Department of Community Health Systems, School of Nursing, University of California, 2 Koret Way, San Francisco, CA, 94143, USA.
Global Programs, University of California, San Francisco, CA, USA.
AIDS Behav. 2021 Dec;25(12):4154-4168. doi: 10.1007/s10461-021-03283-z. Epub 2021 May 16.
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.
全球范围内，感染艾滋病毒的孕妇和产后（即围产期）妇女的抑郁症状令人震惊地高，与不良结局相关，如抗逆转录病毒治疗（ART）依从性差，以及过早停止纯母乳喂养（EBF）。很少有定性研究描述了 WLWH 围产期抑郁的经历，以确定不良心理健康的潜在社会结构决定因素和潜在的干预策略。我们在肯尼亚西部进行了一项纵向定性研究，对 30 名 WLWH 在三个时间点（怀孕 28-38 周、产后 6 周和产后 5-7 个月）进行了半结构式访谈，以了解围产期 WLWH 的心理健康体验。经济不安全是影响妇女心理健康的核心主题。经济不安全通常归因于失业，与怀孕以及母乳喂养和照顾婴儿的需求有关，以及缺乏男性伴侣的支持。收入的丧失和随之而来的经济压力导致粮食不安全程度恶化和关系紧张，并对参与艾滋病毒护理构成挑战。通过这种方式，围产期期间经济压力的增加对围产期 WLWH 的心理健康产生了负面影响。我们的研究结果表明，在怀孕期间和产后提供满足基本需求和继续参与艾滋病毒护理的支持，可以改善这一环境中 WLWH 的围产期心理健康。
