Empowerment in pregnancy: ART adherence among women living with HIV in Cape Town, South Africa

• Published in: Social science & medicine (1982) 2022-03, Vol.296, p.114738-114738, Article 114738
• Main Authors: DiClemente-Bosco, Kira, Weber, Alison Z., Harrison, Abigail, Tsawe, Nokwazi, Rini, Zanele, Brittain, Kirsty, Colvin, Christopher J., Myer, Landon, Pellowski, Jennifer A.
• Format: Article
• Language: English
• Subjects: Adherence; Agency; Anti-HIV Agents - therapeutic use; Antiretroviral drugs; Antiretroviral therapy; Behavior; Empowerment; Female; Health behavior; Health services; HIV; HIV Infections - drug therapy; HIV/AIDS; Human immunodeficiency virus; Humans; Infants; Infectious Disease Transmission, Vertical; Intervention; Maternal and infant welfare; Medication Adherence; Mothers; Patient compliance; Postpartum period; Postpartum women; Pregnancy; Pregnancy Complications, Infectious - drug therapy; Self care; South Africa; Theory; Women; Women's empowerment; Womens health
• ISSN: 0277-9536; 1873-5347
• DOI: 10.1016/j.socscimed.2022.114738

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. 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. 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. 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. 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. •Experiences of pregnant WLHIV fit well in a resources-agency-achievements framework.•Anticipated loss of partner support promotes feelings of independence.•Self-dependence is a valuable resource to promote ART adherence.•Lifetime goals drive ART adherence for pregnant WLHIV.•Programs should consider empowerment theory to improve peripartum ART adherence.