The Pregnancy Experience Among Women With HIV: A Literature Review

The 2018 UNAIDS data showed that 36.9 million people live with HIV. Of these, 4,400 cases found among adults (> 15 years old) and nearly 43% were women. In Sub-Saharan Africa, it was estimated that 24% of maternal deaths during prenatal or postnatal care were associated with HIV. Therefore, clinical attention is highly required during pregnancy and after delivery, particularly for those who are infected or at greater risk of HIV. This study aimed to determine pregnancy experience among women with HIV. PubMed and Proquest were used to search relevant articles from 2015-2018 by typing the keywords: “pregnant HIV” OR “pregnancy HIV” OR “HIV pregnant” OR “HIV pregnancy” AND “experience”. The inclusion and exclusion criteria was determined through: Population, Exposure, Outcome and Study Design (PEOS) framework, PRISMA flow diagram, data extraction and CASP, and mapping the findings. Of 378 selected articles, 7 articles were found to be relevant with the study objective. Using qualitative designs, the articles discussed the disclosure of HIV status that remained hidden. This was due to lack of courage, high level of violence, negative stigma in community and lack of support from health practitioners in providing information about HIV during pregnancy. Support from family and peers can prevent HIV ISSN 2354-7642 (Print), ISSN 2503-1856 (Online) Jurnal Ners dan Kebidanan Indonesia Tersedia online pada: http://ejournal.almaata.ac.id/index.php/JNKI INDONESIAN JOURNAL OF NURSING AND MIDWIFERY

. Pregnant who are infected with HIV need adequate prophylactic steps from prenatal, childbirth and post-natal care so that they require greater attention among health professionals (7)of which 187 infants were exposed and uninfected, 19 seroconverted, and 12 were still inconclusive in July 2015. Therefore, the overall vertical HIV transmission rate in the period was 8.7%. Most (71.6%. Pregnancy experience is different for everyone, through this period is believed to be a motivation for women infected with HIV as a belief that the role of motherhood is stronger so that it requires support from the people involved so that the burden of HIV becomes lighter (8). The purpose of this review literature is to summarize the findings of pregnancy experiences in women infected with HIV.

MATERIALS AND METHODS
The article is searched through the PubMed and Proquest database, entering terms according to purpose, using the Boolean operator to combine the same performing keywords for the two "pregnant HIV" OR "pregnancy HIV "HIV pregnant" OR "HIV pregnancy" AND experience* databases. inclusion at the time of the search was free full-text, data published in 2015 -2018 and in English amounted to 378 articles.The inclusion and exclusion criteria used Population, Exposure, Outcome and Study Design (PEOS), whose population was all women who had been pregnant positively HIV, the result is the experience of pregnancy with a design study that is relevant to the experience of pregnancy in HIV.  Pregnancy support and care for HIV women, and 3) Pregnancy expectations for HIV women.

Disclosure of HIV Status
Almost all participants conceal their HIV status from professional staff as well as partners/family and friends. Lack of disclosure about HIV status due to lack of courage and stigma, especially diaspora in the African community, domestic violence, poor relations and fears of being abandoned by a partner (11)(12)(13)16) and discrimination in society (13,15,16) if they reveal HIV status. Throughout pregnancy and breastfeeding participants are haunted by a fear of death before revealing their status, some participants experience rejection by a partner especially if the partner is tested negative (12), however, it is different for women who have revealed their HIV status to their family, especially to their partners, they get support especially in treatment (11,14).   (17) and the importance of partner involvement during pregnancy (18).

Women
In several studies it was reported that there was no support from a husband or partner and family in treatment (11)(12)(13)(14)16), such as a prohibition by a husband to take HIV drugs (14). and inadequate economic, preventing them from taking medication (13). Lack of support from health practitioners in providing health education and counseling especially pregnancy care and knowledge about HIV is a barrier to their adherence to treatment (11), and officers do not have much time to care about the anxiety that pregnant experience (15). Lacking social support causes them to tend to avoid and withdraw (23).
Participants consider pregnancy with HIV to be a dangerous disease and can cause death which will add to their concern if transmitting HIV to their baby (12,13,15,16).
Basically support from partners, family and peers, support from organizations, groups and service personnel was reported to be able to improve adherence to the use of ART in pregnant women (10)(11)(12)14,15)little is known about  (11,16). In other studies, long distance, low household income and living in a rural environment are significant factors associated with compliance with low utilization of PMTCT services (17). Ethiopia through its strategy by increasing household welfare through economic empowerment for women and increasing access to services in particular paying more attention to rural areas (27).
Some pregnant adhere to treatment during pregnancy and breastfeeding, but leave treatment after the weaning period (16), busy taking care of the baby and other responsibilities or maybe loss or death to the baby (11). Some participants who did not disclose their HIV status to partners managed to follow ART treatment during pregnancy (16), they are motivated because treatment gives them hope of having a baby who will be born HIV negative (10)(11)(12)(13)(14)(15). Disclosure of HIV status is significantly associated with improving treatment adherence, especially in HIV-positive pregnant women such as research in Nigeria (17), however, attitudes differ from studies in Saudi Arabia, more than 40% of them suggest that people living with HIV are negative and should be isolated (23).

Expectations of pregnancy in HIV positive women
According to their pregnancy experience with HIV, the hope for pregnancy at that time was to have a healthy baby free from HIV infection. this is the main motivation for women to start ART, they want to stay healthy and live longer so they can care for children (11), so have the chance to become parents (12) and fulfill her role as a mother (10)