Anxiety, depression, and their relationship with marital satisfaction in Mexican pregnant women living with HIV

Anxiety, depression, and their relationship with marital satisfaction in Mexican pregnant women living with HIV | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Anxiety, depression, and their relationship with marital satisfaction in Mexican pregnant women living with HIV Mario de Jesús Meingüer-Cuevas, Miroslava Avila-García, Claudia Sánchez-Bravo, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5411994/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Introduction: In Mexico, the National Survey of Psychiatric Epidemiology (ENEP) in 2012, refers that 9.2% of the general population suffered an affective disorder at some point in life, the highest frequency was observed in women (10.4%) while in men (5.4%). In pregnancy, the prevalence of depression is higher compared to the general population (22 to 37%). Marital satisfaction during pregnancy may experience fluctuations due to such psycho-emotional conditions, at the same time, the physical and hormonal changes of the woman, as well as the alteration in the dynamics of the relationship with the partner suppose factors that violate the well-being and marital satisfaction, putting at risk the stability of the couple relationship. Methods Cross-sectional, observational, descriptive study that included pregnant women with HIV who presented traits of anxiety and depression. A psychometric battery was applied consisting of: State-Trait Anxiety Inventory (STAI), Beck Depression Inventory II (BDI-II), and the Marital Satisfaction Scale (MSS Spanish version). Results 60 patients were recruited and divided into 2 groups (HIV + and HIV-). Anxiety and depression levels were similar in both groups ( p > 0.05) but HIV + patients showed lower marital satisfaction ( p = 0.051) related to the increase of depressive traits (ρ= -0.33, p < 0.001). Conclusions HIV status during pregnancy may increase the possibility of presenting trait/state anxiety traits and depression, a condition related to major marital dissatisfaction. Clinical Trial Number: 2017-3-128. Emotional disorder couple relationship anxiety disorder mental health women health AIDS perinatal diseases. Introduction Anxiety and depression are one of the most disabling health problems during pregnancy and postpartum with a prevalence of 25% in both stages, with a predominance of generalized anxiety disorder (GAD) and depression ( 1 ). In Mexico, the National Survey of Psychiatric Epidemiology (ENEP) in 2012, refers that 9.2% of the general population suffered an affective disorder at some point in life, the highest frequency was observed in women (10.4%) while in men (5.4%) ( 2 ). In pregnancy, the prevalence of depression is higher compared to the general population (22 to 37%), GAD is less frequent (8 to 10%); however, comorbidity between both disorders may cause a worsening of anxiety symptoms ( 3 ). In other order of ideas, marital satisfaction during pregnancy may experience fluctuations due to such psycho-emotional conditions, at the same time, the physical and hormonal changes of the woman, as well as the alteration in the dynamics of the relationship with the partner supposed factors that violate the well-being and marital satisfaction, putting at risk the stability of the couple relationship ( 4 ). EMOTIONAL DYSREGULATION IN PREGNANT WOMEN LIVING WITH HIV For pregnant patients recently diagnosed with HIV, it is crucial to consider the impact generated by the social representation of the disease, the cultural and psychological stigma associated with the diagnosis, as well as the lack of support networks due to conflicts in personal, family, and partner relationships, and how this affects treatment adherence ( 5 ). Lack of support networks as well as inefficient interpersonal relationships may increase the probability of experiencing symptoms of psychological distress ( 6 ). The presence of anxiety and depressive traits are often prevalent in this population. These assume serious consequences for the quality of life of the mother and the well-being of the baby; therefore, early diagnosis of these disorders allows for timely and effective psychological and/or psychiatric interventions, thus protecting the physical-mental health of the mother and her child ( 7 ). Historically, pregnancy and motherhood have been represented as processes that involve a series of psychosocial changes