“I Found Out I was Pregnant, and I Started Feeling Stressed”: A Longitudinal Qualitative Perspective of Mental Health Experiences Among Perinatal Women Living with HIV

Abstract

Globally, depressive symptoms among pregnant and postpartum (i.e., perinatal) women living with HIV (WLWH) are alarmingly high and associated with poor outcomes such as suboptimal adherence to antiretroviral therapy (ART), and early cessation of exclusive breastfeeding (EBF). Few qualitative studies have described the experience of perinatal depression among WLWH to identify the underlying social-structural determinants of poor mental health and potential strategies to intervene. We conducted a longitudinal qualitative study applying semi-structured interviews with 30 WLWH at three timepoints (28–38 weeks pregnant, 6-weeks postpartum and 5–7 months postpartum) to understand mental health experiences of perinatal WLWH in western Kenya. Financial insecurity emerged as the central theme impacting the mental health of women across time. Financial insecurity was often attributed to the loss of employment, related to pregnancy and the demands of breastfeeding and caring for an infant, as well as a lack of support from male partners. The loss of income and subsequent financial strain contributed to worsening levels of food insecurity and relationship stress and challenged engagement in HIV care. In this way, increased financial strain during the perinatal period negatively impacted the mental health of perinatal WLWH. Our findings suggest support to meet basic needs and remain engaged in HIV care during pregnancy and postpartum could improve perinatal mental health for WLWH in this setting.

Interventions to improve antiretroviral adherence in HIV-infected pregnant women: A systematic review and meta-analysis

“…This meta-analysis found that eSOC, eSOC with supporter, and device reminders positively improved medication adherence among pregnant HIV-positive women compared with standard care conditions. Pregnant women living with HIV are particularly vulnerable, with many factors influencing their medication-taking behavior ( 13 , 16 ). It has been found that poor knowledge of HIV/AIDS amongst pregnant women with HIV is associated with high transmission and delay in health-seeking behavior ( 49 ).…”

“…Multiple factors could lead to inadequate adherence to medication among pregnant women living with HIV, including depressive symptoms, financial dependence, morning sickness, social stigma, and caregiver burden (16)(17)(18)(19). Additionally, in resource-shortage regions, such as South Africa, non-disclosure of HIV serostatus to life partners was significantly associated with poor adherence during pregnancy (20).…”

Women want male partner engagement in antenatal care services: A qualitative study of pregnant women from rural South Africa

“…After repeated reading of transcribed semi-structured interviews, authors CMA, CM, and JH used principles from thematic analysis to independently code interviews in MAXQDA 2022 [ 22 ]. Interview analysis sought to explore the perceived relationship strength, if relationship strength impacted a woman’s interest in male partner engagement in ANC services, and how relationship strength impacted a woman’s preferred strategy to invite her male partner into ANC.…”

“…There has been considerable work in South Africa documenting how power differentials among young women and their male partners impact relationship behaviors [ 18 , 19 ], but this inequality also extends to older women and can worsen during pregnancy [ 20 ]. Power disparities between couples can exacerbate gender inequalities and hinder access to HIV testing and treatment, resulting in poorer health outcomes for both mother and child [ 10 , 21 , 22 ].…”

An Intervention to Improve Mental Health and HIV Care Engagement Among Perinatal Women in Malawi: A Pilot Randomized Controlled Trial

“…Perinatal depression (PND) is common among WLHIV and is an important barrier to ongoing engagement in HIV care [ 11 – 13 ]. PND is defined as onset of depression during pregnancy and/or within the first 3–6 months postpartum [ 14 , 15 ].…”