AIDS and Behavior

, Volume 17, Issue 2, pp 498–507 | Cite as

Psychosocial Variables Associated with Coping of HIV-Positive Women Diagnosed During Pregnancy

  • Marinda Kotzé
  • Maretha VisserEmail author
  • Jenny Makin
  • Kathleen Sikkema
  • Brian Forsyth
Original Paper


To identify psychosocial variables related to the use of coping strategies by HIV-positive South African women diagnosed during pregnancy, structured interviews were conducted with 224 HIV-positive women at antenatal clinics over a period of 2 years. Two coping styles, active and avoidant coping, were assessed using an adapted version of the Brief COPE. Psychosocial variables associated with changes in coping over time were identified with mixed linear analysis. Increases in active coping were associated with decreasing levels of internalized stigma and depression, increasing self-esteem and positive social support, knowing someone who is living with HIV, being physically healthy and living above the poverty line. Increases in avoidant coping were associated with increasing internalized stigma and depression, lower levels of self-esteem, HIV-knowledge and lower levels of education. Recommendations are made for psychological support services to strengthen women’s ability to cope and enhance their health and that of their infants.


Coping styles HIV/AIDS Women Pregnancy South Africa 


Para identificar factores psicosociales relacionados con el uso de estrategias de afrontamiento en mujeres diagnosticadas con sida durante el embarazo se realizaron cuatro entrevistas estructuradas en dos años a 224 mujeres seropositivas en clínicas prenatales de Tshwane, Sudáfrica. Estilos de afrontamiento activo y de evitación fueron evaluados utilizándose una versión adaptada del Brief COPE. El análisis lineal mixto identificó variables psicosociales asociadas con cambios de afrontamiento en el tiempo. El aumento de afrontamiento activo se asoció con disminución del estigma y depresión, alta autoestima y apoyo social positivo, conocer a alguien con sida, estar físicamente saludable y vivir por encima de la pobreza. El aumento del afrontamiento de evitación se asoció con aumento del estigma y depresión, baja autoestima, conocimiento sobre el sida y bajos niveles educativos. Se presentan recomendaciones a los servicios de apoyo psicológico para fortalecer la capacidad de las mujeres de enfrentar y mejorar su salud y la de sus hijos.



This study was funded by National Institute of Child Health and Human Development (NICHD) grant R24HD43558. We acknowledge the valuable contribution of the research team: R. Mkhondo, J. Tatane, M. Zondo, J. Ramodike, F. Nkomo, R. Kgoebane, M. Dikolometsa, P. Mabota, B. Moalosi, S. Sono, K. Lehobye.


