Reduced Adherence to Antiretroviral Therapy in Pregnant Women With HIV With Intimate Partner Violence in the United States

TL;DR

The study finds that pregnant women with HIV who experience intimate partner violence are less likely to adhere to their antiretroviral therapy, emphasizing the need to address violence in HIV care.

Contribution

This study is the first to show a direct link between physical intimate partner violence during pregnancy and reduced ART adherence in HIV-positive pregnant women in the US.

Findings

Physical intimate partner violence during pregnancy was strongly associated with reduced ART adherence (adjusted odds ratio = 0.10).

High rates of depression, stigma, and adverse childhood experiences were observed in pregnant women with HIV who experienced IPV.

Abstract

Despite increased access to antiretroviral therapy (ART) for women with HIV (WWH), poor postpartum HIV care retention persists. This analysis evaluates Intimate Partner Violence (IPV) and ART adherence in pregnant WWH.

We analyzed secondary data from a US behavioral intervention trial to improve postpartum retention in WWH. Data were collected from the baseline survey including the Edinburgh Postnatal Depression Scale (EPDS), adverse childhood experiences (ACE), and HIV-related stigma scores, and the WHO Violence Against Women questionnaire to assess IPV. A multivariable logistic regression examined associations between IPV timing (before, during pregnancy, any) and type (physical, psychological, sexual) and ART adherence (≥80% ART doses in the prior month).

A total of 137 pregnant WWH enrolled between March 2020 and March 2024 were included: mean age was 30.5 (SD 5.6); 83% were Black, 14% Hispanic; mean number of pregnancies was 3.3 (SD 2.1). Depression, stigma, and ACEs were prevalent: EPDS scores of ≥10 were seen in 45% of women, ≥4 ACEs in 23%, and 51% reported HIV-related shame. Forty women (29%) reported IPV exposure. Higher EPDS, ACE, and stigma scores were seen in women exposed to IPV (P < .02). Physical IPV during pregnancy had the strongest association with decreased ART adherence in pregnancy (adjusted odds ratio = 0.10, P = .02). Psychological IPV and any IPV type during or before pregnancy were also associated with lower odds of adherence.

We found high IPV rates and a significant negative association with ART adherence among pregnant WWH highlighting the importance of addressing IPV in HIV care.

Intimate partner violence (IPV) was significantly associated with reduced antiretroviral therapy adherence among pregnant women with HIV in the US. Findings highlight the importance of addressing IPV in HIV care.

Figures