Effects of Depression, Stigma and Intimate Partner Violence on Postpartum Women’s Adherence and Engagement in HIV Care in Kenya

Abstract

We explored the association between HIV-related stigma and experiences of intimate partner violence (IPV) and depression with viral load suppression, and medication and visit adherence in postpartum women receiving lifelong antiretroviral therapy (ART) (N = 200). We administered a cross-sectional survey to 200 women with HIV at 12 months postpartum who were enrolled in the MOTIVATE trial. The MOTIVATE study is a cluster-randomized trial evaluating the impact of community mentor mothers and text messaging on PMTCT outcomes in southwestern Kenya. Simple and multivariable logistic regression analysis was performed in STATA. Women who experienced stigma or IPV were more likely to miss clinic visits (internalized stigma aOR 1.30 95%CI 1.03-1.64; anticipated stigma aOR 1.20 95%CI 1.04-1.42; IPV aOR 15.71 95%CI 1.47-167.80), report difficulty taking ART drugs (internalized stigma aOR 1.32 95%CI 1.10-1.58; anticipated stigma aOR 1.14 95%CI 1.01-1.30) and not taking medication as prescribed (IPV aOR 2.00 95%CI 1.05-3.74). Depression was additionally associated with decreased odds of viral load suppression (aOR 0.16 95%CI 0.04-0.76). There is need to develop tailored psychosocial interventions within PMTCT programs that appropriately address mental health, stigma, and violence.

A qualitative study of the barriers and enhancers to retention in care for pregnant and postpartum women living with HIV

“…This was primarily driven by perceived and experienced stigma and fears of discrimination resulting from disclosure of their HIV status. This finding is supported by prior research in Kenya and the surrounding region [47,48]. This finding also underscores the importance of interventions to reduce barriers stemming from concerns about HIV-related stigma and disclosure.…”

“…This finding also underscores the importance of interventions to reduce barriers stemming from concerns about HIV-related stigma and disclosure. This includes interventions to enhance partner involvement in PMTCT, as well as psychosocial interventions to address mental health, stigma and domestic violence [48,49].…”

Global Systematic Review of Common Mental Health Disorders in Adults Living with HIV

“…PLWH from vulnerable groups such as perinatal WLWH, low-income WLWH, survivors of sexual assault, transgender and gender-nonconforming people, gay and bisexual men, MSM, prisoners, and migrants are particularly at risk of CMHD. In perinatal WLWH, experiencing internalized stigma significantly increased the odds of reporting depressive symptoms [72]. The psychosocial factors significantly associated with antenatal depression are IPV, unintended pregnancy, being unmarried, less stable social situation, or having lower social support [107].…”

Male partner involvement and successful completion of the prevention of mother‐to‐child transmission continuum of care in Kenya

“…Although not well studied within the context of PMTCT, there is some prior literature linking internalized HIV stigma with sub‐optimal PMTCT outcomes, including decreased likelihood of maternal testing for HIV, 27 missed clinic visits, 28 difficulty taking ART drugs, 28 not completing the full course of maternal ART, 27 and lack of HIV testing for infants 27 . The present findings build on these studies and indicate that not only is internalized HIV stigma an important independent predictor of successful PMTCT but that it also serves as an underlying mechanism in the relationship between MPI and positive PMTCT outcomes.…”