People living with HIV are at a heightened risk of stress and mental health concerns. This is especially true of women living with HIV, who have their own unique set of stresses and risks. Are healthcare professionals sufficiently meeting these needs to help these women live better, healthier lives?
A recent study in the Journal of the International Association of Providers of AIDS Care examined the unique mental health concerns of women who live with HIV, and how they are often unmet and undertreated.¹ What are some of the specific mental health needs healthcare providers and nurses should be addressing in these patients?
1. Post-Traumatic Stress Disorder
The researchers note that in addition to living with HIV, these women often have high rates of exposure to traumatic events in their lives, including traumatic partner abuse. These women may experience post-traumatic stress disorder (PTSD) at 5 times the rate of women among the general population. If left untreated, PTSD can be devastating to a person’s mental well-being, which can in turn be very detrimental to an immunocompromised person’s physical health. Medical professionals working with these women may find it necessary to recommend treatments such as group therapy and cognitive behavioral therapy.
2. Depressive Disorders
In addition to the previously mentioned traumas, women with HIV find themselves at risk for other stressors, including stigma, discrimination, loss of social support, and difficulty obtaining mental health services.² These other stressors can make deteriorating mental health even worse; the researchers note that the rates of major depressive disorder diagnoses are 4 times higher in women with HIV than in women without HIV. Women with HIV also have more anxiety symptoms. The researchers also note that the way HIV induces immune activation in the brain has the potential to exacerbate symptoms of depression. The researchers conclude that more options for psychosocial intervention, including ones that specifically focus on depressive disorders in women with HIV, are needed.
3. Internalized Stigma
Because of the stigma surrounding the disorder, women living with HIV can experience internalized stigma. Internalizing HIV stigma, the researchers note, correlates with more severe symptoms of depression and a worse mental adjustment to HIV management. They also found that internalized stigma, along with severe depressive symptoms, was associated with lower adherence to antiretroviral therapy (ART).
4. Mental Health Risk in Vulnerable Communities
Many unmet mental health needs are also due to the added stigma of how many women living with HIV are from vulnerable communities and racial minorities. In 2018, Black people made up 13% of the US population, yet they accounted for 42% of new HIV diagnoses in the United States.³ Women who are members of racial or ethnic minorities and who are living with HIV report higher levels of stress, in part due to the heightened stigma they face.
Transgender women also face heightened stigma and experience HIV at higher rates. A 2019 review suggests 14% of transgender women live with HIV.⁴ Transgender women are also at a higher risk of traumatic experiences and depressive symptoms. Healthcare providers who work with women with HIV may want to educate themselves about transgender issues and the unique healthcare needs of these patients to better treat this underserved and high-risk population.
5. Postpartum Depression
Pregnancy and the postpartum period can be a very vulnerable time for the mental health of women living with HIV. During this time, they can be at high risk for anxiety, depressive symptoms, and postpartum psychosis. These women also remain at risk of trauma and abuse during pregnancy, and pregnant women with HIV who have experienced violence at the hands of their partner may be less likely to adhere to their ART regimen.¹ The researchers conclude that mental health treatment for pregnant women with HIV has primarily focused on mother-to-child transmission, and that more support is needed for these patients.
- Waldron EM, Burnett-Zeigler I, Wee V, et al. Mental health in women living with HIV: the unique and unmet needs. J Int Assoc Provid AIDS Care. 2021;20:2325958220985665. doi:10.1177/2325958220985665
- HIV/AIDS and mental health. National Institute of Mental Health. https://www.nimh.nih.gov/health/topics/hiv-aids/index.shtml. Updated November 2020. Accessed March 11, 2021.
- HIV and African American people. US Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/racialethnic/africanamericans/index.html. Reviewed January 20, 2021. Accessed March 11, 2021.
- HIV and transgender people. US Centers for Disease Control and Prevention. https://www.cdc.gov/hiv/group/gender/transgender/index.html. Reviewed November 12, 2019. Accessed March 11, 2021.