My life as Mae Tid Chua [mothers who contracted HIV disease]: Motherhood and women living with HIV/AIDS in central Thailand

Pregnancy decision making among Thai women living with HIV: a grounded theory study: Pregnancy decision making amongst Thai women living with HIV

OBJECTIVE

this qualitative research study aims to understand and generate a model of the pregnancy decision-making process in Thai women living with HIV.

METHOD

the constructivist grounded theory of Charmaz was chosen as the research approach and method to generate a pregnancy decision-making process which is shaped and constructed by personal and social processes.

DATA COLLECTION

was undertaken in antenatal clinics (ANCs) at two provincial hospitals located in the Northeast of Thailand. In-depth semi-structured interviews were conducted with 15 HIV positive pregnant women. Data analysis involved open coding, making-memos and using the constant comparative method to develop a grounded theory substantive model of HIV pregnancy decision making.

FINDINGS

the substantive model consists of 6 categories; 1) concealing HIV positive status from partner; 2) desire to have a child; 3) becoming pregnant; 4) keeping or terminating pregnancy; 5) accepting the decision; and 6) adapting to the decision. This research finds that the main concerns women living with HIV have in deciding to have a child are balancing fear, concealing HIV status and the information that they have in each decision making step. Based on the research findings, a unique process of decision making has been found amongst these women that relates to personal and Thai social beliefs.

CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

the concept illustrates not only the process of decision making but also highlights the main stages, issues and concerns of women living with HIV wanting a child. This study recommends that health care providers need to pay more attention to counselling women and couples living with HIV by giving sufficient contraceptive information to prevent unplanned and unwanted pregnancy, to support and guide the women who want and plan for pregnancy, in advance of this happening, and helping women to deal with HIV disclosure issues related to morality and the rights of couples. Moreover, respect and support must be accorded to HIV positive women about their right to have a child if they choose to do so.

When Pregnancy Coincides with Positive Diagnosis of HIV: Accounts of the Process of Acceptance of Self and Motherhood among Women in South Africa

Literature has highlighted the unique period of vulnerability following an HIV diagnosis during pregnancy. Despite the high burden of HIV among pregnant women in South Africa, the experiences of women diagnosed with HIV during pregnancy have rarely been explored in isolation from those diagnosed at different times. This paper explored the experiences of women who were diagnosed with HIV when pregnant and assessed their emotional recovery beyond diagnosis. The study used a qualitative descriptive phenomenological approach to conduct interviews with women recruited from ART clinics in a health district in South Africa. Participants included 19 women sampled purposively. The interviews were transcribed verbatim and analysed following the thematic approach. Testing positive during pregnancy and being free of symptoms increased the shock, disbelief, and strong emotions exhibited. For the women, the diagnosis of HIV coincided with pregnancy and transformed pregnancy from excitement to anxiety. Although the transition from being HIV negative to becoming HIV positive and pregnant was overwhelming, with the passage of time, the women transitioned to feelings of acceptance. However, the process of acceptance was slow and varied, with some experiencing non-acceptance for extended periods. Non-acceptance of HIV diagnosis has serious adverse public health consequences for the individual. Integrating continuous HIV counselling and culturally appropriate psychosocial care into practice could foster acceptance for pregnant women with HIV diagnosis.

Experiences and predictors of psychological distress in pregnant women living with HIV

OBJECTIVES

To explore the experiences and predictors of psychological distress in pregnant women living with HIV.

DESIGN

A mixed-methods research design.

METHODS

A representative randomly sampled 840 (age range 22-46 years) HIV-positive pregnant women in Akwa Ibom, Benue, and Rivers States of Nigeria enrolled for the study. Data were collected using standardized questionnaires and in-depth interviews for 4 months and 3 weeks in 6 HIV treatment centres. Collected data were analysed using IBM SPSS statistics (v. 22.0) and thematic analysis.

RESULTS

The mean score on psychological distress was 17.07 ± 5.86. Multiple regression analysis found a significant joint prediction of meaning in life, self-compassion, and acceptance of illness on psychological distress, R = .64, R2  = .41; F (3,828) = 186.18; p = .000, with 41% variance explained. Further, there was a significant independent prediction of each predictor at meaning in life (β = -.19, t = -5.08; p = .000), self-compassion (β = -.23, t = -5.59; p = .000), and acceptance of illness (β = -.30, t = -7.23; p = .000), with acceptance of illness exerting the greatest independent predictive impact. Socio-demographic variables (age, length of living with HIV, high-risk state, highest education attained, marital status, and religious affiliation) had no significant contribution to psychological distress. Qualitative analysis found 'anxious concerns', 'depressive reports, loneliness, and regrets', 'self-blame and guilt feelings', as the experiences of psychological distress, and these experiences were determined by respondents' socio-cultural contexts.

CONCLUSION

These findings emphasize the importance of psychosocial care for HIV-positive pregnant women.

