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Volume 22
Issue 9
10.3390/ijerph22091350
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This is an early access version, the complete PDF, HTML, and XML versions will be available soon.
Article

“I’ll Continue If I Have a Positive Mind”: Identifying the Ways in Which Depression and PTSD Impact PrEP Adherence Among PrEP-Experienced Pregnant and Postpartum Women in Cape Town, South Africa

by
Amelia M. Stanton
1,*,
Madison R. Fertig
1,
Jennifer Nyawira Githaiga
2,
Devisi A. Ashar
1,
Linda Gwangqa
2,
Melinda Onverwacht
2,
Lucia Knight
2,3,
Landon Myer
4,
Jessica E. Haberer
5,6,
John Joska
7,
Conall O’Cleirigh
8,9 and
Christina Psaros
8,9
1
Department of Psychological and Brain Sciences, Boston University, Boston, MA 02215, USA
2
Division of Social and Behavioural Sciences, School of Public Health, University of Cape Town, Cape Town 7925, South Africa
3
School of Public Health, University of the Western Cape, Bellville 7535, South Africa
4
Division of Epidemiology and Biostatistics, University of Cape Town, Cape Town 7701, South Africa
5
Department of Internal Medicine, Massachusetts General Hospital, Boston, MA 02114, USA
6
Department of Medicine, Harvard Medical School, Boston, MA 02115, USA
7
Faculty of Health Sciences, University of Cape Town, Cape Town 7935, South Africa
8
Department of Psychiatry, Massachusetts General Hospital, Boston, MA 02114, USA
9
Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
*
Author to whom correspondence should be addressed.
Int. J. Environ. Res. Public Health 2025, 22(9), 1350; https://doi.org/10.3390/ijerph22091350
Submission received: 30 June 2025 / Revised: 21 August 2025 / Accepted: 26 August 2025 / Published: 28 August 2025
(This article belongs to the Special Issue Women and Pre-Exposure Prophylaxis for HIV Prevention)
Review Reports Versions Notes

Abstract

Pregnant and postpartum people (PPPs) face heightened risk for HIV acquisition, yet depression and trauma-related symptoms can undermine adherence to pre-exposure prophylaxis (PrEP). To inform the development of a brief mental health-focused adherence intervention, we explored the impacts of depression and posttraumatic stress disorder (PTSD) symptoms on PrEP use among PPPs in Cape Town, South Africa. Twenty-eight PPPs with elevated symptoms of depression and/or PTSD and recent PrEP adherence challenges completed qualitative interviews. Six antenatal providers were also interviewed. Thematic analysis revealed three key findings with subthemes that deepen exploration of each theme: (1) depression and PTSD symptoms contributed to missed PrEP doses or late pickups by increasing doubt about PrEP efficacy, amplifying pill burden, intensifying avoidance and withdrawal (e.g., hypersomnia and disengagement from providers), and disrupting memory through rumination and emotional overload; (2) most PPPs preferred support from professional counselors, while a minority preferred informal support; and (3) intervention design considerations included aligning patient and provider goals, selecting between individual or group formats, and addressing integration barriers such as staffing and space constraints. Providers affirmed the need for embedded mental health support. Intervention strategies that increase PrEP knowledge and motivation while targeting emotional withdrawal, fatigue, and cognitive overload may improve adherence and reduce HIV risk in this population.
Keywords: pregnancy; pre-exposure prophylaxis; HIV; South Africa; depression; posttraumatic stress pregnancy; pre-exposure prophylaxis; HIV; South Africa; depression; posttraumatic stress

Share and Cite

MDPI and ACS Style

Stanton, A.M.; Fertig, M.R.; Githaiga, J.N.; Ashar, D.A.; Gwangqa, L.; Onverwacht, M.; Knight, L.; Myer, L.; Haberer, J.E.; Joska, J.; et al. “I’ll Continue If I Have a Positive Mind”: Identifying the Ways in Which Depression and PTSD Impact PrEP Adherence Among PrEP-Experienced Pregnant and Postpartum Women in Cape Town, South Africa. Int. J. Environ. Res. Public Health 2025, 22, 1350. https://doi.org/10.3390/ijerph22091350

AMA Style

Stanton AM, Fertig MR, Githaiga JN, Ashar DA, Gwangqa L, Onverwacht M, Knight L, Myer L, Haberer JE, Joska J, et al. “I’ll Continue If I Have a Positive Mind”: Identifying the Ways in Which Depression and PTSD Impact PrEP Adherence Among PrEP-Experienced Pregnant and Postpartum Women in Cape Town, South Africa. International Journal of Environmental Research and Public Health. 2025; 22(9):1350. https://doi.org/10.3390/ijerph22091350

Chicago/Turabian Style

Stanton, Amelia M., Madison R. Fertig, Jennifer Nyawira Githaiga, Devisi A. Ashar, Linda Gwangqa, Melinda Onverwacht, Lucia Knight, Landon Myer, Jessica E. Haberer, John Joska, and et al. 2025. "“I’ll Continue If I Have a Positive Mind”: Identifying the Ways in Which Depression and PTSD Impact PrEP Adherence Among PrEP-Experienced Pregnant and Postpartum Women in Cape Town, South Africa" International Journal of Environmental Research and Public Health 22, no. 9: 1350. https://doi.org/10.3390/ijerph22091350

APA Style

Stanton, A. M., Fertig, M. R., Githaiga, J. N., Ashar, D. A., Gwangqa, L., Onverwacht, M., Knight, L., Myer, L., Haberer, J. E., Joska, J., O’Cleirigh, C., & Psaros, C. (2025). “I’ll Continue If I Have a Positive Mind”: Identifying the Ways in Which Depression and PTSD Impact PrEP Adherence Among PrEP-Experienced Pregnant and Postpartum Women in Cape Town, South Africa. International Journal of Environmental Research and Public Health, 22(9), 1350. https://doi.org/10.3390/ijerph22091350

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