Inclusion criteria
Exclusion criteria
Burmese migrant women living in Thailand
Acutely ill women (physical as well as in terms of mental health) or
Pregnant or had been pregnant and had either accepted or refused the HIV screening test and ARV prophylaxis in PMTCT (prevention mother-to-child transmission of HIV) program within the last year
Women with increased levels of vulnerability were not approached
Able to speak Thai sufficiently well to communicate with the interviewer
Women unable to speak enough Thai to communicate with the interviewer
20 years old and over (the legal age of consent in Thailand)
Women under 20 years old
Data collection was carried out by the first author, Pleumjit Chotiga, who had previous experience of working in these border areas of Thailand and was able to communicate effectively with the participants. They were interviewed in the Thai language, and all data was transcribed firstly in Thai and then translated into English in order to be coded and categorized.
The study took place with full consideration of the rights of human subjects; ethical approval was granted by the Faculty of Health Ethics committee of the University of East Anglia, UK, and local approval was gained for all the research sites in Thailand. All women gave consent either in writing or by thumb print. For those unable to read the information sheet and consent form, the researcher read the information to them and gave them a copy to take away so that a partner or friend could help them understand. Women who consented did so freely and in the knowledge that they could discontinue their involvement at any time without prejudicing their treatment or care. They were assured of confidentiality and that their data would be kept anonymous but could be used in reports that would help with service development and in academic publications. Although only 38 migrant women participants took part in interviews, two found that they were HIV-positive. The data from these two women are presented because they represent specific experiences of what it is like to know that a person has HIV when pregnant. They are useful in enabling us to understand some of the decisions that needed to be taken and ways in which they thought through their situations. Together with the data from the other women, they also provide insight into some of the specific health and information needs of this vulnerable group.
5 The Case Studies
Two participants had gone through the HIV testing process and learned about their HIV-positive diagnosis.
5.1 Case 1
Pornpen, a Bamar-Burmese woman, was 25 years old and 20 weeks pregnant at the time of the study. She came to Thailand with her parents when she was 5 years old and could not remember the reason for migrating. She was illiterate in both Thai and her language, Burmese. She was married previously and had a child with her first husband, who was Thai and had died, and she claimed that she did not know the cause of his death. She had brought up her son alone and then met her second husband last year. He had left her after she told him she was pregnant and had never come back. She was now living alone with her son and running the small laundry in her first husband’s house near the hospital.
Pornpen was diagnosed HIV-positive but did not know the HIV status of her husbands, and she could not tell which husband had infected her. She disclosed that her second husband had never stayed with her for long, and she supposed that he had had sexual affairs when he went away. Therefore, she decided to take a blood test because she wanted to know her HIV status and she knew that she had some risk factors. She was very scared of AIDS.
I would like to know whether I have got AIDS or not. My husband never stayed with me for long and I did not know whether he slept with someone else. He left me when he knew that I was pregnant. My previous husband died a few years ago and I did not know why he died.
She evaluated her decision to take an HIV test as the right decision. She revealed that she was very fearful and concerned about her baby’s health when she first knew about her HIV-positive result. She had been counseled by the nurse in the antenatal clinic, and she reported that she was informed about safe sex and the AZT drug. When she was offered AZT, she accepted it immediately because she was worried about her baby’s future. She was worried that no one would be around to look after her baby and the other child if she died.
After I knew that I had got AIDS, I decided to take the drug treatment because I feared that there would be no one to look after my children. I needed to take the treatment.
Thereafter, the doctor in HIV/AIDS clinic advised her about how to take AZT and when to take it. She knew that this AZT could prevent mother-to-child transmission of HIV, and she always asked for advice from nurses and doctors when she encountered any problems. She also reported that she had learned about the side effects of the treatment, and she had never had any problems with it. She intended to give her baby formula milk as advised by the health-care workers.
She told us that the health-care insurance was very useful and valuable for her because she did not have enough money to buy the drugs by herself. She usually paid only 30 Bahts [£0.50] per each hospital visit. Pornpen disclosed she felt unhappy and resentful particularly because she was alone. She revealed that her parents did not know her HIV status, and she thought that it was good that they now were living in Burma. Her 6-year-old child was HIV-negative.
She was hopeful that her baby would not suffer with HIV because the nurse had told her there was a strong possibility that treatment would prevent transmission of the virus to her unborn child. She felt very sure that her care was the same as Thai women in the same position.
5.2 Case 2
Nongnang, 28-year-old Burmese-Tai Yai woman, was diagnosed HIV-positive while her current husband received an HIV-negative result. She was told when she was 29 weeks pregnant (pregnancy usually lasts about 40 weeks).
She revealed that she had migrated to Thailand with her parents when she was very young and could not remember which area of Burma she came from. She did not have health insurance because her husband’s employer told them that they did not have the right to apply, so she had never thought to apply for it. She had since learned that she could apply and intended to do so although this would be difficult for her with her low levels of literacy. Her husband was employed as a part-time laborer [house painter] in a small building site while she was a housewife and sometimes worked as a part-time housekeeper. Her husband could earn 170 Baht (£3 UK or US$6) per day. At the time of the study, she needed to pay the full cost for health care which was around 100 Bahts (£1.65 UK or US$3) and pay for transportation 40 Bahts (£0.70 UK or US$1.2). She always expressed concern about the payments she would face for the costing of giving birth in hospital. She reported that she faced financial problems and sometimes had to borrow money from other people. She was illiterate in both Thai and her language, Tai Yai, but her husband had learned to write and read Thai while he was a Buddhist monk.
She had agreed to take a blood test because she thought that it was one of the routine processes involved in attending antenatal clinic. She mentioned that she knew all pregnant women had been offered it. Moreover, she wanted to know her HIV status. But, when she knew her HIV-positive result and was informed about the treatment to prevent MTCT of HIV, she decided to participate in this prevention program because of concern for her baby’s health and safety. And her husband encouraged her to receive the AZT drug because the treatment was free of charge.
In the post-counseling section, she was asked whether she could accept or not the coming result, and then she said that she could accept it. She told us that she was called to the private room and then she was asked by nurse that “will you be shocked or suicidal if I tell something to you” and then she answered that “why I need to do something like that” and confirmed that she would not do it because she thought that we have got just only one life.
She said she felt scared when talking about what happened when she first learned her HIV-positive result. She disclosed that at the early stage, she could not control her mind and had been stunned with fear. [She was crying when she reviewed her first emotion to the HIV-positive result.] She said to the health-care worker that she would like to tell the result to her husband by herself, but she did not tell him until he came to take the blood test.
When she knew that her husband was not HIV-positive like her, she was very sorry and surprised. After knowing the different results, her husband had never asked who she had been infected from. She assumed that it might be because he knew that she had never worked as a prostitute. She told how he took care of her and he always reassured and supported her. He usually reminded her when to take the treatment.
After she knew her HIV-positive result and was informed about the treatment to prevent MTCT of HIV, she decided to participate in this prevention program because of concern for her baby’s health and safety. Her husband encouraged her to receive the AZT drug because the treatment was free of charge. However, she did it due to the hope of living longer.
I did not know what it [the drug] is and what it can do for me. I took it because I hoped that I could live longer to look after my child.Stay updated, free articles. Join our Telegram channel
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