Paper: A CONTENT ANALYSIS STUDY: CONCERNS OF INDONESIAN WOMEN INFECTED WITH HIV BY HUSBANDS WHO USED INTRAVENOUS DRUGS

A CONTENT ANALYSIS STUDY: CONCERNS OF INDONESIAN WOMEN INFECTED WITH HIV BY HUSBANDS WHO USED INTRAVENOUS DRUGS

Rita ismail, ismailr@u.washington.edu

Setting            : Jakarta

Analysis           :Content analysis;

Participant      : 12 Indonesian women, wives to husbands who are IDUs; 12 WLWH;

Aim of study   : describe the concerns of women infected with HIV by their IDU husbands.

Main themes  : 1) dealing with anger and being a dedicated wife,  2)going home to one’s parents as the only place to go, and 3) being strong and staying alive for their children

Ismail, Rita, 2018

Jakarta

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Interview of 12 WLWH Housewives of IDUs husband NGO’s based recruitment Content analysis

Dealing with anger and being dedicated wife View themselves as a good wives and mothers Caring their husband during his sickness

Going home to one’s parents as the only place to go Blaming by their parents to marry IDUs

Being strong and staying alive for their children Concern of their children, particulalry those who have children living with HIV

HIV education about risk of HIV for women, wives of IDUs Educate Husbands about their risk Nurse need to encourage women to get tested during pre natal care

Direct Quotation: 

Abstract

Few international studies document the concerns of women living with HIV (WLWH) who were infected by their intravenous drugs-using husbands. Our content analysis described the concerns of this population by analyzing 12 interviews with WLWH. There main concerns were discussed by the women; dealing with anger and being a dedicated wife, going home to one’s parents as the only place to go, and being strong and staying alive for their children. Dealing with their own emotional responses to the HIV diagnosis, lacking financial resources after their husband’s death, and remaining focused on staying healthy were major issues in their stories. Indonesia needs large-scale public HIV education campaigns about the risks women encounter as wives to husbands who use intravenous drugs as well as campaigns to educate husbands about their risks. Nurses need to encourage women to get tested during prenatal care to prevent infecting their children.

Introduction

Married women is vulnerable to get HIV from their husbands

In Jakarta, many women were infected with HIV as a result of heterosexual intercourse with husbands who are also injection drug users (IDU) and were unaware of their husband’s HIV status (Damar & du Plessis, 2010)

Housewives in Indonesia had the highest number of AIDS cases in 2016 (12,219) compared to other risk groups, such as sex workers (2,953), MOH 2017.

Women receiving an HIV diagnosis have usually been accused of practicing sex work or other ally been accused of practicing sex work or other culturally rejected sexual activities outside of marriage (Damar & du Plessis, 2010)

Pretend to be ‘normal’: Stigma and non-disclosure of HIV status among women

Being aware of the stigma that other people living with HIV have experienced in their communities has resulted in WLWH striving to keep their HIV status secret by disclosing the diagnosis the fewest people possible.

In 2009,  only 196 of 5,170 pregnant WLWH participated in ART (National AIDS Commission, 2010)

Aim of study: description of WLWH infected from their IDU’s husband

Purpose of our study was to describe the concerns of women infected with HIV by their IDU husbands.

Methods

Setting                        : Jakarta, Indonesia

Participants                 : 12 women living with HIV

Recruitment                : fliers that were distributed by staff of NGO related to HIV

Inclusion criteria         : self-identified as a woman infected with HIV by her IDU husband, spoke Indonesian, signed a consent to participate, agree to participate in digitally audio-recorded interviews

Exclusion criteria        : women were an IDU, had sex outside of marriage or were uncertain how they were infected with HIV

Data collection            :

Interviews were conducted in a private office and included only the interviewee and interviewer lasted between 60-90 minutes.

Interview guide were developed based on previous HIV studies and discussion with an expert on HIV

Data were stored in a password-protected computer and participant’s personal information was kept confidential

Data Analysis

Data import to ATLAS

Content analysis: open coding, category creation, and abstractions

Results

Demographic

Age of 30, mostly completed senior high school, monogamous marriage and not IDUs.

Marital status: five widows; three women were in their first marriages, and four were in their second marriage

5 housewife, 4 NGO employee, 1 employee, 1 own business, 1 kindergarten school teacher.

Number of children living with HIV: 7 woman with one HIV-positive child, one woman with two HIV-positive child, 4 with Free HIV child,

Concerns of women living with HIV

The concern of dealing with anger and being a dedicated wife

·      Being shocked and upset

·      Denial

·      Never practiced high-risk behaviours such as using drugs or having multiple sex partners

·      View themselves as good wives and mothers

·      Know their husband ‘IDUs’ before marriage (n-10)

·      5 knew their HIV during pregnancy, and their husbands had denied their HIV results

·      most participant (n-11) chose to stay married and care for their spoues

The concern about going home to parents as the only place to go

·      9 women lived with their husband before their husbands’ death

·      nine returned to their parent’s house

·      victim-blaming from their parents for getting married with husbands (n=5)

·      of the three participants whose husbands were still alive, two received from their husband’s families

The concern about being financially strong and staying alive for children

·      women’s concern: financial issues and their children’s health, and futures

·      concern on their children living with HIV

·      “if I died, who will take care of my children”

·      “for being able to take care of my children, I have to be strong, I have to survive”

·      the women were very concerned about their finances given that they single parents. They were concerned about caring for their children.