The Burden of Prenatal and Postpartum Depression among Women Living with HIV in Kampala and Wakiso, Uganda

Abstract

Women and girls living with HIV aged 15+ who are fulfilling their sexual and reproductive desires of having children are increasing in number, which consequently results in high number of pregnant women living with HIV (PWLHIV). Being HIV positive during prenatal and postpartum periods while having complications exposes the women to double burden experiences. This because they have to deal with an HIV diagnosis which causes depression itself and at the same time dealing with the stress that comes with pregnancy and childbirth, which periods further heightens depression risks. The vulnerability to depression risks among prenatal and postpartum women living with HIV is worsened by worry of infecting the baby, caregiving stress, lack of support, economic incapacitation, consequences of disclosing their HIV status like stigmatization, partner abuse, among others. These emotional and social challenges during pregnancy and postpartum periods can increase stress, potentially worsening mental health and reducing women's quality of life if proper support is not provided. This study investigated the burden of prenatal and postpartum depression among women living with HIV in Kampala and Wakiso, Uganda. It sought to examine the prevalence of prenatal and postpartum depression among women living with HIV, assessed their prenatal and postpartum knowledge, explored their prenatal and postpartum experiences, examined the perinatal characteristics and depression levels among HIV- positive women, and assessed the relationship between prenatal and postpartum factors and depression among the women living with HIV. A mixed method approach was adopted using both quantitative and qualitative primary data collected for the study. The data collection was embedded in the biopsychosocial model, and the vulnerability-stress model. This was to provide a more holistic understanding of the women’s experiences during these critical stages. For the quantitative part of the study, a survey employing computer-assisted personal interviewing (CAPI) method was used to interview 497 women aged 15- 49 years who were currently pregnant and those who had currently given birth from The AIDS Support Organization (TASO) Mulago, Mildmay Uganda, and Mulago Specialised Women and Neonatal Hospital. Again, qualitative data were obtained from ten (10) pregnant women, eleven (11) women who had recently given birth, and six teen (16) key informants. Quantitative data was analysed using Statistical Programme for Social Sciences (SPSS) version 23.0, whereas qualitative data were analysed following Attride-Stirling's (2001) thematic analysis concept using ATLAS.ti. The findings of the univariate analysis, bivariate analysis, and multivariate indicate a significant general depression prevalence (64.4%) among women in Kampala and Wakiso, Uganda, regardless of their HIV status. However, women living with HIV displayed pronounced prenatal and postpartum depressive symptoms compared to HIV-negative counterparts. Furthermore, pregnant women living with HIV showed higher depressive symptoms compared to those who had recently given birth. Despite all the women having moderate knowledge about prenatal and postpartum depression mainly from social networks and health professionals, women living with HIV had higher knowledge of both. Furthermore, even though most women preferred professional help and treatment when depressed, some women preferred seeking informal remedies from traditional and faith healers. The study established the role of experiences during pregnancy and childbirth in influencing women's mental health in the study context. Positive experiences, such as financial stability and supportive family relationships, protected the women against depression. Conversely, negative experiences, such as complicated pregnancies, health complications, partner abandonment, and job loss, contributed to depression risk evidenced in the reported emotional and somatic depression symptoms like suicidal and homicide thoughts in some women, among other symptoms. Again, pregnancy plans and expectations played a significant role in women's mental health, with those with planned pregnancies experiencing partner support and overall happiness. However, unplanned pregnancies led to feelings of sadness and mixed emotions. Women living with HIV further faced challenges such as stigma, treatment adherence, and discrimination from healthcare providers. Factors that were statistically associated with prenatal and postpartum depression included HIV positive status, being in the age group of 15–24, lack of social support, food insecurity, having no dependents, multigravida status, complications after delivery, currently working, violence and abuse, and family alcohol use. Despite the increased risks of experiencing depression among women living with HIV during their prenatal and postpartum periods, diagnosing and treating the condition remains a challenge for healthcare providers. This is due to a lack of standardized procedures, gaps in mental health training, and excessive workloads, among other barriers. Therefore, this study recommends policy makers in collaboration with the Uganda’s Ministry of Health, health experts and partners into reproductive health, mental health and HIV/AIDS to design interventions and programmes that encourage the integration of routine screening for depression of prenatal and postpartum women in HIV care. This will enable early detection and intervention for women at risk for better maternal and child health outcomes.