Depression, alcohol use, and stigma in younger versus older HIV-infected pregnant women initiating antiretroviral therapy in Cape Town, South Africa

Abstract

Purpose HIV-infected pregnant women in sub-Saharan Africa are at risk for depression and alcohol abuse. Young women may be more vulnerable, but little is known about the psychosocial functioning of this population. Methods We compared younger (18–24 year-olds) and older (≥25 year-olds) HIV-infected pregnant women initiating antiretroviral therapy (ART) in Cape Town, South Africa. Women were assessed on a range of psychosocial measures, including the Alcohol Use Disorders Identification Test, and the Edinburgh Postnatal Depression Scale (EPDS). Results Among 625 women initiating ART, 16% reported risky alcohol use, and 21% alcohol-related harm; these percentages were similar across age groups. When younger women were stratified by age, 37% of 18–21 year-olds vs. 20% of 22–24 year-olds reported alcohol-related harm (p=0.02). Overall, 11% of women had EPDS scores suggesting probable depression, and 6% reported self-harming thoughts. Younger women reported more depressive symptoms. Report of self-harming thoughts was 11% in younger and 4% in older women (p=0.003). In multivariable analysis, age remained significantly associated with depressive symptoms and report of self-harming thoughts. Level of HIV-related stigma and report of intimate partner violence modified the association between age and depressive symptoms. Conclusions Young HIV-infected pregnant women in South Africa were more likely to report depressive symptoms and self-harming thoughts compared to older women and the youngest women reported the highest levels of alcohol-related harm. HIV-related stigma may be a moderating factor. These findings have implications for maternal and infant health, underscoring the urgent need for effective targeted interventions in this vulnerable population.

Optimizing Antiretroviral Therapy (ART) for Maternal and Child Health (MCH): Rationale and Design of the MCH-ART Study

“…21 Phase 1 data also demonstrated the discordance between depressed CD4 cell count and elevated viral loads in women not yet on ART—with a substantial proportion of women with viral load >10,000 copies per milliliter despite CD4 cell counts >350 cells per microliter—an important finding that speaks to the limitations of CD4-based ART eligibility for PMTCT programs. Other analyses have shown high levels of unintended pregnancy, 22 intimate partner violence, 23 and mental health problems among HIV+ women in this setting, 24 raising important concerns for long-term PMTCT outcomes.…”

Maternal Morbidity and Co-morbidity During and After Pregnancy in Women in Low- and Middle-Income Countries: A Systematic Literature Review

“…Nine studies assessed <500 women per study ; [22][23][24][25][26][27][28][29][30][31][32][33][34] thirteen studies assessed 500-999 women per study. 13,16,18,19,[35][36][37][38][39][40][41][42] Nine studies assessed 1000-1999 women per study; 17,20,25,26,[43][44][45][46][47] and five studies had a sample size of ≥2000 women ( Supplementary Table 2). 6,23,24,48,49…”

“…19,29,32,33 In 11 of the 23 studies, the gestation was not given . 31,35,37,38,40,41,42,43,44,47,48 Seven studies assessed women within 12 weeks of childbirth. 16,20,27,28,34,,45,49 In one study, data was collected at three stages after childbirth: at 4-12 weeks; at 12-24 weeks; and at 24-56 weeks.…”

“…13,16,35,38,46 For four studies the site was unclear. 27,31,33,41 In 12 studies, data collection took place in the community or home of women ( Supplementary Table 2). 6,17,18,20,22,28,36,39,41,44,45,48,49 Data collection…”

“…All three types of maternal morbidity including physical, psychological and social ill-health were assessed in 12 studies; 6,13,14,18,38,40,31,42,45,47 psychological and social ill-health were assessed in nine studies; 16,23,27,29,30,33,34,38,41 physical and psychological ill-health in 11 studies; 17,19,20,22,25,27,30,31,48 and physical and social ill-health assessed in six studies ( Supplementary Table 2). 15,43,44,46,49…”