CATIE News

13 April 2015 

Québec researchers call for interventions to support HIV-positive mothers

A team of researchers at several universities and clinics in Montreal conducted a study to explore issues related to healthcare access and mental health among HIV-positive mothers. In detailed interviews with 100 mothers, the researchers uncovered several issues that affected the women’s mental health. The team made recommendations for doctors, nurses and other care providers, which, if implemented, could greatly improve the mental health and wellbeing of HIV-positive women who have children.

Study details

Researchers from the following universities and in some cases their affiliated hospitals and clinics entered into collaboration:

  • Université du Québec à Montréal
  • McGill University
  • Université de Montréal

Hospital clinics and community-based agencies helped advertise the study.

On average, participants were 41 years old, had been diagnosed with HIV for 12 years and had two children. Nearly half of the women had an annual income of less than $20,000.

Results

Women reported having an average of four healthcare providers. (This can be common in some regions, particularly big cities, where there are many doctors available and women can make use of the services of a family doctor, infectious disease specialist, gynecologist and other specialists as needed.)

According to the researchers, overall, the women were “quite satisfied with the quality of communication with their healthcare providers and the services they provided.”

Barriers to care

The women told researchers that the most common barriers to accessing care were as follows:

  • concern about stigma—negative attitudes and behaviour toward HIV-positive people in the community
  • inability to access resources

The main sources of stigma identified by the women stemmed from the following:

  • consequences of disclosing HIV status
  • public attitudes toward people with HIV

Distress

Researchers found that about 45% of the women had symptoms of psychological distress. This figure is nearly twice as high as that reported for the average HIV-negative woman in Quebec. Furthermore, HIV-positive women with such distress reported more barriers to care, barriers to accessing care-related resources, and concerns about disclosure, and they tended to have what the researchers called a “negative self-image.”

The researchers stated that the prevalence of psychological distress was not explained by any of the following factors:

  • social and economic status
  • immigration status
  • duration of HIV infection

A background of concern and worry

The researchers reported that the women in the study had the following concerns regarding disclosing their HIV status (due to discrimination and other related issues): “controlling information, keeping secret one’s HIV status, and worrying that people who knew their status would tell others. The more [that] participants were living in fear of [their HIV status] being discovered and being hyper-vigilant about possible threats about [revealing] their HIV status, the more likely they were to be clinically distressed…”

Other barriers to care

The researchers found that the following factors acted as barriers to care:

  • inadequate housing
  • unemployment
  • a workplace environment that was insensitive to people living with HIV
  • financial stress

Recommendations from the researchers

Based on their findings, the researchers made the following recommendations:

  • Ideally, mothers with HIV should receive care from a multidisciplinary team, including family doctors, nurses, psychologists or psychiatrists, and social workers.
  • Healthcare providers should identify “patients [at] higher risk of psychological distress and refer such patients to mental healthcare providers.”
  • Psychologists, psychiatrists, social workers and other mental healthcare providers should “aim at [helping positive mothers develop] coping and resilience strategies to face the everyday challenges related to HIV management and stigma.”
  • To improve the quality of communication with patients, doctors should “take time to explain…test results (for example, CD4+ cell counts, HIV viral load, biopsy reports) and decisions regarding the choice of treatment in a language that is accessible to the patients, making sure that they fully understand their explanations.”

Furthermore, the researchers encouraged social workers to help HIV-positive mothers develop the knowledge and skills to access resources that address their basic needs, including the following:

  • food
  • stable housing
  • childcare assistance
  • clothing

If implemented, these recommendations could greatly improve the lives of mothers living with HIV in Quebec and elsewhere.

The present study was cross-sectional in nature; that is, participants were only interviewed at one point in time. However, this study should be seen as an important first step. A second future study that assessed and interviewed participants over several years could yield valuable information that could be used to assess the care needs of HIV-positive mothers.

Resource

HIV and emotional wellness – CATIE

—Sean R. Hosein

REFERENCE:

Blais M, Fernet M, Proulx-Boucher K, et al. Barriers to health care and psychological distress among mothers living with HIV in Quebec (Canada). AIDS Care. 2015 Jun;27(6):731-8.