Résumé

<p>Introduction: Disclosure of one’s HIV status may decrease depression and improve the quality of life among people living with<br>HIV. However, there is mixed evidence on the impact of disclosure to partners for pregnant women living with HIV (WLHIV) in<br>areas of intersecting social concerns over disclosure and high prevalence of intimate partner violence (IPV). We assessed the<br>association between HIV disclosure and depressive symptoms among pregnant WLHIV in the Democratic Republic of Congo<br>(DRC) and examined whether the knowledge of partner’s status or recent IPV modified this association.<br>Methods: We utilized data from participants enrolled in a trial to evaluate the effect of continuous quality interventions on<br>long-term therapy outcomes among HIV-positive pregnant and breastfeeding women in DRC (NCT03048669). Only pregnant<br>women (n = 1392) were included in this cross-sectional analysis. Between November 2016 and June 2019, enrolled participants<br>completed a survey that included the Patient Health Questionnaire-9 (PHQ-9) to screen recent depressive symptoms,<br>questions about disclosure, knowledge of partner’s status and IPV. We used linear models to calculate crude and adjusted<br>mean differences (MDs) between disclosure and depressive symptoms. All analyses were stratified by timing of HIV diagnosis.<br>Results: Disclosure was higher among participants diagnosed prior to current pregnancy (41% to their partners and 24% to<br>family, friends or others) relative to those diagnosed during current pregnancy (21% to partners and 12% to family). About<br>one-quarter of women reported any type of IPV in the past 12 months. Disclosure to a partner was associated with lower<br>depressive symptoms among women diagnosed prior to current pregnancy (MD −0.55; 95% CI: −1.06, −0.04) but the opposite<br>was observed among those diagnosed during current pregnancy (MD 0.5; 95% CI: −0.4, 1.4). Adjustment for IPV, knowledge<br>of partner’s status, age, number of living children and primigravidae did not change MDs substantially.<br>Conclusions: Women in our sample mostly disclosed to partners despite high IPV burden. The observed association between<br>disclosure to partners and lower depressive symptoms among women diagnosed prior to current pregnancy is consistent with<br>cross-national evidence. A prospective study among pregnant WLHIV is needed to examine longitudinal effects of HIV status<br>disclosure.</p>