Navigating intersecting identities and stigmas - narratives from women who drop in and out of PMTCT care in western Kenya

In resource-limited settings, defaulter tracing is a key strategy for re-engaging women living with HIV and their infants who miss scheduled clinic visits for the prevention of mother-to-child transmission of HIV (PMTCT). This qualitative study seeks to understand the social realities of women in western Kenya who drop in and out of PMTCT care despite continuous tracing efforts to keep them in care. Fifteen in-depth interviews were conducted, with ten women traced and re-engaged in routine care. The data were analysed via a narrative approach and interpreted and discussed through an intersectional lens. The findings are presented in two constructed type narratives, illustrating PMTCT care (dis)engagement as a complex and social process and practice that involves navigating multiple intersecting identities and stigmas. Gender power imbalances and poverty, together with intersectional stigma, needs, and dependencies, stood out as obstacles to sustained engagement. Food security and caretaking of loved ones took precedence over scheduled clinic visits, despite the appreciation of defaulter tracing and social support from health care providers. We call for the recognition of how the gendered and complex lived realities of many women in resource constrained contexts, in different ways and to different degrees, intersect with their PMTCT care engagement and challenge equitable HIV care and prevention.