Pathways between intimate partner violence and HIV care and treatment during pregnancy and postpartum: A qualitative study in southwestern Kenya.

Intimate partner violence (IPV) is associated with suboptimal HIV treatment behaviors and health outcomes among perinatal women. Less is known about the postpartum phase or how distinct types of perinatal IPV exposure may inhibit HIV-related care. We conducted a qualitative study nested within an ongoing trial among perinatal women in rural Kenya to explore the influence of IPV on adherence to HIV treatment during pregnancy and postpartum. In 2022, a trained researcher fluent in Dholuo and Kiswahili conducted 23 semi-structured interviews with women up to 2 years postpartum living with HIV and self-reported IPV in their current relationship. Digitally recorded interviews were translated into English, transcribed verbatim, and thematically coded using deductive and inductive techniques. Nearly all women reported psychological and financial IPV, the majority reported physical IPV, half reported male controlling behaviors, half reported reproductive coercion, and many reported sexual IPV. Many women described a link between IPV and their adherence to perinatal HIV care and treatment. An indirect pathway was exhibited when psychological IPV heightened mental distress, leading to non-adherence through symptoms of depression and anxiety. A second path occurred when financial IPV and withholding food led to HIV treatment challenges. A direct pathway occurred when male partners sabotaged HIV treatment or controlled women's access to HIV care. In turn, women's evasion of IPV through leaving home or strategic non-disclosure had unanticipated consequences for their HIV treatment. Despite enduring IPV, many women described adhering to HIV treatment to sustain good health for themselves and their children. IPV-exposed women living with HIV described multiple ways a violent relationship was detrimental to maintaining their HIV treatment. To meet global goals to end vertical transmission of HIV and improve maternal and infant health, preventing and addressing IPV within maternal health settings should be prioritized in HIV programming.