in women's lives ( 8 ). These experiences represent opportunities, challenges in bond formation, as well as gratification in child-rearing ( 9 ). These representations are often limited to specific sociocultural contexts, which do not only consider physical and/or psychological conditions in the difficulty of diagnosis and treatment of anxiety and depression during pregnancy ( 10 ). Anxiety is a complex emotional state characterized by an unpleasant feeling of worry, nervousness, or fear, accompanied by psychosomatic changes. It can arise as an adaptive response to stressful or traumatic situations in a person's life ( 11 ). During pregnancy, anxiety is a common experience that can be influenced mainly by factors related to gestation and motherhood. This condition not only affects the mother but can also have repercussions on the development of the fetus (low birth weight, preterm delivery, preeclampsia, thinning of the cerebral cortex, increased amygdala size) and the emotional health of the newborn ( 12 ). Anxiety is often related to specific concerns. Physical appearance, method of pregnancy resolution, fear of having a child with congenital malformations and/or developmental disability, risk of miscarriage and/or spontaneous gestational loss or the possibility of sudden infant death ( 13 ), and fear of vertical transmission ( 14 ). Depression is a complex and multifactorial condition characterized by a predominant mood of sadness, hopelessness, or emptiness, leading to a loss of interest or pleasure in activities of daily living ( 15 ). At the beginning of the depressive state before pregnancy can further magnify symptomatology and affect adherence to pharmacological treatment before or during conception ( 16 ). Among the multiple causes of depression during pregnancy include traumatic experiences, brain chemical imbalances, chronic stress, and a history of abuse or violence, both intimate partner and intrafamilial or social ( 17 ). This condition can negatively impact the quality of life of the mother and/or the fetus or newborn ( 18 ), increasing the risk of complications such as preterm delivery, low birth weight, and emotional problems ( 19 ). Other risk factors include low socioeconomic and educational status, being a single mother, lack of partner support, multiple parenting, experiences of previous physical, psychological, or sexual violence, unresolved grief, and social isolation, with a greater impact on HIV cases ( 20 – 22 ). These conditions not only leave implicit the importance of the gestational medical approach but also the emotional and social challenges faced by such a population ( 23 , 24 ). Anxiety and depression are conditions that can coexist and exacerbate each other during pregnancy ( 19 ). The emotional changes and worries generated by both anxiety and depression can hinder communication and emotional connection between expectant parents, which can result in conflict or tension in the couple's relationship and impact marital satisfaction ( 25 ). MARITAL SATISFACTION Marital satisfaction is defined as the quality of the interpersonal relationship between partners or spouses, which is closely linked to the sense of psychological and emotional well-being within the couple’s relationship ( 26 ). This includes a series of behaviors aimed at maintaining the physical, mental, and emotional well-being of both partners, as well as feelings of acceptance, security, protection, and mutual support ( 27 ). These behaviors and feelings may stem from positive parenting, family support, trust, and loyalty in their couple relationship. On the one hand, women tend to have affectionate and pleasant behaviors toward their husbands ( 28 ). In contrast, husbands attach greater importance to protective and providing behaviors through practical and useful actions of their wives ( 28 ). In turn, the positive perception of oneself and one's partner is crucial to evaluate and identify whether the relationship satisfies individual needs. This promotes a state of peace (emotional stability) and balance in daily life, facilitating effective conflict resolution, the ability to reach agreements, and fostering mutual respect ( 29 ). Even if the relationship is satisfactory, sometimes it is likely to experience incompatibility or imbalance in the exercise of power in the couple ( 26 , 30 ). If it becomes a permanent form of interaction, it could cause dissatisfaction and lead to marital separation. In