Barriers to participation in the prevention of mother-to-child HIV transmission program in Gaborone, Botswana a qualitative approach

The existing belief that if money and free antiretroviral drugs were offered to developing countries, people would flock to use the services does seem to hold for the Prevention of Mother-to-Child Transmission of HIV Program (PMTCT) in Botswana. The government offers free counseling, testing, free antiretroviral drugs and free infant formula for babies born to infected mothers and yet some women are reluctant to enroll in this program to protect their infants. A qualitative study on factors that motivated and hindered pregnant women from participating in the PMTCT program was conducted in Gaborone, Botswana. Forty subjects (ten HIV-positive pregnant women who accepted the program, eleven who rejected the program, nine PMTCT health workers and ten key informants) participated in in-depth interviews. Thematic content analysis yielded the following barriers to participation in the program: fear of knowing one's own HIV status, infant feeding distribution stigma, lack of male partners' support and negative attitudes of health workers. Reinforcing factors were: availability of free antiretroviral drugs and free infant formula. In conclusion, stigma and discrimination are still the main impediments to women's participation in the PMTCT program. Mitigating these barriers could reduce AIDS-related infant mortality in this country.