Identifying the unique needs of HIV-positive pregnant women and HIV-positive new mothers in Brazil: a qualitative study
Background: The perinatal period presents an important time to study mental health and psychosocial needs of HIV-infected women for whom medical aspects of HIV infection are under control. Pregnant women and new mothers with HIV are at risk for problems due to neurotropic properties of HIV, psychological stressors of stigma, and knowledge that they have a disease with no known cure. While most research investigates issues that researchers select as relevant, this qualitative study identifies problems from the point of view of the women themselves.
Methods: Free Listing interviews, a method that asks respondents questions designed to elicit responses in the form of a list, were implemented. Respondents included HIV-infected (N=30 pregnant; N=25 new mothers) and uninfected women (N=20 pregnant; N=20 new mothers), recruited from maternity hospitals in Porto Alegre and Caxias do Sul, Brazil. Results were compared across respondent HIV-status. Interviewers were local students and nurses.
Results: Among pregnant women, both HIV-infected and uninfected women reported anxiety, depression and lack of support from family and friends. Unique to HIV-infected women were worries about HIV transmission, impact of ART on the fetus, and fears specifically about not being around to see the child grow up. Among new mothers, depression and anxiety, as well as the issues with social support, continued for both groups. HIV-infected new mothers also talked about challenges they face with not being able to breastfeed, including stigma and their feelings of self-worth as a mother.
Conclusions: Women in the perinatal period experience a wide range of mental health and psychosocial issues. Assuring adequate HIV-treatment in this period does not reduce the burden of these challenges and adds new ones specific living with HIV. Learning directly from the women themselves can improve our ability to develop locally appropriate and sustainable programs to reduce these problems.
J. Bass1, C. Alquati Bisol2, R.D. Sperhacke3, M. Paim Paganella3, A. Vazzano4, A. Mahvi5
1Johns Hopkins Bloomberg School of Public Health, Department of Mental Health, Baltimore, United States, 2Universidade de Caxias do Sul/UCS, Curso de Psicologia, Caxias do Sul, Brazil, 3Universidade de Caxias do Sul/UCS, LPHA - Laboratório de Pesquisa em HIV/AIDS, Caxias do Sul, Brazil, 4Johns Hopkins Bloomberg School of Public Health, Baltimore, United States, 5Johns Hopkins Bloomberg School of Public Health, Department of Population, Family, and Reproductive Health, Baltimore, United States