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Abstract

Approximately 1400 HIV-positive women are known to become pregnant in the UK each year, the overwhelming majority being from Sub-Saharan Africa. The overall question I pose in this thesis is: how do African women living with HIV in the UK engage with HIV services and interventions during and after pregnancy? The question is addressed through a mixed methods approach. Drawing upon epidemiological data from the UK and Ireland's National Study of HIV in Pregnancy and Childhood, and primary ethnographic data, I examine key outcomes (not receiving antiretroviral therapy during pregnancy, detectable maternal HIV viral load at delivery, vertical transmission, late antenatal booking and maternal loss to follow-up from HIV care after pregnancy), as well as exploring women's experiences. Women from Western Africa and those who had arrived in the UK after conception appeared to be at greater risk of poorer outcomes. Pentecostal beliefs in divine healing, although cited by professionals as a potential barrier to HIV care, did not necessarily prevent women from engaging with HIV services and interventions. Instead, a complex constellation of cultural and structural factors including stigma and lack of UK citizenship rights emerged as a greater challenge to engagement with care. Women described good relationships with their multidisciplinary HIV antenatal teams that fostered confidence in medical systems. On the other hand, some reported negative experiences, particularly with regards to poor maternity care at the time of delivery and difficulties in abstaining from breastfeeding. Overall I found that the majority of African women living with HIV in the UK engage well with HIV services and interventions during and after pregnancy, resulting in low rates of both vertical transmission and loss to follow-up after pregnancy. This highlights women's resilience and determination to engage with HIV care, despite challenges, in order to secure the health of their babies.

Publication Type:	Thesis (Doctoral)
Subjects:	R Medicine
Departments:	School of Health & Psychological Sciences Doctoral Theses School of Health & Psychological Sciences > School of Health & Psychological Sciences Doctoral Theses

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