Quality of life and coping styles of HIV positive compared to HIV negative women in Zimbabwe participating in the prevention of mother to child transmission of HIV program

Abstract

Objectives: To describe the quality of life of women participating in the prevention of mother to child transmission of HIV (PMTCT) program and how it has influenced their coping towards risky sexual behaviors.

Methods: A cross-sectional study with a total of 273 women, 189(69%) HIV positive and 84(31%) HIV negative. These are women in their reproductive age ranging from 17 to 41 years, mean age of 27.7 years who delivered their index babies under the (PMTCT) program in Zimbabwe. A questionnaire was interview administered to the women from three months postpartum. The modified questions were derived from the Medical Outcomes Survey- HIV (MOS-HIV). This instrument is used to assess functional status and well-being, measuring subject perceptions of overall health, physical, role and social functioning and mental health. Coping was assessed according to Lazarus and Folkman’s concept of problem focused and emotion focused strategies and the available social supports. Risky sexual behaviors were assessed by asking about contraceptive use, condom use, future pregnancies, and disclosure of HIV status and knowledge of sexual partner’s HIV status.

Results: HIV infection risk increases with age with those above 24 years most infected 86% versus 46% for the younger women (p=<.01). Being single and formally employed exposed one to higher risk of HIV infection. Women were significantly compromised in mental health and family functioning domain, with the HIV positive reporting highest in the “poor” facet 43% (p=<.01), 45% (p=0.01) respectively. Among the HIV positive women, 22% did not use any contraceptive method versus 14% among HIV negative (p=<.01). Moreover as many as 47% HIV positive and 87% HIV negative women did not use condoms currently (p=<.01). 24% HIV positive had not disclosed status and 11% were divorced due to disclosure of status. 13% HIV positive women expressed desire to have more children versus 49% among HIV negative (p=<.01). Most available type of support was informational (p=0.01) with the family as the highest unit providing ongoing support 40% HIV positive versus 54% among HIV negative (p=0.03).

Conclusion: There is need to target interventions that address and promote mental well being and provision of adequate mental health services. The family unit needs to be strengthened and equipped with resources, so as to be able to cope with the demands of the HIV infected family members. Health education should be targeted on reduction of sexual risky behaviors by involving male partners. At antenatal booking male partners should be encouraged to be screened for HIV. Interventions that enhance women’s social networks and encouragement of health promoting behaviors should be developed and evaluated constantly for their effectiveness. There is need for further analysis, identifying barriers and facilitator’s women experience in practicing health promoting behaviors. Quality of life evaluation is an important outcome measure which can identify areas of need for the HIV positive people especially in poor resource countries where HIV laboratory markers are beyond the reach of many.