Despite the availability of HIV testing and counselling in antenatal care clinic settings, many HIV infected mothers in sub-Saharan Africa give birth in health facilities without knowledge of their own HIV status, thereby missing an opportunity to prevent the vertical transmission of HIV to their infants and to care for their own health. The study identifies system-related, social and behavioural reasons that pregnant women present themselves at labour wards with unknown HIV status and do not receive testing and counselling, either during labour or following delivery. Using primarily qualitative methods, a descriptive study was conducted in two districts in southern Malawi.The barriers identified in the study compelled women to refuse testing, hide results or develop strategies to keep their HIV status unknown or undisclosed. Understanding the dynamics and cultural boundaries that limit women’s access to testing is essential to improving this gateway to prevention of mother-to-child transmission care.

The Africa Initiative Discussion Paper Series presents policy-relevant, peer-reviewed, field-based research that addresses substantive issues in the areas of conflict resolution, energy, food security, health, migration and climate change. The aim of the series is to promote discussion and advance knowledge on issues relevant to policy makers and opinion leaders in Africa. Papers in this series are written by experienced African and Canadian researchers, and have gone through the grant review process, or, in select cases, are commissioned studies supported by the Africa Initiative research program.