contrast, marital dissatisfaction is associated with a series of negative factors, such as family violence, alcoholism, addictions, and other causes ( 30 ). By failing to meet the psycho-emotional needs of the partners, conflicts, and tensions can arise that negatively affect the well-being of both partners ( 25 ). Marital satisfaction or dissatisfaction can affect other areas such as the relationship with children, job stability, general well-being, health care, and quality of life ( 28 , 31 , 32 ). Marital satisfaction during pregnancy represents a phase of transformation or challenges for the couple’s relationship ( 33 ). The influence of factors such as physical and emotional changes are preponderant at this stage in women. The success of the relationship during pregnancy will depend on how the couple copes and adapts to the challenges that arise secondary to this event. Assertive communication, mutual support, and participation in each other's needs are related to improved marital satisfaction during pregnancy ( 34 ). MARITAL SATISFACTION, PREGNANCY LIVING WITH HIV Pregnant women living with HIV present high levels of stress, which can exacerbate the course of the disease and the couple's relationship. It has been identified that a significant percentage of these women experience anxiety and depression during pregnancy ( 35 ), which negatively impacts mothers by generating conflicts in their family and couple relationships ( 36 – 38 ). The social representation of the disease hinders its evolution due to the stigma that revolves around it, complicating the detection and treatment of related anxiety and emotional symptoms, as this condition acts as a risk factor that can influence decision-making regarding health improvement and treatment adherence ( 39 ). In addition, the duration of the couple's relationship, having children with the infected person, concern about the risk of contagion, lack of understanding of individual needs, as well as low socioeconomic and educational level, in conjunction with family and social prejudices, act as additional risk factors ( 40 ). These elements can generate dysfunctions in the couple's relationship due to the stigmas associated with the diagnosis, lack of commitment, and little or no emotional support from the partner, which harms marital satisfaction ( 41 ). Understanding this problem is crucial to planning and improving the early intervention of mental health services that comprehensively address the specific needs of these women; from the use of specific assessment instruments, the development of effective coping strategies, and the implementation of therapeutic interventions that help, prevent, and promote psycho-emotional well-being in this population ( 42 ). The present study aimed to analyze and identify the relationship between traits of anxiety, depression, and marital satisfaction, comparing two groups: normal-evolutionary pregnant women and pregnant women living with HIV. Methods An observational, cross-sectional, prospective, analytical, and comparative was performed at the National Institute of Perinatology during the years 2019 to 2022. The study was approved by the Institute's research and ethics committee (Reg. 2017-3-128) under the standards established by the Declaration of Helsinki on research involving human subjects. Third-trimester pregnant women between 18 and 50 years old were invited to participate in her prenatal follow-up. The patients who met the inclusion criteria and who agreed to participate in the study after signing a written informed consent form were divided into two groups based on the criterion of presence/absence of HIV. Evaluation of mental state A semi-structured clinical history was taken from the participants to collect sociodemographic data and to track the clinical data, after which the psychometric battery designed for the evaluation of clinical variables was applied. For the measurement of trait anxiety and state anxiety traits, the Trait-State Anxiety Inventory (STAI) was used, which consists of 40 standardized items for the Mexican population ( 43 ), the cut-off points used were: 47 points for trait anxiety and 43 points for state anxiety ( 44 ). In the evaluation of depression traits, the Beck Depression Inventory (BDI-II) validated for the Mexican population was used, which consists of 21 items ( 45 ) whose cut-off points are: 0–9 absence, 10–16 mild depression, 17–29 moderate depression, and greater than 30 