Reducing Vertical Transmission of HIV/AIDS in El Salvador: Barriers and Supportive Factors

USAID/El Salvador funded this study to assist in the development of a national strategy to prevent maternal-to-child (vertical) HIV/AIDS transmission (PMTCT). This 8-page executive summary provides the key findings of this research study, carried out by The CHANGE Project, which included the participation of the Academy for Educational Development/Manoff Group International and USAID, and USAID/El Salvador. The study sought to examine "factors that influence key behaviors related to HIV testing during pregnancy ... as they contribute to a reduction in vertical transmission of HIV/AIDS in El Salvador."

The study included "a representative public opinion survey of 900 urban men and women 15 to 44 years old from all socioeconomic levels of Greater San Salvador, as well as focused qualitative research. Qualitative research included focus group discussions and in-depth interviews with Ministry of Health (MOH) prenatal care health providers; pregnant women attending the MOH prenatal care services and their partners/spouses."

The objectives of the study were to "identify barriers and motivating factors related to behaviors around the HIV test during pregnancy among health providers, pregnant women, and their partners." Additionally, the social environment was considered in respect to the voluntary HIV testing of pregnant women. Part of the research examined barriers and enabling factors, both internal and external, in relation to the HIV test offered as part of the prenatal care package for pregnant women."

"The study revealed strong support to offer universal HIV testing to pregnant women. There is little resistance from the general public, prenatal care health providers, pregnant women and their spouses/partners to the offer of HIV testing during prenatal care. While there is strong support for HIV testing, knowledge levels of the probability of vertical transmission or of the advantages of HIV testing during prenatal care are very low. According to the findings, 82 % know that HIV test is the only way to know if someone is HIV positive and 96 % say that ALL pregnant women should be tested for HIV AIDS as part of prenatal care visits, after they were told that there is medication available that can reduce the vertical transmission of HIV AIDS."

The study also revealed that "there is very little knowledge of specific things that can help pregnant women who are HIV positive to reduce chances of vertical transmission. The vast majority expressed that an HIV positive mother and her child will soon die of AIDS. (In fact, about 1/3 of newborns of HIV positive women contract HIV, even if no treatment is given.

Some of the key research conclusions were considered positive because there was minimal resistance to HIV testing for pregnant women and "the barriers identified were controlled and resolved in the short term." The initial recommendations for ways to reduce vertical transmission of HIV/AIDS in El Salvador included these institutional factors:

• Improve logistics/ supplies to assure the availability of tests
• Dissemination of existing protocols/ establish referral protocols
• Improved quality of services, particularly the interpersonal elements surrounding voluntary testing and counseling
• Readjustment of counseling spaces to improve comfort and confidentiality
• Competency-based training in pre- and –post-test counseling
• Standardize practices to reduce stigmatisation
• Improve monitoring of test compliance to assure women get their test and return for results

Another set of key findings at the population level included the suggestion that "focused promotion to address specific concerns will yield better results than general promotion. " Suggested messages might focus on: "early detection of HIV in pregnant moms can help get treatment that significantly reduces vertical transmission." as one example.

The full report is available in Spanish only and can be obtained by emailing: Changeinfo@aed.org