Understanding coping strategies during pregnancy and the postpartum period: a qualitative study of women living with HIV in rural Uganda

BMC Pregnancy and Childbirth

Research Article

Christina Psaros¹  Alexander C. Tsai¹  Scholastic Ashaba²  Angela Kaida³  Emma Dunkley³  Bridget Frances Burns⁴  Kasey O’Neil⁴  Lynn T. Matthews⁵  David R. Bangsberg⁶  Jasmine Kastner⁷ 

[1]Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA

[2]Harvard Medical School, Boston, MA, USA

[3]Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda

[4]Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada

[5]MGH Global Health, Massachusetts General Hospital, Boston, MA, USA

[6]MGH Global Health, Massachusetts General Hospital, Boston, MA, USA

[7]Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

[8]MGH Global Health, Massachusetts General Hospital, Boston, MA, USA

[9]Harvard Medical School, Boston, MA, USA

[10]Research Institute McGill University Health Centre Montreal, Montreal, Canada

关键词: Women;    HIV;    Pregnancy;    Postpartum;    Coping strategies;    Rural Uganda;   

DOI  :  10.1186/s12884-017-1321-9

 received in 2016-05-03, accepted in 2017-05-03,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundIn sub-Saharan Africa, 58% of adults living with HIV are women. In Uganda, HIV prevalence is 8.3% for women compared to 6.1% for men. Access to antiretroviral therapy (ART) and prevention of mother to child transmission (PMTCT) programs have enabled women living with HIV (WLWH) to have children with minimal risk of perinatal transmission. Nevertheless, pregnant WLWH face many challenges. We explored women’s perceptions of how they cope with the challenges of pregnancy and the postpartum period as HIV-infected women.MethodsWe conducted semi-structured interviews with postpartum WLWH accessing ART who had a pregnancy within 2 years prior to recruitment between February–August, 2014. Childbearing associated stressors and coping strategies were discussed. We used content analysis to identify major themes and NVivo 10 software facilitated data analysis.ResultsTwenty women were interviewed with median age 33 (IQR: 28–35) years, CD4 cell count 677 cells/mm3 (IQR: 440–767), number of live births 4 (IQR: 2–6), and number of living children 3 (IQR: 2–4.3). We summarize five identified coping strategies within a socio-ecological framework according to Bronfenbrenner’s Ecological Model. Coping strategies on the individual level included acceptance of self and HIV status, and self-reliance. On the interpersonal level, participants reported coping through support from partners, family, and friends. On the organizational level, participants reported coping through HIV-related healthcare delivery and system supports. At the community level, women reported coping through support from church and spirituality.ConclusionsThe results highlight coping strategies used by WLWH to manage the myriad challenges faced during pregnancy and the postpartum period. Intervention programs for WLWH must emphasize psychosocial care and incorporate strategies that address psychosocial challenges in the HIV care package in order to optimize well-being. Additionally policies that support networks of WLWH should be put in place and funding support should be provided through existing funding mechanisms in order to respond to the needs and challenges of WLWH. Programmes that support WLWH for economic empowerment and improved livelihoods should be strengthened across all regions in the country.

【 授权许可】

CC BY   
© The Author(s). 2017