Perinatal HIV Treatment in the Context of Financial and Psychological Intimate Partner Violence in Urban South Africa

Objective: Intimate partner violence (IPV) is associated with worsened perinatal antiretroviral therapy (ART) adherence. While physical and sexual forms of IPV have been focused on, psychological and financial IPV have received less attention. We explored how perinatal women's experiences with psychological and financial IPV influenced their well-being, mental health, and HIV treatment. Method: We conducted 45 in-depth qualitative interviews with perinatal women living with HIV and exposure to past-year IPV in Johannesburg, South Africa. Interviews were conducted in English, isiZulu, or Sesotho in two phases (2014-2015 and 2019-2020), transcribed verbatim, translated into English as necessary, and thematically double-coded. Results: Pregnant and postpartum women described experiencing physical, sexual, psychological, and financial IPV. In addition to traditional acts of psychological violence, women described infidelity, abandonment, ignoring, and blame. Several women described psychological abuse as the "worst type" of violence because of the long-lasting, debilitating effects on mental health. Dealing with the repetition of psychological abuse heightened depressive symptoms for some women, which in turn made ART adherence harder. Most participants were financially dependent on their partners and described their partners as having exclusive control over money and access to household food. Financial violence such as withholding food or refusing to give money for essentials seemed to indirectly reduce women's ability to take ART. Conclusions: Psychological and financial IPV have a pronounced influence on how women navigate the perinatal phase and HIV treatment. Addressing IPV during the perinatal phase may help to improve HIV outcomes and women's and children's health.