Screening for Traumatic Experiences and Mental Health Distress Among Women in HIV Care in Cape Town, South Africa
“Traumatic events can negatively affect clinical outcomes among HIV positive women, particularly when those events result in ongoing psychological distress. Consequently, there have been calls to integrate screening and treatment of traumatic experiences and associated mental health disorders into HIV care. In South Africa, screening for traumatic experiences and mental health is not a routine part of HIV care. […]
Participants [of this study] almost unanimously agreed that it would be appropriate and acceptable to screen all women in the clinic setting for trauma and mental health symptoms. […]
The high prevalence of traumatic experiences and psychological distress in this study highlights an urgent need to integrate screening into routine HIV care. The study provides evidence of the acceptability of screening for trauma and mental health symptoms among HIV positive women, at the critical points of care engagement when they are initiating ART or have defaulted on ART. In addition, there is need to link women screened to interventions and services, as part of trauma informed HIV care.”
Full text available on Sage Journals
Intimate partner violence (IPV) during or before pregnancy is associated with many adverse health outcomes.
Pregnancy-related complications or poor infant health outcomes can arise from direct trauma as well as physiological effects of stress, both of which impact maternal health and fetal growth and development.
Antenatal care can be a key entry point within the health system for many women, particularly in low-resource settings. Interventions to identify violence during pregnancy and offer women support and counselling may reduce the occurrence of violence and mitigate its consequences.
This research will provide much-needed evidence on whether a short counselling intervention delivered by nurses is efficacious and feasible in low-resource settings that have a high prevalence of IPV and HIV.
Source: BMC Health Services ResearchBMC series
Follow the project: BioMed Central
In low- and middle-income countries (LMICs), competing health priorities, civil conflict, and a lack of political will mean that expenditure on mental health is a fraction of that needed to meet the mental health care needs of the population.
For mothers, this treatment gap is most notable in regions where health agendas focus on maternal mortality indicators.
Who is at risk of perinatal mental health disorder?
Common mental disorders during pregnancy and in the first year after birth are associated with certain risk factors. These include poverty, migration, extreme stress, exposure to violence (domestic, sexual and gender-based), previous history of mental disorders, alcohol and other drug use as well as low social support.
In South Africa, there is a very high prevalence of adolescent pregnancies with 39% of 15- to 19-year old girls being pregnant at least once. When adolescent mothers suffer from depression, the likelihood of a subsequent teenage pregnancy nearly doubles.
How to address maternal mental illness among economically disadvantaged parents?
Integration of services!
Mothers in many settings are using maternal and child health services as well as social services. Thus, detection and access will increase if maternal health screening and services are integrated into these public care platforms.
How to implement a maternal mental health intervention in low-resource settings?
We are sharing our lessons learned in this learning brief.
We have also developed a Service Development Guidelines which demonstrates how to develop a mental health intervention at your facility, even with limited resources.
Find more free & open access resources for professionals on our website
And what about dads?
Postnatal depression can affect dads too. Find out about common concerns for new dads and discover helpful tips on how they can become more involved. We compiled a leaflet with information that could help you be better prepared for what is happening. The leaflets are available in
Prevalence and Risk Factors in South Africa
Violence against women is a global problem which exacts a high burden of suffering on millions of women and families, including women who are pregnant and postpartum.
In South Africa, studies have shown that 36-40% of pregnant women experience physical IPV, while 15-19% experience sexual IPV.
In this vulnerable population, IPV is associated with a range of physical and mental health consequences for the mother including pregnancy loss, depression and post-traumatic stress disorder.
South African data have suggested a direct link between violence and HIV infection, where HIV-positive women are more likely than HIV-negative women to have experienced physical violence perpetrated by their partner. Alcohol and other drug use have been identified as another risk factor for IPV during pregnancy, as intoxication may lead to irresponsible behaviour such as violence
In South Africa, the mortality rate attributed to IPV is the highest globally and is double that of the United States. For the infant, there are increased risks associated with preterm delivery and low birth weight.
Read our policy brief on violence against women in South Africa and how to break the cycle on our website
.. despite Prevention of Mother-To-Child Transmission (PMTCT) success in South Africa
article by Keith Alcorn @ ‘aidsmap’
Read the final paragraph of this sobering article. The PMHP asks why are mothers defaulting their antiretrovirals or not engaging with care?
Could the fact that more than one third have depression or anxiety have anything to do with it? Providing the testing and treatment protocols is not be enough. The health system needs to address the distress experienced by HIV positive pregnant women.
For the full article go to aidsmap
Differences between HIV-infected men and women in antiretroviral therapy outcomes – six African countries, 2004–2012
US Department of Health and Human Services Centers for Disease Control and Prevention (CDC)
Morbidity and Mortality Weekly Report (MMWR) – 29 November 2013
(republished on the SHARE website, 20 February 2014)
This analysis is an evaluation of differences between human immunodeficiency virus (HIV)-infected men and women in antiretroviral therapy (ART) enrollment characteristics and outcomes.
The studies include representative samples of adult men and women (aged ≥ 15 and ≥ 18) who initiated ART during 2004 -2010 in six countries in western (Côte d’Ivoire), southern (Swaziland, Mozambique and Zambia) and eastern (Uganda and Tanzania) Africa.
Proportionally more HIV-infected women than men access ART services in sub-Saharan Africa.
The study authors propose further research on country-specific causes for increased attrition and delayed initiation of care among men that may identify strategies to improve male enrolment, retention and programme outcomes.
Read the full article here