Kira DiClemente-Bosco1, Alison Z Weber2, Abigail Harrison3, Nokwazi Tsawe4, Zanele Rini5, Kirsty Brittain6, Christopher J Colvin7, Landon Myer8, Jennifer A Pellowski9. 1. Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St, Box G-S121-3, Providence, RI, 02912, USA. Electronic address: kira_diclemente@brown.edu. 2. Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St, Box G-S121-3, Providence, RI, 02912, USA. Electronic address: alison_weber@brown.edu. 3. Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St, Box G-S121-3, Providence, RI, 02912, USA. Electronic address: abigail_harrison@brown.edu. 4. Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Falmouth 3.46, UCT Health Sciences Campus, Observatory, Cape Town, 7925, South Africa. Electronic address: lizizikazi@gmail.com. 5. Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Falmouth 3.46, UCT Health Sciences Campus, Observatory, Cape Town, 7925, South Africa. Electronic address: zanele.rini@gmail.com. 6. Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Falmouth 3.46, UCT Health Sciences Campus, Observatory, Cape Town, 7925, South Africa. Electronic address: kirstybrittain@gmail.com. 7. Division of Social and Behavioural Sciences, University of Cape Town School of Public Health and Family Medicine, Falmouth 3.46, UCT Health Sciences Campus, Observatory, Cape Town, 7925, South Africa; Public Health Sciences, University of Virginia, 200 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA; Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St, Box G-S121-3, Providence, RI, 02912, USA. Electronic address: coldvine@gmail.com. 8. Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Falmouth 3.46, UCT Health Sciences Campus, Observatory, Cape Town, 7925, South Africa. Electronic address: Landon.Myer@uct.ac.za. 9. Department of Behavioral and Social Sciences, Brown University School of Public Health, 121 South Main St, Box G-S121-3, Providence, RI, 02912, USA; Division of Epidemiology and Biostatistics, University of Cape Town School of Public Health and Family Medicine, Falmouth 3.46, UCT Health Sciences Campus, Observatory, Cape Town, 7925, South Africa. Electronic address: jennifer_pellowski@brown.edu.
Abstract
RATIONALE: Adherence to antiretroviral therapy (ART) is a global concern among pregnant and postpartum women living with HIV (WLHIV). Research focusing on peripartum WLHIV and how they balance adherence, engaging in HIV care, and other forms of self-care is limited. Women's empowerment theories have been applied to myriad health behaviors to understand patterns, establish mechanisms, and develop interventions; yet empowerment theory as applied to ART is under-researched. OBJECTIVE: Seeking deeper insight into peripartum health behaviors, we examine these factors using Naila Kabeer's (1999) women's empowerment theory, which denotes resources, agency, and achievements as three primary and interrelated components of empowerment. METHODS: Data were collected in Gugulethu, South Africa, between March and July 2018. Thirty in-depth interviews were conducted with WLHIV at 32-35 weeks of pregnancy, with topics including experiences related to ART adherence and meanings of empowerment in motherhood. Analyses had two phases: (1) inductive open-coding for emergent themes; and (2) classifying themes into Kabeer's empowerment theory. RESULTS: Participants expressed that resources play a critical role in adherence, ranging from practical support to motivational support provided by both family and partners. Agency is experienced as a desire to be an independent mother in the often-expected event that partners withdraw support. Participants described achievements as time-oriented goals, ranging from having a baby born without HIV to living a long and productive life. CONCLUSIONS: These findings suggest that a promising and innovative approach to improving ART adherence across the peripartum transition would focus on understanding resources as an enabling environment, build on existing feelings of agency, and highlight the lifelong goals achievable with high levels of adherence. A better understanding of how women's empowerment evolves over the course of pregnancy and into the postpartum period will support intervention development aimed at improving ART adherence and potentially additional peripartum health behaviors.
RATIONALE: Adherence to antiretroviral therapy (ART) is a global concern among pregnant and postpartum women living with HIV (WLHIV). Research focusing on peripartum WLHIV and how they balance adherence, engaging in HIV care, and other forms of self-care is limited. Women's empowerment theories have been applied to myriad health behaviors to understand patterns, establish mechanisms, and develop interventions; yet empowerment theory as applied to ART is under-researched. OBJECTIVE: Seeking deeper insight into peripartum health behaviors, we examine these factors using Naila Kabeer's (1999) women's empowerment theory, which denotes resources, agency, and achievements as three primary and interrelated components of empowerment. METHODS: Data were collected in Gugulethu, South Africa, between March and July 2018. Thirty in-depth interviews were conducted with WLHIV at 32-35 weeks of pregnancy, with topics including experiences related to ART adherence and meanings of empowerment in motherhood. Analyses had two phases: (1) inductive open-coding for emergent themes; and (2) classifying themes into Kabeer's empowerment theory. RESULTS: Participants expressed that resources play a critical role in adherence, ranging from practical support to motivational support provided by both family and partners. Agency is experienced as a desire to be an independent mother in the often-expected event that partners withdraw support. Participants described achievements as time-oriented goals, ranging from having a baby born without HIV to living a long and productive life. CONCLUSIONS: These findings suggest that a promising and innovative approach to improving ART adherence across the peripartum transition would focus on understanding resources as an enabling environment, build on existing feelings of agency, and highlight the lifelong goals achievable with high levels of adherence. A better understanding of how women's empowerment evolves over the course of pregnancy and into the postpartum period will support intervention development aimed at improving ART adherence and potentially additional peripartum health behaviors.
Authors: Khangelani Zuma; Olive Shisana; Thomas M Rehle; Leickness C Simbayi; Sean Jooste; Nompumelelo Zungu; Demetre Labadarios; Dorina Onoya; Meredith Evans; Sizulu Moyo; Fareed Abdullah Journal: Afr J AIDS Res Date: 2016 Impact factor: 1.300
Authors: Norma C Ware; John Idoko; Sylvia Kaaya; Irene Andia Biraro; Monique A Wyatt; Oche Agbaji; Guerino Chalamilla; David R Bangsberg Journal: PLoS Med Date: 2009-01-27 Impact factor: 11.069