  1. 1.
    Department of Health. National antenatal sentinel HIV and syphilis prevalence survey in South Africa 2009. Pretoria: Department of Health; 2010. Available from
  2. 2.
    Eller LS, Bunch EH, Wantland DJ, Portillo CJ, Reynolds NR, Nokes KM, et al. Prevalence, correlates, and self-management of HIV-related depressive symptoms. AIDS Care. 2010;22(9):1159–70.PubMedCrossRefGoogle Scholar
  3. 3.
    Kagee A, Martin L. Symptoms of depression and anxiety among a sample of South African patients living with HIV. AIDS Care. 2010;22(2):159–65.PubMedCrossRefGoogle Scholar
  4. 4.
    Lazarus R, Struthers H, Violari A. Hopes, fears, knowledge and misunderstandings: responses of HIV-positive mothers to early knowledge of the status of their baby. AIDS Care. 2009;21(3):329–34.PubMedCrossRefGoogle Scholar
  5. 5.
    Mello VA, Segurado AA, Malbergier A. Depression in women living with HIV: clinical and psychosocial correlates. Arch Women Ment Health. 2010;13:193–9.CrossRefGoogle Scholar
  6. 6.
    Olley BO. Psychological distress in the first year after diagnosis of HIV infection among women in South Africa. AJAR. 2006;5(3):207–15.CrossRefGoogle Scholar
  7. 7.
    Pittiglio L, Hough E. Coping with HIV: perspectives of mothers. JANAC. 2009;20(3):184–92.PubMedGoogle Scholar
  8. 8.
    Sanders LB. Women’s voices: the lived experience of pregnancy and motherhood after diagnosis. JANAC. 2008;19(1):47–57.PubMedGoogle Scholar
  9. 9.
    Visser MJ, Makin JD, Vandormael A, Sikkema KJ, Forsyth BWC. HIV/AIDS stigma in a South African community. AIDS Care. 2009;21(2):197–206.PubMedCrossRefGoogle Scholar
  10. 10.
    Visser MJ, Neufeld S, De Villiers A, Makin JD, Forsyth BWC. To tell or not to tell: South African women’s disclosure of HIV status during pregnancy. AIDS Care. 2008;20(9):1138–45.PubMedCrossRefGoogle Scholar
  11. 11.
    Kwalombota M. The effect of pregnancy in HIV-infected women. AIDS Care. 2002;14(3):431–3.PubMedCrossRefGoogle Scholar
  12. 12.
    Do NT, Phiri K, Bussmann H, Gaolathe T, Marlink RG, Wester CW. Psychosocial factors affecting medication adherence among HIV-1 infected adults receiving combination antiretroviral therapy (cART) in Botswana. AIDS Res Hum Retroviruses. 2010;26(6):685–91.PubMedCrossRefGoogle Scholar
  13. 13.
    Bhatia R, Hartman C, Kallen MA, Graham J, Giordano TP. Persons newly diagnosed with HIV infection are at high risk for depression and poor linkage to care: results from the steps study. AIDS Behav. 2010;15(6):1161–70.CrossRefGoogle Scholar
  14. 14.
    Antelman G, Kaaya S, Wei R, Mbwambo J, Msamanga GI, Fawzi WW, et al. Depressive symptoms increase risk of HIV disease progression and mortality among women in Tanzania. J Acquir Immune Defic Syndr. 2007;44(4):470–7.PubMedCrossRefGoogle Scholar
  15. 15.
    Chronis AM, Lahey BB, Pelham WE, Williams SH, Baumann BL, Kipp H, et al. Maternal depression and early positive parenting predict future conduct problems in young children with attention-deficit/hyperactivity disorder. Dev Psychol. 2007;43(1):70–82.PubMedCrossRefGoogle Scholar
  16. 16.
    Pearson RM, Cooper RM, Penton-Voak IS, Lightman LS, Evans J. Depressive symptoms in early pregnancy disrupt attentional processing in infant emotion. Psychol Med. 2010;40:621–31.PubMedCrossRefGoogle Scholar
  17. 17.
    Oswalt KL, Biasini FJ. Characteristics of HIV-infected mothers associated with increased risk of poor mother-infant interactions and infant outcomes. J Pediatr Health Care. 2012;26(2):83–91.PubMedCrossRefGoogle Scholar
  18. 18.
    Lazarus RS, Folkman S. Stress, appraisal and coping. New York: Springer; 1984.Google Scholar
  19. 19.
    Smith L, Feaster DJ, Prado G, Kamin M, Blaney N, Szapocznik J. The psychosocial functioning of HIV-positive and HIV-negative African American recent mothers. AIDS Behav. 2001;5(3):219–31.CrossRefGoogle Scholar
  20. 20.
    Chida Y, Vedhara K. Adverse psychosocial factors predict poorer prognosis in HIV disease: a meta-analytic review of prospective investigations. Brain Behav Immun. 2009;23:434–45.PubMedCrossRefGoogle Scholar
  21. 21.
    Vyavaharkar M, Moneyham L, Murdaugh C, Tavakoli A. Factors associated with quality of life among rural women with HIV disease. AIDS Behav. 2012;16(2):295–303.PubMedCrossRefGoogle Scholar
  22. 22.
    Deichert NT, Fekete EM, Boarts JM, Druley JA, Delahanty DL. Emotional support and affect: associations with health behaviours and active coping efforts in men living with HIV. AIDS Behav. 2008;12:139–45.PubMedCrossRefGoogle Scholar