severe depression ( 46 ). Finally, for the evaluation of marital satisfaction (MSS Spanish version), the instrument validated for the Mexican population was used, consisting of 48 dichotomous items ( 47 ), to measure the degree of satisfaction of couples, where the cut-off points are identified as follows: satisfaction in those couples who obtain scores lower than 187; on the contrary, scores higher than 188 are dissatisfied couples. From the evaluation of the study, those patients who were diagnosed with anxiety, depression and/or marital dissatisfaction had access to psychological care by the Neurosciences department. Statistical Analysis For the analysis of the sociodemographic variables, measures of central tendency were used. In the case of clinical variables: obstetric history, state-trait anxiety, depression, and marital satisfaction, parametric statistics of Chi-square, and Student's t-test were used. The clinical variables were correlated with Spearman's Rho. Results Population Description. Sixty patients were recruited and were evenly distributed in both groups based on HIV diagnosis or absence. In the case of patients living with HIV the mean age was 29.53 years, their highest level of education was high school, most were engaged in housekeeping and mostly living in union with their partners (Table 1 ). In the case of women without HIV (Control), the mean age was 32.77 years, with a high school education, but mostly dedicated to housekeeping and living in a union or marriage (Table 1 ). Table 1 Sociodemographic variables. +HIV Mean± SD n = 30 -HIV Mean± SD n = 30 P value Age (years) 29.53±5.588 32.77±7.113 0.055 † Education 8.77±3.287 13.00±2.865 < 0.001 † Education (years) Elementary school 8 0 0.001 ǂ Middle school 14 5 High school 5 12 Professional Technician 1 2 University 2 9 Postgraduate 0 2 Occupation Housekeeper 16 5 0.002 ǂ Student 0 4 Merchant 7 3 Employee 5 4 Professional 1 4 Unemployed 1 10 Relationship Single 10 6 0.011 ǂ Living together 17 9 Marriage 3 7 To split up 0 3 Divorce 0 5 Alcohol and tobacco Alcohol 14 9 0.184 ǂ Tobacco 8 6 0.542 ǂ Drugs Marijuana 5 2 0.129 ǂ Cocaine 1 0 Crack 0 0 † Student T-test, P-value < 0.05 ǂ = Chi-square, P value < 0.05 Table 1 Sociodemographic variables (continue). +HIV Mean± SD n = 30 -HIV Mean± SD n = 30 P value Route of transmission Unknown 8 0 < 0.001 ǂ Perinatal 1 0 By perforation 1 0 Sexual 20 0 Without contagion 0 30 Couple knows the diagnosis Yes 17 0 < 0.001 ǂ No 13 0 HIV + couples Si 9 0 0.001 ǂ No 21 0 Who infected it (sexual borne) Current couple 11 0 < 0.001 ǂ Previous couple 9 0 OBSTETRICAL HISTORY Pregnancy 2.77±1.431 1.77±0.774 0.001 † Labor 1.37±1.273 0.90±0.995 0.119 † Cesarean 0.30±0.596 0.30±0.596 1.000 † Miscarriage 0.33±0.547 0.33±0.479 1.000 † Death 0.10±0.305 0.03±0.183 0.309 † † Student T-test, P-value < 0.05 ǂ = Chi-square, P value < 0.05 In the obstetric history, most of the patients living with HIV delivered vaginally (euthyroid delivery), with a low prevalence of miscarriages, deaths and cesarean section (Table 1 ). As for the control group, most of the patients were primigravidae (X̄= 1.77 gestations), so there is no information on the route of pregnancy resolution, history of gestational losses, miscarriages or termination by cesarean section. Referent to drug addictions, alcoholism was the most frequent in both groups, followed by tobacco use; concerning narcotic drug use (marijuana, cocaine) the incidence was higher in patients living with HIV. Their partners presented a similar behavioral pattern; as for the control group, only a pattern of social alcoholism was observed in both patients and their partners (Table 1 ). Referent to the route of transmission of the infection, the most frequent was sexual (n = 20), 8 of them did not know the route of infection. About the partners of the patients studied, 17 knew the diagnosis and 9 of them were HIV seropositive (Table 1 ). Evaluation of mental status. According to the results generated by the psychometric analyses, it was observed that both groups presented very similar levels of depression (T-test, p = 0.754) and trait anxiety (T-test, p = 0.693) and state (T-test, p = 0.526). In women living with HIV, they presented greater marital dissatisfaction compared to the control group (T-test, p = 0.051) (Table 2 ). In both groups, the central concern is about the health status of the product. Table 2 Mental status assessment. +HIV Mean± SD n = 30 -HIV Mean± SD n = 30 