Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda

Abstract

The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum.We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28–35], a median of 3 living children [IQR: 2–5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy makers, funders and program implementers to work together for the common cause. These consolidated efforts may not only lower the risk of psychological distress but has potential to create long lasting solutions to benefit the wider community.

The Role of HIV Stigma in ART Adherence and Quality of Life Among Rural Women Living with HIV in India

“…Women living with HIV (WLHIV) in Chile, South Africa, and Namibia experienced forced sterilization by providers wanting to limit mother-to-child transmission, highlighting widespread discrimination (50). A study of HIV-positive pregnant women in Uganda described high levels of perceived stigma and personal shame, which interfered with HIV care engagement and, coupled with fear of intimate partner violence and lack of family support, led to high levels of distress and limited disclosure (51). …”

A narrative systematic review of quantitative and qualitative evidence on the impacts of HIV on women living with HIV and their families in developing countries

“…The general characteristics of the included studies are presented in Table 1. Ten studies (11 articles) were conducted in Asia and the Pacific region, six in Africa (4,6,23,(33)(34)(35), one study (two articles) in Caribbean (11,12), and one study in both Zimbabwe and USA (36). Of the 20 articles, eleven employed face to face qualitative interviews (4,11,12,14,23,24,34,(37)(38)(39)(40).…”

“…This study aimed to explore the literature to improve our understanding of HIV impacts on and the mechanisms through which these impacts influence the life of WLHIV and their families, and how the impacts relate to each other. The need to understand this topic is important because of existing evidence of gendered high burden of disease on WLHIV especially those residing in developing countries compared to men or other key-affected populations (KAPs) (5,14,(21)(22)(23)(24)(25). It has also been stipulated that HIV impacts on men and other KAPs reported in previous studies might not be applicable to women (26)(27)(28).…”

Women’s healthcare decision-making capacity and HIV testing in sub-Saharan Africa: a multi-country analysis of demographic and health surveys

“…HIV testing among women is a challenge in SSA, especially among married women aged 15-49 [3,4]. Some of the challenges identi ed in some studies include but not limited to HIV-related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy, intimate partner violence, HIV and environmental structural barriers, distress and fear related to maternal and child health [3,5]. The few studies on this subject target individual women who access health services in speci c countries [6].…”