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Background <p>Poor mental health may influence the uptake and persistence of pre-exposure prophylaxis (PrEP) use to prevent HIV. Because HIV acquisition risk increases during the perinatal period, we explored the anticipated impacts of mental health symptoms on PrEP uptake and continued use during pregnancy and breastfeeding among pregnant and postpartum persons in South Africa.</p> Methods <p>PrEP-naive pregnant and postpartum people (PPP) with elevated depression and/or post-traumatic stress disorder (PTSD) symptoms completed qualitative interviews between May 2022 and May 2023. Interviews probed the anticipated impacts of these symptoms on the likelihood of starting and continuing PrEP while pregnant or breastfeeding. After transcription and translation, a codebook was developed using inductive and deductive methods. Coded data were analyzed via thematic analysis.</p> Results <p>Twenty-three participants completed 30 interviews (seven were interviewed twice—once during pregnancy and once post-delivery); on average, they were 25.1&#xa0;years old and had 2.1 previous pregnancies. Thirteen participants met criteria for probable depression, two for PTSD, and eight for both. Participants articulated a range of mental health symptoms (e.g., persistent negative emotions, anhedonia, fatigue) that might impact PrEP use. Four themes related to the anticipated impact of these symptoms on PrEP uptake and persistence emerged: (1) skipping doses when experiencing negative emotions; (2) delaying pick up from the clinic; (3) specific negative impacts of trauma-related fear, worry/rumination, and associated forgetfulness; and (4) no or minimal anticipated impact of mental health symptoms on PrEP use. A minority anticipated no or minimal impacts on PrEP use.</p> Conclusion <p>This study suggests that depression and PTSD symptoms may negatively impact PrEP uptake and use during pregnancy and postpartum. Specific strategies that reduce the impacts of negative emotions and associated withdrawal/avoidance behaviors could help PPP with depression and/or PTSD use PrEP during this critical period.</p>

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“If I’m Not Okay, I Won’t Take the Pills”: Anticipating the Effects of Depression and PTSD on PrEP Use Among PrEP Naïve Pregnant and Postpartum Persons in South Africa

  • 期刊论文

  • 发表日期：

    2026年5月22日

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  • Amelia M. Stanton,
  • Lauren Gulbicki,
  • Anvita Bhardwaj,
  • Madison R. Fertig,
  • Jennifer N. Githaiga,
  • Katherine E. Kabel,
  • Linda Gwangqa,
  • Landon Myer,
  • Lucia Knight,
  • Conall M. O’Cleirigh,
  • Christina Psaros

摘要

Background

Poor mental health may influence the uptake and persistence of pre-exposure prophylaxis (PrEP) use to prevent HIV. Because HIV acquisition risk increases during the perinatal period, we explored the anticipated impacts of mental health symptoms on PrEP uptake and continued use during pregnancy and breastfeeding among pregnant and postpartum persons in South Africa.

Methods

PrEP-naive pregnant and postpartum people (PPP) with elevated depression and/or post-traumatic stress disorder (PTSD) symptoms completed qualitative interviews between May 2022 and May 2023. Interviews probed the anticipated impacts of these symptoms on the likelihood of starting and continuing PrEP while pregnant or breastfeeding. After transcription and translation, a codebook was developed using inductive and deductive methods. Coded data were analyzed via thematic analysis.

Results

Twenty-three participants completed 30 interviews (seven were interviewed twice—once during pregnancy and once post-delivery); on average, they were 25.1 years old and had 2.1 previous pregnancies. Thirteen participants met criteria for probable depression, two for PTSD, and eight for both. Participants articulated a range of mental health symptoms (e.g., persistent negative emotions, anhedonia, fatigue) that might impact PrEP use. Four themes related to the anticipated impact of these symptoms on PrEP uptake and persistence emerged: (1) skipping doses when experiencing negative emotions; (2) delaying pick up from the clinic; (3) specific negative impacts of trauma-related fear, worry/rumination, and associated forgetfulness; and (4) no or minimal anticipated impact of mental health symptoms on PrEP use. A minority anticipated no or minimal impacts on PrEP use.

Conclusion

This study suggests that depression and PTSD symptoms may negatively impact PrEP uptake and use during pregnancy and postpartum. Specific strategies that reduce the impacts of negative emotions and associated withdrawal/avoidance behaviors could help PPP with depression and/or PTSD use PrEP during this critical period.