P value Anxiety State (STAI-S) 36.43±13.299 38.47±11.279 0.526 † Low [ 45] 8 8 Anxiety Trait (STAI-T) 38.50±12.426 39.57±7.899 0.693 † Low [ 45] 9 6 Depression (BDI-II) 11.93±12.814 11.03±9.042 0.754 † Absentee [0–9] 12 17 0.292 ǂ Mild [10–16] 11 6 Moderate [17–29] 4 6 Deep [> 30] 3 1 Marital Satisfaction (MSS) 172.20±35.715 153.53±36.765 0.051 † Satisfaction [ 188] 12 6 † Student T-test, p-value < 0.05 ǂ Chi-square test, p-value < 0.05 Table 3 Correlations matrix between sociodemographic variables and mental status assessment. Age Education (years) Pregnancy Labor Miscarriage Death Cesarean +HIV/-HIV Marital Satisfaction (MSS) Depression (BDI-II) Anxiety State (STAI-S) Anxiety Trait (STAI-T) Age 1 Education (years) -0.036 1 Pregnancy 0.223 -0.371 ** 1 Labor 0.091 -0.276 * 0.576 ** 1 Miscarriage 0.343 ** -0.065 0.209 -0.187 1 Death 0.002 -0.114 0.269 * -0.117 0.145 1 Cesarean 0.244 0.017 0.171 0.151 -0.045 .0183 1 +HIV/-HIV 0.242 0.597 ** -0.376 ** -0.182 0.024 -0.134 0.000 1 Marital Satisfaction (MSS) -0.123 0.084 0.032 -0.063 -0.157 -0.100 0.050 -0.271 * 1 Depression (BDI-II) 0.169 -0.175 -0.042 0.080 0.256 * -0.118 0.053 0.007 -0.336 ** 1 Anxiety State (STAI-S) 0.270 * -0.080 0.080 0.177 0.095 0.068 0.230 0.067 -0.242 0.523 ** 1 Anxiety Trait (STAI-T) 0.100 -0.037 -0.158 -0.060 0.056 0.075 0.047 0.021 -0.196 0.596 ** 0.613 ** 1 Interpretative results of sociodemographic variables and psychological tests. Spearman Rho (ρ), p- value * <0.05 and ** <0.001 Clinical correlations . A positive correlation was observed between the variables of age with a history of miscarriages (ρ = 0.34, p = 0.007), symptoms of depression (ρ = 0.25, p = 0.048), and anxiety-state (ρ = 0.27, p = 0.037). As for years of schooling, negative correlations were observed with history of pregnancy (ρ= -0.37, p = 0.003) and number of births (ρ= -0.27, p = 0.033). As part of the shared symptomatology in mood and anxiety traits, positive correlations were observed between depression and the variables of state anxiety (ρ = 0.52, p < 0.001) and Trait Anxiety (ρ = 0.59, p < 0.001). In turn, there was a positive correlation between state and trait anxiety (ρ = 0.61, p < 0.001). Seropositivity status has a negative correlation with marital satisfaction (ρ= -0.27, p = 0.036) which is possibly related to increased depressive symptoms (ρ= -0.33, p < 0.001). Discussion Human immunodeficiency virus (HIV) infection is a public health problem. Women living with HIV are of reproductive age, which implies that their pregnancy may be compromised. The diagnosis is known on most occasions during prenatal control, this constitutes a challenge for mothers at the psychological, social, and family levels ( 48 – 50 ). The effects generate uncertainty affecting effective communication with the people around them, by adopting avoidant behavior due to emotional, family, and social stigma ( 51 , 52 ). In our study, this behavior is reproduced with what is reported in the literature, by adopting an avoidant behavior generating deterioration in communication with their environment. In these women, we detected traits of psychological distress and in some cases symptoms of anxiety and depression. In women who presented features of psychological distress, it has been identified that residence within urbanized areas, access to health services, adequate management of information, and presence of social and family support are a protective factor ( 53 – 55 ). This coincides with our population who despite residing in suburban areas, have problems of marginalization which conditions a low socioeconomic level, and limited access to specialized health services, and relevant information. In addition, the development of traits of psychological distress, as well as symptoms of anxiety and depression can be influenced by other factors such as lack of a partner, ineffective assertive communication, little or no perception of marital satisfaction, lack of emotional, social and economic support or attention from their partner in HIV-negative women ( 35 , 52 , 56 ). In the face of HIV infection, the formalization of a sentimental relationship that modifies marital status is a protective factor. On the other hand, the couple's serodiscordant does not allow assertive communication between them, generates mutual uncertainty by generating instability in the couple's relationship, and deteriorates marital satisfaction which can lead to breakup. In turn, these phenomena can trigger