Table 2 Key quotes from patients and key informants

Women’s knowledge of HIV/AIDS and PMTCT

Int-2

I only know one way, it’s through sex. When someone is positive and you have sex with him, you can get it.

KI-1

About PMTCT they [pregnant women] know almost nothing. A lot of explanations need to be given. (midwife)

Attitudes to, and perceptions, of HIV

KI-3

In Guinea-Bissau we view HIV as a bad thing…Those who have it will be very secretive, they would not tell anyone because of fear of discrimination. (female HIV awareness worker)

Int-27

(Int-27) When I told my younger sister that I tested positive she and my uncle told me to change house and find my own place to stay. They said I had to leave because they worried they could also get infected.

Experience of HIV counselling and testing for PMTCT

Int-14

I went directly to the delivery room and delivered. Then they [healthcare workers] pricked my finger… They didn’t ask for permission and they didn’t say why they are doing this. It is better to tell what it [the test] is for but it’s not a problem that they didn’t tell me

Int-21

They didn’t ask me to do the test…I think they did the test when I was asleep. They did it and then gave me the result, then they gave me some medicine.

Difficulties with counselling, testing and treatment

KI-4

We [midwives] try and talk to the patient with as few other people around as possible…We don’t have a counselling room, we talk to the patient when they come to deliver… I think counselling should take place at the antenatal clinic and when giving health advice…But most patients have not been to the antenatal clinic. (midwife)

KI-1

Some of them [women] don’t know what it [HIV] means... sometimes there is not enough time to talk, when the woman is ready to deliver we must work quickly…it is quite difficult to convince someone to take the test…I need more training for counselling and to provide psychological support. (midwife)

KI-6

When someone tests positive, and we are giving medicine to the mother and the child some people ask questions…they think something is wrong with that patient.

I repair episiotomies and I haven’t had a needle stick yet, I always take good care...I am careful because I know I can get it [HIV] that way…One must protect oneself, especially when you have a positive woman, you put two pairs of gloves and you make sure you disinfect your hands afterwards…It would be great if we had more money for testing and gloves. Because we often don’t know whether the woman is positive…if she is contaminated we must take extra care. (midwife)

Motivation for and against HIV testing

Int-8

They refuse because they live another life outside of marriage. Some of them are not faithful. Since I married I have only been with my husband.

Int-17

When you ask someone to do the test, and they refuse it is because they are afraid, afraid because she/he could have HIV because of their lifestyle

Int-25

Those who decline the test are those who do not want to live a good life

Int-24

Some women don’t want to test [for HIV] because of shame. If you are positive many people will say you are not faithful.

KI-9

The majority of women agree to testing once they understand that this [HIV testing] is done so that their child does not get sick. The issue is with their partner...women are afraid of losing their marriage, being left without funds, and don’t know how to tell their husband. To be honest, even with counselling, we had some husbands filing for divorce. (healthcare worker)

Customary and cultural beliefs in relation to HIV/AIDS

KI-10

Some patients have the idea that AIDS is something that comes from traditions…. people try to find a justification for getting ill with AIDS, for example that it is because of a ceremony they haven’t done. (healthcare worker)

Int-27

Many women say that when they are sick, their breast milk is not good. That’s why I believe my breast milk is not good for my baby.