HIV disclosure and depressive symptoms among pregnant women living with HIV: a cross‐sectional study in the Democratic Republic of Congo

Abstract

Introduction: 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. Methods: 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. Results: 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. Conclusions: 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.

Depression during the COVID‐19 pandemic among people living with HIV: Are low HIV/AIDS stigma and high perceived emotional support protective resources?

“…Moreover, long‐term prospective research has found depression the most important predictor of poor treatment adherence (Gonzales et al., 2011; Rutakumwa et al., 2021), low health‐related quality of life (Pérez‐Chaparro et al., 2022; Rzeszutek & Gruszczyńska, 2018), faster HIV infection progression, and even increasing mortality in this patient group (Ickovicks et al., 2001; Namagga et al., 2021). However, the aetiology of depression is very complex, and various biological and psychosocial factors co‐occur as risk factors in this clinical sample, including potentially terminal diagnosis (Filiatreau et al., 2022; Leserman, 2003), challenges with HIV disclosure and related HIV/AIDS stigma (Kiene et al., 2018; Zotova et al., 2022), and the burden of life‐long treatment adherence and associated side‐effects (Borran et al., 2021; Fumaz et al., 2005). To make matters complicated, depressive symptoms may sometimes overlap with HIV infection symptoms (Cruess et al., 2003).…”

Development and Validation of a New Comprehensive Assessment Scale of HIV-Related Psychological Distress in China: A Methodological Study

“…For instance, disclosure is a critical first step in obtaining HIV-specific social support and, under some circumstances, can facilitate adherence to ART and improve engagement in care (Adeoye-Agboola et al, 2016; Li et al, 2016). Despite these positive outcomes, disclosure also carries significant risks because disclosure decisions are made in the context of acute HIV-related stigma, exposing PLWH to stigmatizing reactions (Aurpibul et al, 2022; Zotova et al, 2022). Thus, whether to disclose one's HIV status has been described as a dilemma.…”