Relationship between Decision Making Power and Mental Health among HIV-positive Women

The findings were published in the journal AIDS Care.There is an association between low decision-making power and HIV seropositivity among women in sub-Saharan Africa. As treatment accessibility and life expectancy for HIV-positive individuals increase, there is a need for greater attention to the mental health and well-being of HIV-positive women. This study examined whether low decision-making power was associated with psychological distress, social support or health-related quality of life among women initiating antiretroviral treatment.

The sample included 722 women who were aged 18 or older and initiating antiretroviral treatment during 2012 to 2013 at six HIV clinics in Oromia, Ethiopia. Decision-making power was assessed with five questions about household resource control and decision-making. Psychological distress was assessed with the Kessler Psychological Distress Scale (K10). Health-related quality of life was assessed with the overall subscale of the HIV/AIDS-Targeted Quality of Life instrument. Multivariable logistic regression analyses controlled for age, education, and location (urban/rural).63% of the respondents reported high decision-making power, followed by medium (27%) and low (10%) decision-making power. At 57%, more than half reported psychological distress. Compared to medium decision-making power, low decision-making power among married or cohabitating women was associated with greater odds of low social support; high decision-making power among women not in a relationship was associated with greater odds of low social support and psychological distress.

The authors concluded that interventions to reduce psychological distress among women initiating antiretroviral treatment should consider the familial context, as high decision-making power among women not in a relationship was associated with psychological distress. High decision-making power may indicate weak social ties and fewer material resources, particularly among women not in a relationship.

Dr. Nash concludes, “The associations between decision making power and psychological distress among the HIV positive Ethiopian women in our study is a complex one that merits further investigation in my view. However, our work suggests that it is very important to consider women’s relationship status, as high levels of decision making power, particularly among women not in a relationship, could indicate weaker social ties and fewer material resources.”

Parcesepe, A., Tymejczyk, O., Remien, R., Gadisa, T., Kulkarni, S., Hoffman, S., Melaku, Z., Elul, B. and Nash, D. (2017). Household decision-making power and the mental health and well-being of women initiating antiretroviral treatment in Oromia, Ethiopia. AIDS Care, pp.1-8.