The first step of prevention of mother-to-child HIV-transmission (PMTCT)
programmes is offering HIV couselling and testing to pregnant women. In
developing countries where HIV-testing remains rare, it represents a unique
opportunity for many women to learn their own HIV status. This prenatal HIV
testing is not only the entry point to prevention of mother-to-child HIV transmission,
but also an occasion for women to sensitize their male partner to sexual risks. We
explore here if these women, HIV-tested as mothers, apply the prevention
recommendations they also receive as women.
In the Ditrame Plus PMTCT program in Abidjan, Côte d’Ivoire, two cohorts of
women (475 HIV-infected women and 400 HIV-negative women) were followed-up
two years after the pregnancy when they were offered prenatal HIV testing. In each
cohort, we compared the proportion of women who communicated with their
regular partner on sexual risks, prior to and after prenatal HIV testing. We analysed
sociodemographic factors related to this communication. We measured two potential
conjugal outcomes of women HIV testing: the level of condom use at sex resumption
after delivery and the risk of union break-up.
Prenatal HIV testing increased conjugal communication regarding sexual risks,
whatever the woman serostatus. This communication was less frequent for women in
polygamous union or not residing with their partner. Around 30% of women
systematically used condoms at sex resumption. Among HIV infected ones, conjugal
talk on sexual risks was related to improved condom use. After HIV testing, HIVinfected
women separated more from their partner than HIV-uninfected women,
despite very few negative reactions from the notified partners.
In conclusion, offering prenatal HIV counselling and testing is an efficient tool to
sensitize women and their partners to HIV prevention. But sexual prevention in a
conjugal context remains difficult and need to be specifically adressed.