Does HIV matter when you are poor and how ? : the impact of HIV/AIDS on the psychological adjustment of South African mothers in the era of HAART
Doctoral Thesis
2007
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University of Cape Town
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Abstract
The study investigated the psychological adjustment of HIV -infected South African mothers living in poverty in the era of HAART. One hundred and eighty adult women living in long-term poverty who were the primary caregiver of at least one child under 18 years were administered a structured questionnaire. The sample comprised infected women (n=130), some but not all of whom were on antiretroviral therapy, as well as a comparison group of non-infected women from the same community (n=50). Of those who were receiving antiretroviral therapy (n=80), half had just commenced treatment and half had been on treatment for six months. In addition, five women were selected as case studies and followed up with in-depth interviews for six months. Data were analysed using analysis of variance, planned comparisons and multiple regression, and narrative analysis respectively. Results showed that HIV status had a significant, independent impact on levels of depressive symptoms but not anxiety. HIV positive women exhibited significantly more symptoms of depression and anxiety than seronegative women, regardless of their stage of disease. An irregular household income, poorer perceived physical health and the use of avoidant coping predicted higher levels of depressive symptoms amongst infected women, while less active coping and greater avoidant coping predicted higher levels of anxiety. Avoidant coping was the best predictor of levels of depression and anxiety amongst women, independent of HIV status. When assessed at six months after commencing treatment, antiretroviral therapy had had no impact on anxiety. However, levels of depression were lower than amongst women who had just commenced treatment. Qualitative data of women's own accounts supported the role of HIV in psychological distress, but pointed to poverty as an underlying narrative through which women's experiences of living with HIV were continually filtered. While HIV was sometimes the source of disruption and disturbance, it typically lacked salience in the presence of HAART and for women who were relatively asymptomatic, particularly given the substantive poverty-related stressors that women faced on an ongoing basis. Key findings indicated that HIV status contributed to the mental health burden experienced by women living in poverty, and that longer-term use of antiretroviral therapy was associated with reduced depression. Since avoidant coping was the best predictor of poor psychological adjustment, it may be an appropriate focus for future targeted mental health interventions for this population group. However, the fact that poverty had considerable, and even greater, salience for women at times, should also inform the planning and provision of services.
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Includes bibliographical references (p. 262-304).
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Brandt, R. 2007. Does HIV matter when you are poor and how ? : the impact of HIV/AIDS on the psychological adjustment of South African mothers in the era of HAART. University of Cape Town.