Social and community perspectives on prevention of mother-to-child transmission of HIV: Free State

This report is the third in a series of studies on the social and community aspects of prevention of mother to child transmission (PMTCT). The aim of these studies was to identify social issues influencing the South African Government's PMTCT pilot program. The aim of this study was to collect information about socio-cultural and community dynamics of PMTCT with the potential to inform the implementation and effectiveness of Free State's PMTCT programme. This work stems from a growing recognition of the need to approach medical interventions such as PMTCT from a contextual and community-oriented perspective. While the central focus of the study is on women's experience of PMTCT services, for a number of reasons it was also deemed important to characterize the knowledge and beliefs of the community at large. Individuals do not accumulate and interpret information, make choices or act in a vacuum. In order to gain perspective on women's PMTCT experiences - and by extension identify factors affecting the efficacy of PMTCT services - it is necessary to understand the stance of their family members and other influential figures in their communities. In addition, and related to this first point, in order to be effective, a PMTCT communications/IEC strategy would likely have to target a broader audience; not simply women themselves. Thus, by focusing on the community at large we are able to collect information which will both inform a community-wide communications strategy as well as serve as a baseline to assess community changes in knowledge, attitudes and perceptions surrounding prevention of mother-to-child HIV transmission over time. This study also shows the voices of expertise of counsellors, community health workers and clinic staff to be heard; both in order to provide quality PMTCT care but also - equally importantly - to cope with the personal and professional challenges this service presents for those who offer them. We hope the research strategy used in this study has helped give communities a voice for addressing their health problems.