Abstract:
BACKGROUND : HIV/AIDS has had a significant impact on maternal and child health in South
Africa. It is thus of vital importance to implement interventions to prevent mother-to-child
transmission of HIV (PMTCT) as early as possible during pregnancy. Negative interactions
between patients and health care providers (HCPs) can be an important barrier to antenatal
care, PMTCT use and PMTCT adherence. Research about respectful maternity care has focused
more on the patient perspective. We therefore compared the patient and HCP perspectives
and reflected on how interactions between HCPs and patients can be improved.
OBJECTIVE : To obtain insights into the attitudes of HCPs in the context of HIV and PMTCTrelated
care, by studying patient and HCP perceptions of their interactions, in a peri-urban
hospital setting in Gauteng province, South Africa.
METHODS : A qualitative study was conducted in a public tertiary-level hospital. Fourteen semistructured
in-depth interviews were conducted with nurses and doctors in the antenatal clinic
and postnatal ward. Thirty-one semi-structured in-depth interviews and two focus group
discussions were conducted with HIV positive and negative women on the postnatal ward.
RESULTS : HCPs experienced a difficult work environment due to a high workload. This was
combined with frustrations when they felt that patients did not take responsibility for their
own or their child’s health. They were motivated by the need to help the child. Patients
experienced judging comments by HCPs especially towards younger, older and foreign
women. They expressed fear to ask questions and self-blame, which in some cases delayed
health care seeking. No discrimination or isolation of HIV infected patients was reported by
patients and HCPs.
CONCLUSION : We hypothesize that more humane working conditions for obstetric HCPs and
a caring, personalised approach to patient management can improve patient-provider interactions
and access to respectful care. These are critical to preventing mother-to-child transmission
of HIV.
