Ashaba Scholastic, Kaida Angela, Coleman Jessica N, Burns Bridget F, Dunkley Emma, O'Neil Kasey, Kastner Jasmine, Sanyu Naomi, Akatukwasa Cecilia, Bangsberg David R, Matthews Lynn T, Psaros Christina
Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda.
Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada.
PLoS One. 2017 May 1;12(5):e0176256. doi: 10.1371/journal.pone.0176256. eCollection 2017.
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.
感染艾滋病毒的女性在孕期面临诸多复杂情况，这使她们承受更多压力。设法在围产期将心理社会挑战降至最低，可能会使感染艾滋病毒的母亲及其子女的福祉最大化。本研究的目的是探讨感染艾滋病毒的女性（WLWH）在孕期和产后所经历的心理社会挑战。我们对从乌干达姆巴拉拉一项艾滋病毒治疗队列研究中招募的20名WLWH进行了个人深度访谈，这是一项探索围产期抑郁症的更大规模研究的一部分。我们进行了内容分析，以确定与WLWH在孕期和产后所面临挑战相关的主题。参与者的年龄中位数为33岁[四分位间距：28 - 35岁]，存活子女数中位数为3个[四分位间距：2 - 5个]，95%的人实现了艾滋病毒RNA抑制。挑战围绕以下主题展开：来自医护人员的与艾滋病毒相关的耻辱感、艾滋病毒感染状况披露困境、意外怀孕和亲密伴侣暴力、艾滋病毒与环境结构障碍以及与母婴健康相关的痛苦和恐惧。耻辱感主要集中在医护人员的歧视以及作为感染艾滋病毒的孕妇所伴随的个人羞耻感。这导致在接受艾滋病毒护理方面存在困难，特别是当与结构障碍（如缺乏前往诊所的交通）相结合时。参与者遭受亲密伴侣暴力，且缺乏伴侣和家庭成员的支持。由于母亲身体健康状况恶化，对未出生婴儿的健康状况感到痛苦和恐惧以及对其未来感到不确定的情况很常见。围产期对感染艾滋病毒 的女性来说是一个压力时期。感染艾滋病毒的女性所面临的挑战可能会影响她们成功接受艾滋病毒护理，并可能降低妇女及其子女的生活质量。旨在减轻感染艾滋病毒的女性所面临挑战的策略应涉及更大的结构环境，包括伴侣、家庭和社区成员以及政策制定者、资助者和项目实施者，共同为这一共同事业努力。这些共同努力不仅可能降低心理困扰的风险，而且有可能创造持久的解决方案，使更广泛的社区受益。
