Mechanisms linking intimate partner violence and prevention of mother-to-child transmission of HIV: A qualitative study in South Africa

Prevention of mother-to-child transmission (PMTCT) can virtually eliminate HIV infection among infants, yet up to one-third of women miss PMTCT steps. Little is known about how partner dynamics such as intimate partner violence (IPV) influence pregnant and postpartum women's adherence to PMTCT....

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Published in:	Social science & medicine (1982) Vol. 168; pp. 130 - 139
Main Authors:	Hatcher, A.M., Stöckl, H., Christofides, N., Woollett, N., Pallitto, C.C., Garcia-Moreno, C., Turan, J.M.
Format:	Journal Article
Language:	English
Published:	England Elsevier Ltd 01-11-2016 Pergamon Press Inc
Subjects:	Acquired immune deficiency syndrome Adherence Adult AIDS Children Coping Disease prevention Domestic violence Female Females Health Behavior Health services HIV HIV Infections - prevention & control HIV Infections - psychology HIV Infections - transmission Human immunodeficiency virus Humans Identity Infants Infectious Disease Transmission, Vertical - prevention & control Intimate partner violence Intimate Partner Violence - psychology Johannesburg South Africa Males Maternal & child health Mental health services Mothers Pediatrics Perinatal Pregnancy Prevention Psychological distress Qualitative Qualitative Research Self destructive behavior Self disclosure Sex roles Social support Software South Africa Suicides & suicide attempts Surveys and Questionnaires Violence Well being South Africa Johannesburg South Africa Adherence Perinatal South Africa HIV Qualitative Intimate partner violence
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Summary:	Prevention of mother-to-child transmission (PMTCT) can virtually eliminate HIV infection among infants, yet up to one-third of women miss PMTCT steps. Little is known about how partner dynamics such as intimate partner violence (IPV) influence pregnant and postpartum women's adherence to PMTCT. We conducted 32 qualitative interviews with HIV-positive pregnant and postpartum women in Johannesburg who experienced IPV. Trained researchers conducted in-depth interviews over the period of May 2014–Nov 2015 using narrative and social constructionist approaches. Interviews were transcribed verbatim and analyzed thematically and inductively using Dedoose qualitative software. Twenty-six women experienced recent IPV and one-third had poor adherence to PMTCT. Women's experience of partner violence influenced PMTCT behaviors through four pathways. First, fear of partner disclosure led some women to hide their HIV status to avoid a violent reaction. Despite strategic non-disclosure, several maintained good adherence by hiding medication or moving out from their partner's home. Second, IPV caused feelings of depression and anxiety that led to intentionally or accidentally missing medication. Five women stopped treatment altogether, in a type of passive suicidality, hoping to end the distress of IPV. Third, men's controlling behaviors reduced access to friends and family, limiting social support needed for good adherence. Fourth, in a protective pathway, women reported good adherence partly due to their mothering role. The identity around motherhood was used as a coping technique, reminding women that their infant's wellbeing depended on their own health. PMTCT is essential to prevent vertical HIV transmission, but women living with IPV face multiple pathways to non-adherence. Addressing IPV in antenatal care can support the health of women and infants and may enhance PMTCT coverage. •First robust qualitative work among women living with both HIV and intimate partner violence (IPV).•Identifies mechanisms through which IPV alters pregnant women's HIV treatment adherence.•Reveals that IPV-related depression can lead women to intentionally stop HIV medication.•Shows how partner non-disclosure can be a safety strategy for women in violent relationships.•Uncovers how ‘motherhood’ identity may help women adhere to medication despite IPV.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0277-9536 1873-5347
DOI:	10.1016/j.socscimed.2016.09.013