Motherhood among Black women living with HIV: A "north-south" comparison of sociocultural and psychological factors

We compared factors mediating motherhood experiences among Black nursing mothers living with HIV in two North American cities to one African city. Motherhood was measured with the Being a Mother Scale, and we compared their predictors between the two continents using difference in difference estimation within hierarchical linear modeling. Cultural beliefs congruent with infant feeding guidelines and social support had significant positive but differing effects on motherhood in the two continents. Perceived stress had significant negative impact on motherhood in the two continents. Due considerations to sociocultural contexts in policy development, HIV interventions and education of health care providers were recommended.

Parenting the child with HIV in limited resource communities in South Africa: mothers with HIV's emotional vulnerability and hope for the future

Introduction:

A diagnosis of HIV does not affect the well-being of mothers alone but also affects how they care for their children. The aim of this study was to explore how mothers who were diagnosed with HIV when pregnant or when their children became ill experience raising children living with HIV. The purpose was to understand how a diagnosis of HIV impacts mothering their children at different points on the mothering journey.

Methods:

Using descriptive phenomenological enquiry, interviews were conducted with 28 mothers recruited via purposeful sampling from clinics in health district in South Africa. The interviews were audiotaped, transcribed verbatim, and analysed following the thematic approach.

Results:

The mothers found mothering a child living with HIV stressful and associated with constant thoughts of death. The burden of mothering was increased for mothers who had to confront emotions of self-blame and guilt for unintentionally infecting the child. They used secrecy to protect their children from the social consequences of a diagnosis of HIV. The thought of living with HIV weighed on them every day and they expressed their experience of intense feelings of chronic worry, anxiety, and sadness. The findings identified high levels of stress, with the mothers expressing emotions suggestive of depression. With time, they accepted living with HIV and embraced motherhood, and became better mothers.

Conclusion:

The negative coping strategies used to deal with the child’s HIV diagnosis and high levels of stress and anxiety identified in the study underscore the need to address the psychosocial needs of mothers living with HIV. There is need to provide psychosocial support and continuous counselling for these mothers post diagnosis and upon a positive HIV diagnosis of the child to women enrolled in the prevention of mother to child transmission of HIV programme.

Experience of pregnancy and maternity by adolescents/young people born infected with HIV

OBJECTIVE

to understand the experience of pregnancy and motherhood by adolescents/young people who were born infected with HIV.

METHOD

we carried out a qualitative study specialized in HIV service in Porto Alegre (RS/Brazil). Ten adolescents/young people were interviewed from June 2017 to March 2018. Thematic analysis was performed, using a vulnerability framework to reflect about unplanned pregnancy and its implications for care.

RESULTS

four categories were highlighted: Discovery of the ongoing pregnancy: ambivalent feelings towards seropositivity; Breaking the news of the pregnancy to partner, family and health professionals; Experience of childbirth and prophylaxis of vertical transmission of HIV; and Experience of motherhood: implications for life stories and future projects.

FINAL CONSIDERATIONS

the study contributes to addressing situations of vulnerability to the occurrence of unplanned pregnancy, showing the need for dialogical proposals that respect human rights in the production of comprehensive care and reproductive planning.

Motherhood and HIV: reproductive desire, ambivalent feelings and a/an (not) offered care

OBJECTIVE

To identify in the scientific literature the feelings of women living with HIV in relation to reproduction and motherhood, as well as the care provided by health professionals regarding reproductive health as a right.

METHOD

Integrative review carried out in 2017, in the databases LILACS, PUBMED, BDENF and SciELO Virtual Library. We analyzed 30 articles.

RESULTS

As feelings, the motivation for reproduction and self-care, fears, uncertainties and hopes were evidenced. As care, services that support reproductive decisions were evidenced, but, predominantly, the disregard for the desire and care incipience for reproductive planning.

CONCLUSION

There is no comprehensive and humanized work on the reproductive issues of these women, either through the neglect of the desire and viability of gestation or by the incipient care to the ambivalent emotional experiences. There is a need to qualify the care model in order to configure it, in fact, as care, aiming at guaranteeing reproductive rights.

'I was told not to do it but…': Infant feeding practices amongst HIV-positive women in southern Thailand

BACKGROUND AND OBJECTIVES

mothers living with HIV are encouraged not to breastfeed as it can transmit HIV to their infants. However, there is little known about how Thai women with HIV perceive and experience their infant feeding practices. This paper explores the breastfeeding experiences among Thai women living with HIV in southern Thailand.

METHODS

semi-structured interviews and drawing methods were used with 30 HIV-positive women in rural communities of southern Thailand. Thematic analysis was used for data analysis.

FINDINGS

HIV-positive mothers had ambivalent feelings about not being able to breastfeed their infants. They perceived themselves as a 'contaminated mother'. Healthcare centres and hospitals supply free infant formula for HIV-positive mothers up to one and a half years. Despite this, many mothers had to deal with some difficulties. Some infants developed an allergy to the infant formula. The free infant formula was not sufficient for some infants and the mothers had to find alternative means for the well-being of their infants: many mothers relied on condensed milk whereas some fed mashed banana. The women made every effort to fulfill their ideology of being a good and responsible mother.

CONCLUSION

this paper contributes a conceptual understanding about the lived experiences of breastfeeding among women living with HIV in southern Thailand. The findings have implications for midwifery care and health policy. The provision of different options of feeding should be made available to infants along with accessible resources and professional support and guidance.