[Attitudes and behavior of pregnant women towards HIV screening in Abidjan (Ivory Coast) in 1995 and 1996]. / Attitudes et comportements des femmes enceintes face au dépistage du VIH à Abidjan (Côte d'Ivoire), en 1995 et 1996. Raisons du refus du test et indifférence face aux résultats.

A research program into ways of reducing the maternal transmission of HIV (Project DITRAME, trial ANRS 049) was started in December 1994 in the maternity and child health clinics of the University Hospital and a community health center (Formation Sanitaire de Yopougon, FSU) in Abidjan. The first stage of this program was the introduction of voluntary HIV testing for pregnant women. During their first visit to the maternity clinic, all women were asked their age, how long they had been pregnant and where they were planning to give birth. Women over the age of 18, less than 32 weeks into gestation, who were planning to give birth in Abidjan were routinely offered an HIV test. Women who gave written consent to the test then gave a blood sample for HIV testing. Those testing positive for HIV were given posttest counseling and were invited to participate in a clinical trial of AZT. There were high rates of refusal to be tested and failure to return for posttest counseling during the first year of voluntary HIV testing. We therefore carried out a qualitative study of the reasons for refusal and failing to return. The study involved in-depth interviews with 50 pregnant women who refused to be tested and 50 others who missed the posttest appointment. Most of the women who refused to be tested thought they were probably HIV-positive. The main reason for refusing the test was the fear that the disease process would accelerate once they were informed of their HIV infection. Many women were also afraid of the reactions of their relatives, and particularly of their husband or partner, to a positive test result. There was also concern about possible breaches of confidentiality. Some women felt that pregnancy was not the best time to find out that they were HIV-positive. The reasons for not returning after testing were essentially the same, although some women were confused about the date of the appointment or did not understand the difference between standard prenatal blood test and HIV testing. Our study shows that even when most pregnant women accept the test, there are persistent problems. Some relate to the perception of HIV infection in Africa as "the disease" that cannot be cured, resulting in the view that there is no point in knowing that you are infected. Refusal to be tested is also associated with the socioeconomic vulnerability of women and their fear of exclusion. Means of reducing the maternal transmission of HIV will shortly become available in developing countries. Therefore, we need to address this problem and make voluntary HIV testing for pregnant women as widely available as possible.

Sociocultural aspects of AIDS in an urban peripheral area of Abidjan (Côte d'Ivoire).

This study aimed to gain a better understanding of the social dynamics--migration, urbanization, the status of women, education--related to AIDS in an urban peripheral area of Abidjan. Structured interviews were administered to 420 people, selected through cluster random sampling. Focus groups and semi-structured interviews were performed with key-informants. The results show that 26.9% of the interviewees are foreigners and 40% of all people interviewed participate in ethnic associations. Knowledge of AIDS is associated with age, gender, educational level and purchasing power. Those who are generally better informed about AIDS are: younger people; people with a higher education; and wealthier people. Men respond correctly to questions more frequently than women. French, the chosen language of the education campaigns, is not understood by 18% of the immigrants, and when considering only immigrant women, the figure increases to 38%. Particular attention should be paid to the design of health education messages and strategies for specific groups, such as non-educated people, women and immigrants. Care must also be taken to match the language used to the target population. Ethnic associations constitute an important starting point, particularly in relation to their use by immigrants, and these should be involved in educational programmes.