  23. 23.
    Stein JA, Rotheram-Borus M. Cross-sectional and longitudinal associations in coping strategies and physical health outcomes among HIV-positive youth. Psychol Health. 2004;19(3):321–36.CrossRefGoogle Scholar
  24. 24.
    Trevino KM, Pargament KI, Cotton S, Leonard AC, Hahn J, Caprini-Faigin CA, et al. Religious coping and physiological, psychological, social, and spiritual outcomes in patients with HIV/AIDS: cross-sectional and longitudinal findings. AIDS Behav. 2007;14(2):379–89.PubMedCrossRefGoogle Scholar
  25. 25.
    Chan I, Au A, Li P, Chung R, Lee MP, Yu P. Illness-related factors, stress and coping strategies in relation to psychological distress in HIV-infected persons in Hong Kong. AIDS Care. 2006;18(8):977–82.PubMedCrossRefGoogle Scholar
  26. 26.
    Kraaij V, Van der Veek SMC, Garnefski N, Schroevers M, Witlox R, Maes S. Coping, goal adjustment, and psychological well-being in HIV-infected men who have sex with men. AIDS Patient Care STDs. 2008;22(5):395–402.PubMedCrossRefGoogle Scholar
  27. 27.
    Pence BW, Thielman NM, Whetten K, Ostermann J, Kumar V, Mugavero MJ. Coping strategies and patterns of alcohol and drug use among HIV-infected patients in the Unites States southeast. AIDS Patient Care STDs. 2008;22(11):869–77.PubMedCrossRefGoogle Scholar
  28. 28.
    Vervoort SCJM, Grypdonck MHF, de Grauwe A, Hoepelman AIM, Borleffs JCC. Adherence to HAART: processes explaining adherence behaviour in acceptors and non-acceptors. AIDS Care. 2009;21(4):431–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Griswold GA, Evans S, Spielman L, Fishman B. Coping strategies of HIV patients with peripheral neuropathy. AIDS Care. 2005;17(6):711–20.PubMedCrossRefGoogle Scholar
  30. 30.
    Weaver KE, Antoni MH, Lechner SC, Durán REF, Penendo F, Fernandez MI, et al. Perceived stress mediates the effects of coping on the quality of life in HIV-positive women on highly active antiretroviral therapy. AIDS Behav. 2004;8(2):175–83.PubMedCrossRefGoogle Scholar
  31. 31.
    Blaney NT, Fernandez MI, Ethier KA, Wilson TE, Walter E, Koenig LJ. Psychosocial and behavioural correlates of depression among HIV-infected pregnant women. AIDS patient care STDs. 2004;18(7):405–15.PubMedCrossRefGoogle Scholar
  32. 32.
    McNeill FG. AIDS, politics and music in South Africa. London: Cambridge University Press; 2012.Google Scholar
  33. 33.
    Rehle T, Shisana O, Pillay V, Zuma K, Puren A, Parker W. National incidence measure—new insights into the South African epidemic. SAMJ. 2007;97(3):194–9.PubMedGoogle Scholar
  34. 34.
    Dageid W, Duckert F. Balancing between normality and social death: Black, rural, South African women coping with HIV/AIDS. Qual Health Res. 2008;18(2):182–95.PubMedCrossRefGoogle Scholar
  35. 35.
    McNeill FG, Niehaus I. Magic! AIDS review 2009. Pretoria: Center for Study of AIDS, University of Pretoria; 2010.Google Scholar
  36. 36.
    Niehaus I. Leprosy of a deadlier kind: conceptions of AIDS, sex and death in the South African lowveld. Paper presented at The Institute for Social and Economic Research, Rhodes University; 2006 October; Grahamstown, South Africa.Google Scholar
  37. 37.
    Campbell C, Nair Y, Maimane S, Nicholson J. “Dying twice”: a multi-level model of the roots of AIDS stigma in two South African communities. J Health Psychol. 2007;12(3):403–16.PubMedCrossRefGoogle Scholar
  38. 38.
    Carver CS. You want to measure coping but your protocol’s too long: consider the Brief COPE. Int J Behav Med. 1997;4:92–100.PubMedCrossRefGoogle Scholar
  39. 39.
    Makin JD, Forsyth BWC, Visser MJ, Sikkema KJ, Neufeld S, Jeffery B. Factors affecting disclosure in South African HIV-positive pregnant women. AIDS Patient Care STDs. 2008;22(11):907–16.PubMedCrossRefGoogle Scholar
  40. 40.
    World Health Organisation. Research package: knowledge, attitudes, beliefs and practices on AIDS, phase 1: the questionnaire. The global programme on AIDS, Social and Behavioural Research Unit. Geneva: World Health Organisation; 1990.Google Scholar
  41. 41.
    Visser MJ, Kershaw T, Makin JD, Forsyth BWC. Development of parallel scales to measure HIV-related stigma. AIDS Behav. 2008;12:759–71.PubMedCrossRefGoogle Scholar
  42. 42.
    Carey MP, Schroder KEE. Development and psychometric evaluation of the brief HIV knowledge questionnaire. AIDS Educ Prev. 2002;14(2):172–82.PubMedCrossRefGoogle Scholar
