title: How does living with HIV impact on women's mental health? Voices from a global survey.
abstract: BACKGROUND
  Women living with HIV experience a disproportionate burden of mental health issues. To date, global guidelines contain insufficient guidance on mental health support, particularly regarding perinatal care. The aim of this article is to describe the extent and impact of mental health issues as experienced by women living with HIV on their sexual and reproductive health and human rights (SRH&HR).
  
  
  METHODS
  A global, mixed-methods, user-led and designed survey on SRH&HR of women living with HIV was conducted using snowball sampling, containing an optional section exploring mental health issues. Statistical quantitative data analysis included descriptive statistics, correlation and multiple linear regression analysis for the mental health responses. Thematic analysis of open free-text responses was performed for qualitative data.
  
  
  RESULTS
  A total of 832 respondents from 94 countries participated in the online survey with 489 responses to the optional mental health section. Of the respondents, 82% reported depression symptoms and 78% rejection. One-fifth reported mental health issues before HIV diagnosis. Respondents reported experiencing a 3.5-fold higher number of mental health issues after diagnosis (8.71 vs 2.48, t[488]=23.00, p<0.001). Nearly half (n=224; 45.8%) had multiple socially disadvantaged identities (SDIs). The number of SDIs was positively correlated with experiencing mental health issues (p<0.05). Women described how mental health issues affected their ability to enjoy their right to sexual and reproductive health and to access services. These included depression, rejection and social exclusion, sleep problems, intersectional stigma, challenges with sexual and intimate relationships, substance use and sexual risk, reproductive health barriers and human rights (HR) violations. Respondents recommended that policymakers and clinicians provide psychological support and counselling, funding for peer support and interventions to challenge gender-based violence and to promote HR.
  
  
  CONCLUSIONS
  Interventions addressing intersecting stigmas and any especial impacts of diagnosis during pregnancy are required to ensure women's SRH&HR. Global policy guidelines regarding women living with HIV must incorporate mental health considerations.
authors.affiliation: ATHENA Network, London, UK.|Salamander Trust, London, UK.
authors.forename: Luisa
authors.initials: L
authors.lastname: Orza
authors.affiliation: Women's Health Academic Centre, King's College London, London, UK.
authors.forename: Susan
authors.initials: S
authors.lastname: Bewley
authors.affiliation: Factor-Inwentash Faculty of Social Work, University of Toronto, Toronto, ON, Canada.
authors.forename: Carmen H
authors.initials: CH
authors.lastname: Logie
authors.affiliation: ATHENA Network, Seattle, WA, USA.
authors.forename: Elizabeth Tyler
authors.initials: ET
authors.lastname: Crone
authors.affiliation: Eurasian Women's Network on AIDS, Kiev, Ukraine.
authors.forename: Svetlana
authors.initials: S
authors.lastname: Moroz
authors.affiliation: UNAIDS Dialogue Platform, London, UK.
authors.forename: Sophie
authors.initials: S
authors.lastname: Strachan
authors.affiliation: ATHENA Network, London, UK.|Salamander Trust, London, UK.
authors.forename: Marijo
authors.initials: M
authors.lastname: Vazquez
authors.affiliation: Salamander Trust, London, UK; alice@salamandertrust.net.
authors.forename: Alice
authors.initials: A
authors.lastname: Welbourn
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D008603:Mental Health; D008875:Middle Aged; D011247:Pregnancy; D060728:Reproductive Health; D012747:Sexual Partners; D057545:Social Stigma; D011795:Surveys and Questionnaires; D014754:Violence; D016387:Women's Health; D014933:Women's Rights
keywords: HIV; evidence base; gender-based violence; human rights; intimate partner violence; mental health; survey; values and preferences; women