Coping with HIV: perspectives of mothers

Analysing the experience of motherhood among adolescents living with HIV

Aim

Adolescent motherhood is considered a condition of vulnerability that can be further complicated by the presence of HIV infection, but little is known about how adolescent mothers experience this process. The aim of this study was to analyse the experience of motherhood among adolescents living with HIV.

Method

Seven mothers (15-21 years) recruited in specialized services in Porto Alegre/Brazil, whose babies’ ages ranged from four to six months, were interviewed. Interviews were tape-recorded and transcribed verbatim.

Results

The qualitative content analysis of the interviews revealed a positive vision of motherhood, related to satisfaction with the maternal role and personal fulfilment. Pregnancy and motherhood served to these adolescents as an encouragement for self-care. The mothers’ difficulties were related to HIV and to the repercussions of this clinical condition, especially feelings of frustration and incompleteness of motherhood on the impossibility of breastfeeding, as well as fear facing the risk of MTCT.

Conclusion

Future research of longitudinal design and with larger samples will be important to extend the knowledge of the specificities of this experience over time for young people of different ages and social backgrounds.

HIV-infected mothers' experiences during their infants' HIV testing

Both survival with HIV and rates of perinatal HIV infection have significantly declined during the past decade, due to antiretroviral therapies that interrupt HIV transmission to the fetus and newborn. Although HIV is no longer routinely fatal to mothers or transmitted to fetuses, and the testing of newborns for HIV has been improved, evidence about HIV-infected mothers' experiences during the months of their infants' HIV testing predates these improvements. This qualitative study on 16 mothers was an analysis of interviews conducted several weeks after testing was completed and all infants had been determined to be uninfected. Mothers reported that their experiences evolved during the months of testing. Initial reactions included maternal trauma and guilt associated with infant testing. They then reported learning to cope with the roller coaster ride of repeated testing with the help of information from clinicians. By the end of the testing period, ambiguity began to resolve as they engaged in tentative maternal-infant attachment and expressed desire for a sense of normalcy. Need for support and fear of stigma persisted throughout. These findings expand current knowledge about this experience and suggest clinical strategies to guide HIV-infected women during this stressful period.

Psychosocial variables associated with coping of HIV-positive women diagnosed during pregnancy

To identify psychosocial variables related to the use of coping strategies by HIV-positive South African women diagnosed during pregnancy, structured interviews were conducted with 224 HIV-positive women at antenatal clinics over a period of 2 years. Two coping styles, active and avoidant coping, were assessed using an adapted version of the Brief COPE. Psychosocial variables associated with changes in coping over time were identified with mixed linear analysis. Increases in active coping were associated with decreasing levels of internalized stigma and depression, increasing self-esteem and positive social support, knowing someone who is living with HIV, being physically healthy and living above the poverty line. Increases in avoidant coping were associated with increasing internalized stigma and depression, lower levels of self-esteem, HIV-knowledge and lower levels of education. Recommendations are made for psychological support services to strengthen women's ability to cope and enhance their health and that of their infants.