  43. 43.
    Bauman LJ, Weiss E. Multidimensional social support inventory: revised. New York: Albert Einstein College of Medicine; 1995.Google Scholar
  44. 44.
    Rosenberg M. Society and the adolescent self image. New York: Princeton University; 1965.Google Scholar
  45. 45.
    Radloff LS. The CES-D scale: a self-report depression scale for research on the general population. Appl Psychol Meas. 1977;1:385–401.CrossRefGoogle Scholar
  46. 46.
    Kalichman SC, Rompa D, Cage M. Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. J Nerv Ment Dis. 2000;188:662–70.PubMedCrossRefGoogle Scholar
  47. 47.
    Dunkle KL, Jewkes RK, Brown HC, Yoshihama M, Gray GE, McIntyre JA, et al. Prevalence and patterns of gender-based violence and revictimisation among women attending antenatal clinics in Soweto, South Africa. Am J Epidemiol. 2004;160:230–9.PubMedCrossRefGoogle Scholar
  48. 48.
    Hox JJ. Multilevel analysis: techniques and applications. 2nd ed. New York: Routledge; 2010.Google Scholar
  49. 49.
    Lazarus RS. Stress and emotion. New York: Springer; 1999.Google Scholar
  50. 50.
    Lee RS, Kochman A, Sikkema K. Internalized stigma among people living with HIV/AIDS. AIDS Behav. 2002;6(4):309–19.CrossRefGoogle Scholar
  51. 51.
    Simbayi LC, Kalichman S, Strebel A, Cloete A, Henda N, Mqeketo A. Internalized stigma, discrimination, and depression among men and women living with HIV/AIDS in Cape Town, South Africa. Soc Sci Med. 2007;64:1823–31.PubMedCrossRefGoogle Scholar
  52. 52.
    Rohleder P, Gibson K. We are not fresh’: HIV-positive women talk of their experience of living with their ‘spoiled identity. SAJP. 2006;36(1):25–44.Google Scholar
  53. 53.
    Mellins CA, Ehrhardt AA, Rapkin B, Havens JF. Psychosocial factors associated with adaptation in HIV-infected mothers. AIDS Behav. 2000;4(4):317–28.CrossRefGoogle Scholar
  54. 54.
    Prado G, Feaster DJ, Schwartz SJ, Pratt IA, Smith L, Szapocznik J. Religious involvement, coping, social support, and psychological distress in HIV-seropositive African American Mothers. AIDS Behav. 2004;8(3):221–35.PubMedCrossRefGoogle Scholar
  55. 55.
    Medley AM, Kennedy CE, Lunyolo S, Sweat MD. Disclosure outcomes, coping strategies, and life changes among women living with HIV in Uganda. Qual Health Res. 2009;19(2):1744–54.PubMedCrossRefGoogle Scholar
  56. 56.
    Blalock AC, McDaniel JS, Farber EW. Effect of employment on quality of life and psychological functioning in patients with HIV/AIDS. Psychosomatics. 2002;43:400–4.PubMedCrossRefGoogle Scholar
  57. 57.
    Updegraff JA, Taylor SE, Kemeny ME, Wyatt GE. Positive and negative effects of HIV infection in women with low socioeconomic resources. Pers Soc Psychol Bull. 2002;28(3):382–94.CrossRefGoogle Scholar
  58. 58.
    Reece M, Shacham E, Monahan P, Yebei V, Ong’or WO, Omollo O, et al. Psychological distress symptoms of individuals seeking HIV-related psychosocial support in western Kenya. AIDS Care. 2007;19(10):1194–200.PubMedCrossRefGoogle Scholar
  59. 59.
    Visser MJ, Sipsma H. The experience of HIV-related stigma in South Africa. In: Liamputtong P, editor. Stigma, discrimination and HIV/AIDS: a cross-cultural perspective. New York: Springer (in press).Google Scholar
  60. 60.
    Department of Health. National antiretroviral treatment guidelines. Pretoria: Department of Health; 2004. Available from
  61. 61.
    Simoni JM, Demas P, Mason HRC, Drossman JA, Davis ML. HIV disclosure among women of African descent: associations with coping, social support, and psychological adaptation. AIDS Behav. 2000;4(2):147–58.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2012

Authors and Affiliations

  • Marinda Kotzé
    • 1
    • 2
  • Maretha Visser
    • 1
    Email author
  • Jenny Makin
    • 3
  • Kathleen Sikkema
    • 4
  • Brian Forsyth
    • 5
  1. 1.Department of PsychologyUniversity of PretoriaPretoriaSouth Africa
  2. 2.Safety and Peace Promotion Research UnitMedical Research Council—University of South AfricaTygerbergSouth Africa
  3. 3.Medical Research Unit for Maternal and Infant Health Care StrategiesPretoriaSouth Africa
  4. 4.Department of Psychology and Neuroscience and Duke Global Health InstituteDuke UniversityDurhamUSA
  5. 5.Centre of Interdisciplinary Research on AIDSYale UniversityNew HavenUSA

Personalised recommendations