family stigmatization and domestic violence. For the prevention and treatment of psychological distress or other mental disorders during the perinatal stage, effective coping is necessary. This approach should address the origin of the problems by encouraging patients to make use of their resources to resolve such conditions, adapting appropriately to their social, family, and couple environment ( 57 , 58 ). Even though effective coping consists of psychotherapy and/or psychopharmacological treatment, cognitive-behavioral therapy is the most important tool in pregnant women. Only in case there is no improvement in the symptomatology of psychological distress, psychopharmacological therapy can be chosen ( 7 , 59 ). The exacerbation of anxiety and depression symptoms in patients living with HIV may be due to the perception of their disease and the process of coping with it even when psychotherapy was applied after diagnosis situation that is a limitation in our study, contrary to others who initiated treatment upon suspicion of HIV infection ( 17 , 60 ). Because the study population admitted was referred from another hospital center it is difficult to perform assessments before HIV diagnosis for the identification of predisposing traits to psychological distress and coping. Based on our results, we suggest that it is necessary to provide psychotherapeutic support to patients living with HIV from the early stages of pregnancy and, if necessary, to provide joint care with the perinatal psychiatry service. Based on the intensity and severity of the symptomatology of psychological distress, anxiety, or depression, pharmacological treatment is indicated without restriction. Even when patients may have chronic degenerative diseases, both treatments are administered together. It has been shown that psychopharmacological treatment only presents side effects during the adaptation period compared to the benefit that can be provided by the control of anxiety and perinatal depression ( 61 – 63 ). This benefit should be prioritized in this population. Our results broaden the perspective of an integrative treatment in pregnant women living with HIV, by emphasizing the importance of providing them with personal tools for the development of effective coping with the disease, social and family esteem; in this way, generating efficient support networks, search for adequate solutions, psychotherapeutic accompaniment for the strengthening of the couple's relationship. The identification of features of psychological discomfort, anxiety, and depression allows the suggestion of psychological screening interventions in the possibility of a positive diagnosis that would work as a protective factor during the beginning of the perinatal period. Screening would avoid late referral of the patient to mental health personnel. We suggest that it is pertinent to develop algorithms or criteria that allow the identification of the mental health needs of patients by both psychology and psychiatry, forming comprehensive care. Additionally, screening in first-level health institutions or the possibility of attending through technological tools such as telemedicine, facilitates the timely care of patients in an early manner. Conclusions HIV status during pregnancy increases the possibility of presenting trait anxiety and depression, a condition that is related to greater marital dissatisfaction. Abbreviations MSS Marital Satisfaction Scale GAD Generalized Anxiety Disorder PWLWH Pregnant women living with HIV EMEP National Survey of Psychiatric Epidemiology, México STAI State-Trate Anxiety Inventory STAI T-State-Trate Anxiety Inventory-Trait STAI S-State-Trate Anxiety Inventory-State BDI II-Beck Depression Inventory Declarations Ethics approval and consent. The Ethics Committee from Instituto Nacional de Perinatología approved the research results, Research Number 2017-3-128. Informed consent was obtained from all individual participants included in the study; we do not include participants under 18 years. This study and all their protocols were evaluated by the Research, Ethics and Biosafety committees of Instituto Nacional de Perinatología; all methods were carried out under Helsinki Declaration and local research guidelines. Consent for publication. The informed consent also includes all subjects for publication of identifying information, results and/or images in an online open-access publication. All authors allows to publish of results