Division of General Internal Medicine, Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA.
Department of Psychiatry, Michigan State University, East Lansing, Michigan, USA.
J Int AIDS Soc. 2022 Feb;25(2):e25865. doi: 10.1002/jia2.25865.
Disclosure of one's HIV status may decrease depression and improve the quality of life among people living with HIV. However, there is mixed evidence on the impact of disclosure to partners for pregnant women living with HIV (WLHIV) in areas of intersecting social concerns over disclosure and high prevalence of intimate partner violence (IPV). We assessed the association between HIV disclosure and depressive symptoms among pregnant WLHIV in the Democratic Republic of Congo (DRC) and examined whether the knowledge of partner's status or recent IPV modified this association.
We utilized data from participants enrolled in a trial to evaluate the effect of continuous quality interventions on long-term therapy outcomes among HIV-positive pregnant and breastfeeding women in DRC (NCT03048669). Only pregnant women (n = 1392) were included in this cross-sectional analysis. Between November 2016 and June 2019, enrolled participants completed a survey that included the Patient Health Questionnaire-9 (PHQ-9) to screen recent depressive symptoms, questions about disclosure, knowledge of partner's status and IPV. We used linear models to calculate crude and adjusted mean differences (MDs) between disclosure and depressive symptoms. All analyses were stratified by timing of HIV diagnosis.
Disclosure was higher among participants diagnosed prior to current pregnancy (41% to their partners and 24% to family, friends or others) relative to those diagnosed during current pregnancy (21% to partners and 12% to family). About one-quarter of women reported any type of IPV in the past 12 months. Disclosure to a partner was associated with lower depressive symptoms among women diagnosed prior to current pregnancy (MD -0.55; 95% CI: -1.06, -0.04) but the opposite was observed among those diagnosed during current pregnancy (MD 0.5; 95% CI: -0.4, 1.4). Adjustment for IPV, knowledge of partner's status, age, number of living children and primigravidae did not change MDs substantially.
Women in our sample mostly disclosed to partners despite high IPV burden. The observed association between disclosure to partners and lower depressive symptoms among women diagnosed prior to current pregnancy is consistent with cross-national evidence. A prospective study among pregnant WLHIV is needed to examine longitudinal effects of HIV status disclosure.
向他人透露 HIV 状况可能会降低 HIV 感染者的抑郁程度并提高他们的生活质量。然而，在存在着对公开性的社会关注以及亲密伴侣暴力（IPV）高发的交叉领域中，对于 HIV 阳性孕妇（WLHIV）向伴侣公开 HIV 状况的影响，证据不一。我们评估了在刚果民主共和国（刚果（金）），HIV 阳性孕妇向伴侣公开 HIV 状况与抑郁症状之间的关联，并研究了伴侣状况的了解或近期 IPV 是否会改变这种关联。
我们利用了一项评估在刚果民主共和国对 HIV 阳性孕妇和哺乳期妇女进行长期治疗结果的连续质量干预试验中参与者的数据（NCT03048669）。仅纳入了该试验中的孕妇（n = 1392）进行此项横断面分析。在 2016 年 11 月至 2019 年 6 月期间，入组的参与者完成了一项调查，其中包括患者健康问卷-9（PHQ-9），以筛查近期抑郁症状、与公开性相关的问题、伴侣状况的了解和 IPV。我们使用线性模型计算了公开性与抑郁症状之间的未经调整和调整平均差异（MD）。所有分析均按 HIV 诊断时间进行分层。
与当前妊娠期间诊断的参与者（向伴侣公开的比例为 21%，向家人、朋友或其他人公开的比例为 12%）相比，在当前妊娠前诊断的参与者中，向伴侣（41%）和家人（24%）公开 HIV 状况的比例更高。大约四分之一的女性在过去 12 个月中报告遭受过任何类型的 IPV。与当前妊娠期间诊断的参与者相比，在当前妊娠前诊断的参与者中，向伴侣公开 HIV 状况与较低的抑郁症状相关（MD-0.55；95%CI：-1.06，-0.04），而在当前妊娠期间诊断的参与者中，向伴侣公开 HIV 状况与较高的抑郁症状相关（MD 0.5；95%CI：-0.4，1.4）。调整 IPV、伴侣状况的了解、年龄、存活子女数量和初产妇状况并未显著改变 MD。
尽管存在着较高的 IPV 负担，我们研究中的大多数女性仍向伴侣公开了 HIV 状况。在当前妊娠前诊断的参与者中，向伴侣公开 HIV 状况与较低的抑郁症状之间的观察到的关联与跨国家的证据一致。需要对 HIV 阳性孕妇进行前瞻性研究，以检验 HIV 状况公开的纵向影响。
