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Background: Prevention of mother-to-child transmission (PMTCT) programmes have been reported to reduce the rate of transmission of human immunodeficiency virus (HIV) infection by 30%-40% during pregnancy and childbirth. The PMTCT transmission is achieved by offering HIV prophylaxis or initiating antiretrovirals to pregnant women who test HIV positive. Being aware of the experiences of these women will assist in planning and implementing the relevant care and support. The study was conducted in three phases. Aim: This article will address phase 1 which is to explore and describe the experiences of pregnant women living with HIV. Setting: The study setting was a PMTCT site in a Provincial Hospital, in Zimbabwe. Methods: The study design was qualitative, exploratory, descriptive and contextual. In-depth face-to-face interviews were conducted from a purposive sample of 20 pregnant women. Thematic data analysis was performed. Results: Six themes emerged: realities of disclosure, a need for quality of life, perceived stigmatisation, inadequate knowledge on infant feeding, continuity of care, empowerment and support. Conclusions: The study concluded that pregnant women living with HIV require empowerment and support to live positively with HIV.
The study was conducted in Zimbabwe at a Provincial Hospital in the maternal and child health (MCH) department. The PMTCT was incorporated in the MCH programme. The research design used in this phase of the study was a qualitative, exploratory approach, descriptive and contextual in nature, to explore and describe the experiences of pregnant women living with HIV. The research approach was chosen because it allows the researcher to collect information from the person experiencing the phenomenon as the focus of the study was on understanding an experience. The accessible population was pregnant women living with HIV who were enrolled in a PMTCT programme at a Provincial Hospital in Zimbabwe. The site was purposively selected as the researcher has worked as a midwifery lecturer in this setting. The motivation for the study came as a result of the women within the site’s catchment area confiding in the researcher on the challenges they faced as people living with HIV. A purposive sample of pregnant women who tested positive for HIV as a result of PI-HTC in the PMTCT programme was used. The inclusion criteria were as follows: The participants were identified by the midwife in charge of the MCH department from a queue of pregnant women who had reported for their scheduled antenatal visits. The identified participants were then each taken to a side room where they were introduced to the researcher. The researcher explained the purpose of the study to each of the participants and highlighted that participation was voluntary. Participants were also free to discontinue the interview at any point without any penalty and also without affecting the services they received. The researcher then obtained an informed verbal and written consent before conducting the interviews. Because of the sensitive nature of living with HIV and the stigma still attached to HIV, access to participants was at the hospital site, instead of participant homes, to maintain their privacy and confidentiality, and to protect them from stigmatisation by society as a whole. A total of 20 pregnant women participated in the study. Data saturation determined the sample size. According to Polit and Beck (2014), data saturation entails sampling to the point where no new information is obtained and redundancy is achieved. In this study, no new themes or categories emerged from the in-depth interviews after the 20 participants. Data were collected by the researcher through in-depth individual face-to-face interviews during 2013. The interviews were tape-recorded and conducted privately in side rooms, away from the other women to ensure privacy, anonymity and confidentiality. The interviews were conducted in Shona (one of the vernacular languages in Zimbabwe) and data were also analysed in Shona before being translated into English. One central question was asked, namely: ‘How has it been for you since the time you were informed that you are living with HIV infection?’ In this study, each individual in-depth face-to-face interview took about 45 min to 1 h per participant. This includes the time taken to create rapport. Field notes were used by the researcher to support the emerging themes and categories. Data from the audiotapes and field notes were transcribed and formed a written record of each of the interviews conducted. The researcher engaged an independent coder who carried out an in-depth analysis of the data, while the researcher also analysed the data. The independent coder is a nurse-midwife who holds a doctoral degree and is well versed in qualitative research with an understanding of both languages (Shona and English). Tesch’s data analysis method (in Creswell 1994:154–156) was used which includes eight steps described as follows: Step 1: The researcher listened to the tapes (recordings) and obtained a sense of the whole, carefully reading through the transcriptions and jotting down some ideas as they came into the researcher’s mind. Step 2: The researcher picked one interview recording at a time and went through it, asking herself what it was about, and thinking about the underlying meaning. The researcher then wrote down her thoughts in the margins. Step 3: Upon completion of the task, the researcher made a list of topics. The researcher then clustered together similar topics in typed form and arranged these topics in columns under major topics, unit topics and topics left over that had no similarity. Step 4: The researcher used the list of topics and went back to the data, abbreviated the topics as codes and wrote the codes next to the appropriate segments of the texts. The researcher then made a preliminary organising scheme to see whether new categories and codes emerged. Step 5: The researcher identified the most descriptive wording for the topics and turned these into categories. Topics that relate to each other were grouped together, thereby reducing the list of categories. The researcher then identified interrelationships between categories. Step 6: The researcher made a final decision on the categories that were then merged into themes. Step 7: Data belonging to each category were identified and put together, then a preliminary analysis was performed. Step 8: All the existing data were recorded. Trustworthiness was ensured according to the framework by Lincoln and Guba (1985) (credibility, dependability, confirmability and transferability). Ethical clearance was provided by the academic ethical committee of a university in South Africa. Permission to carry out the study was obtained from the Acting Medical Superintendent of the Provincial Hospital, while written informed consent was obtained from the participants. Ethical considerations adhered to in the study were the following: freedom to participate in or withdraw from the study, freedom from harm, the right to full disclosure, benefits of the study, the risk/benefit ratio, the right to privacy, anonymity and confidentiality (ethics approval number AEC39/02-2011, Faculty of Health Sciences, University of Johannesburg). Anonymity was also achieved by not linking the names of the participants to the data collected and by using identifying numbers.
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