Ethical decision-making with regard to children born HIV-positive in Kinshasa City, Democratic Republic of the Congo: Experience and expectations of those involved in the prevention of mother-to-child transmission

Abstract

Introduction HIV infection is a formidable pandemic with an incalculable impact. Pregnancy and HIV infection together create an immunobiological risk duo and a myriad of ethical conflicts throughout gestation and the birth of an exposed baby who may be HIV-positive. Purpose This study aims to understand the ethical decision-making process used by those involved in the Prevention of Mother-to-Child Transmission (PMTCT) of HIV. Methods An exploratory study based on grounded theory involved semi-structured interviews with twenty-one participants at Saint-Joseph General Hospital and Kintambo Maternity Hospital. Results The study identified two value conflicts experienced by the participants: interpersonal conflicts and intra-personal conflicts. Ethical decision-making involved not sharing information, stopping the maternity project, and analysing facts and possible decisions. Major factors influencing ethical decision-making included internal factors (lack of experience, personal values, non-exposure to ethical conflicts, attitude of silence) and external factors (economic aspects, non-existence of an ethics committee, and ignorance of ethical decision stages). Participants described levers such as sharing experiences, raising personal values, and peer education. Their expectations included male partner involvement, zero HIV-positive babies, access to inputs and medicines, open exchanges with others, state support, literacy campaigns, and better health for people living with HIV and their babies. Conclusion Ethical decision-making among PMTCT actors is predominantly individual rather than collective. The analysis reveals common points and underscores the need for ethical reflection among the actors.

Keywords

• Ethical decision-making
• HIV-positive progeny
• experience
• expectation
• PMTCT actors