title: HIV, violence and women: unmet mental health care needs.
abstract: BACKGROUND
  HIV-infected (HIV+) women have high rates of Gender Based Violence (GBV). Studies of GBV find that approximately 50-90% of survivors develop mood and anxiety disorders. Given that women in sub-Saharan African constitute the largest population of HIV+ individuals in the world and the region׳s high GBV prevalence, mental health research with HIV+ women affected by GBV (HIV+GBV+) in this region is urgently needed.
  
  
  METHODS
  Qualitative methods were used to evaluate the mental health care needs of HIV+GBV+ female patients at an HIV clinic in the Kisumu County, Kenya. Thirty in-depth interviews and four focus groups were conducted with patients, healthcare providers and community leaders. Interviews were transcribed, translated and analyzed using qualitative data software.
  
  
  RESULTS
  Respondents stated that physical, sexual and emotional violence against HIV+ women was widely prevalent and perpetrated primarily by untested husbands accusing a wife of marital infidelity following her positive HIV test result. Mental health problems among HIV+GBV+ women included depressive, anxiety, traumatic stress symptoms and suicidal thoughts. Participants opined that emotional distress from GBV not only caused HIV treatment default, but also led to poor HIV health even if adherent. Respondents agreed that mental health treatment was needed for HIV+GBV+ women; most agreed that the best treatment modality was individual counseling delivered weekly at the HIV clinic.
  
  
  CONCLUSIONS
  Emotional distress may be higher and/or more varied among HIV+GBV+ women who are not engaged in HIV care.
  
  
  CONCLUSIONS
  Mental health care is needed and desired by HIV+GBV+ women in Kisumu County, Kenya.
authors.affiliation: School of Nursing, University of California, San Francisco, CA, USA.
authors.forename: Brian
authors.initials: B
authors.lastname: Zunner
authors.affiliation: Department of Social and Behavioral Sciences, University of California, San Francisco, CA, USA.
authors.forename: Shari L
authors.initials: SL
authors.lastname: Dworkin
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA, USA.
authors.forename: Thomas C
authors.initials: TC
authors.lastname: Neylan
authors.affiliation: Kenya Medical Research Institute, Department of Obstetrics and Gynecology, University of Nairobi, Kenya; Family AIDS Care Education & Services, Kenya.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.affiliation: Family AIDS Care Education & Services, Kenya.
authors.forename: Patrick
authors.initials: P
authors.lastname: Oyaro
authors.affiliation: Family AIDS Care Education & Services, Kenya; Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, CA, USA.
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.affiliation: Family AIDS Care Education & Services, Kenya.
authors.forename: Matilda
authors.initials: M
authors.lastname: Abwok
authors.affiliation: Department of Psychiatry, University of California, San Francisco, CA, USA. Electronic address: Susan.Meffert@ucsf.edu.
authors.forename: Susan M
authors.initials: SM
authors.lastname: Meffert
mesh_terms: D001007:Anxiety; D001008:Anxiety Disorders / Q000453:epidemiology / Q000209:etiology*; D017579:Domestic Violence / Q000523:psychology; D005260:Female; D017144:Focus Groups; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D006301:Health Services Needs and Demand; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008297:Male; D001523:Mental Disorders / Q000209:etiology; D008603:Mental Health; D015995:Prevalence; D036301:Qualitative Research; D012725:Sexual Behavior; D059020:Suicidal Ideation; D017741:Survivors / Q000523:psychology* / Q000706:statistics & numerical data; D014754:Violence / Q000523:psychology* / Q000706:statistics & numerical data; D016387:Women's Health
keywords: Depression; Domestic violence; Gender-Based Violence; Global health; HIV; Posttraumatic Stress Disorder