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Barriers to the use of antiretroviral therapy among HIV-positive pregnant women in Awka, South-East Nigeria.
Abstract
Background: Despite significant scale-up of Prevention of Mother-to-Child Transmission (PMTCT) programmes in Nigeria, adherence to antiretroviral therapy (ART) among HIV-positive pregnant women remains suboptimal, sustaining the risk of vertical HIV transmission.
Objective: This study explored the socio-cultural, health system, stigma-related, and economic factors influencing ART uptake and adherence among HIV-positive pregnant women in Awka, South-East Nigeria.
Methodology: A cross-sectional descriptive survey was conducted involving 200 HIV-positive pregnant women accessing PMTCT services in selected health facilities. Data were collected using structured interviewer-administered questionnaires and analysed with descriptive statistics including frequencies and percentages.
Results: Key socio-cultural barriers included fear of stigma and social rejection (74%), preference for traditional or religious healing (36%), fear of partner violence following disclosure (29%), and limited autonomy in health decisions (32%). Health system challenges identified were long clinic waiting times (61%), inadequate counselling services (48%), frequent drug stock-outs (43%), and poor integration of PMTCT with antenatal care (37%). Stigma-related and familial constraints involved limited male partner involvement (69%), pervasive community stigma (63%), and fear of losing family support (42%). Economic impediments encompassed high transportation costs (56%), inability to afford adequate nutrition (52%), opportunity costs (46%), and long distances to health facilities (39%).
Conclusion: ART adherence among HIV-positive pregnant women in Awka is impeded by intersecting socio-cultural, systemic, and economic factors. Comprehensive, multi-sectoral strategies targeting stigma reduction, male partner engagement, service integration, and economic support are critical to improving adherence and advancing elimination of mother-to-child HIV transmission.
