that HIV stigma inhibits uptake of services along the multiple steps of the PMTCT cascade that must be followed, beginning with HIV testing during pregnancy through infant feeding. This incremental drop-off in uptake and retention across the steps of the PMTCT cascade means that women and infants at risk of HIV infection may not take advantage of life-saving PMTCT programs when they are available.

For example, some pregnant women may avoid antenatal care (ANC) services altogether if they fear they will be forced to get tested for HIV. Those who do access ANC may refuse HIV testing, or may not be offered testing at all by health workers who have stigmatizing attitudes. Among women who do reach later stages of PMTCT services, some who test HIV-positive may decide not to enroll in treatment and care programs for themselves or their infants for fear that their HIV status will become known to the larger community. Anticipated, perceived, or actual experiences of stigma thus act as significant barriers to uptake of PMTCT services.

"The world has set an ambitious agenda to eliminate newborn HIV infection and reduce maternal mortality," said Sarah Clark, Director of the USAID-supported Health Policy Project (HPP) at Futures Group. "We will not get to zero new infections without addressing stigma and discrimination."

The authors recommend renewed attention to strategies to reduce HIV-related stigma, improve confidentiality, and increase acceptance of these services through community outreach, media campaigns, and advocacy.   

Turan, Janet M. and Laura Nyblade. 2013. HIV-Related Stigma as a Barrier to Achievement of Global PMTCT and Maternal Health Goals: A Review of the Evidence. AIDS and Behavior. Available online at

Learn more about the Health Policy Project's activities in stigma and discrimination.

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The Health Policy Project is a five-year cooperative agreement funded by the U.S. Agency for International Development under Agreement No. AID-OAA-A-10-00067, beginning September 30, 2010. The project's HIV-related activities are supported by the U.S. President's Emergency Plan for AIDS Relief (PEPFAR). It is implemented by Futures Group, in collaboration with Plan International USA, Avenir Health (previously Futures Institute), Partners in Population and Development, Africa Regional Office (PPD ARO), Population Reference Bureau (PRB), RTI International, and White Ribbon Alliance for Safe Motherhood (WRA). The information provided on this Web site is not official U.S. Government information and does not represent the views or positions of the U.S. Agency for International Development or the U.S. Government.

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