of the current research. Data Availability Statement. The data and psychometric instruments are available to obtain access to raw data you must contact María del Pilar Meza-Rodríguez by email: [email protected] upon reasonable request. Competing interests . The authors declare no competing interests. Funding. The research leading to these results received funding from Instituto Nacional de Perinatología under grant agreement number 2017-3-128. Authors’ contributions Conceptualization: Mario de Jesús Meingüer-Cuevas, María del Pilar Meza-Rodríguez and Claudia Sánchez-Bravo. Methodology: Mario de Jesús Meingüer-Cuevas, Miroslava Avila-García and Javier Mancilla-Ramírez. Formal analysis: Miroslava Avila-García, Ricardo Figueroa-Damián and Noemí Guadalupe Plazola-Camacho. Writing – original draft preparation: Mario de Jesús Meingüer-Cuevas and Miroslava Avila-García. Writing – review and editing: Mario de Jesús Meingüer-Cuevas, Miroslava Avila-García, María del Pilar Meza-Rodríguez and Javier Mancilla-Ramírez. Funding acquisition: María del Pilar Meza-Rodríguez. Acknowledgments . We thank RNC Virginia Elena Santillán Palomo and the invaluable staff member of our HIV clinic care program. Author information . Mario de Jesús Meingüer-Cuevas was a postgraduate student of the Maestría en Ciencias de la Salud in the Escuela Superior de Medicina of Instituto Politecnico Nacional in Mexico City. References del Pilar Meza-Rodríguez M, Ramírez JM, Garza SJ, Morales NGPC, Palomo VES, Arroyo ICJREdPI. Factores psicológicos asociados a la planificación familiar postparto en mujeres VIH positivas. 2020;23(3):1105. Berenzon S, Lara MA, Robles R, Medina-Mora MEJSpdM. 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Bravo CS, Silva RMHJRadcp. La satisfacción marital y el manejo del poder en la pareja: prevención para la salud. 2018;27(1):72-82. Tomicich M. Estilos de apego adulto y la satisfacción de pareja en mujeres embarazadas: Tesis de licenciatura). Universidad Argentina de la Empresa, Buenos Aires …; 2017. Párraga Moreno F. Impacto de una intervención breve en el afrontamiento diádico, la satisfacción en la relación y la adherencia al tratamiento, en pacientes con VIH positivo y sus parejas. Lawrence EM, Rogers RG, Wadsworth T. Happiness and longevity in the United States. Soc Sci Med. 2015;145:115-9. Alipour Z, Kazemi A, Kheirabadi G, Eslami AA. Marital communication skills training to promote marital satisfaction and psychological health during pregnancy: a couple focused approach. Reproductive health. 2020;17(1):23. Lara MA, Navarrete L, Nieto L, Berenzon SJSm. Acceptability and barriers to treatment for perinatal depression: An exploratory study in Mexican women. 2014;37(4):293-301. van Ravesteyn LM, Lambregtse-van den Berg MP, Hoogendijk WJ, Kamperman AMJPO. Interventions to treat mental disorders during pregnancy: a systematic review and multiple treatment meta-analysis. 2017;12(3):e0173397. Köhler-Forsberg O, Cusin C, Nierenberg AAJJ. Evolving issues in the treatment of depression. 2019;321(24):2401-2. Dagher RK, Bruckheim HE, Colpe LJ, Edwards E, White DBJJoWsH. Perinatal depression: Challenges and opportunities. 2021;30(2):154-9. Chaudron LHJAJoP. Complex challenges in treating depression during pregnancy. 2013;170(1):12-20. Rejón MdPO, Galaz MMFJEeIeP. Funcionamiento familiar como predictor de la satisfacción marital en hombres y mujeres. 2016;21(2):141-52. García FE, Fuentes Zarate R, Sánchez Sánchez AJAóddcdddpU. Amor, satisfacción en la pareja y resolución de conflictos en adultos jóvenes. 2016;14(2):284-302. Dunkel Schetter C, Tanner L. Anxiety, depression and stress in pregnancy: implications for mothers, children, research, and practice. Current opinion in psychiatry. 2012;25(2):141-8. Spielberger CD, Díaz-Guerrero RIJMEmm. Inventario de ansiedad: rasgo-estado. 1975;28(2). Morales F, González GJRmdp. Normalización del instrumento de ansiedad (IDARE) en mujeres embarazadas. 1990;7(1):75-80. Aranda BDE, Álvarez CD, Hernández RL, Ramírez MTGJUP. Propiedades psicométricas del modelo bifactorial del BDI-II (versión española) en muestras mexicanas de población general y estudiantes universitarios. 2015;14(1):125-36. Jurado S, Villegas ME, Méndez L, Rodríguez F, Loperena V, Varela RJSm. La estandarización del Inventario de Depresión de Beck para los residentes de la Ciudad de México. 1998;21(3):26-31. Zicavo N, Vera CJRDP. Incidencia del ajuste diádico y sentido del humor en la satisfacción marital. 2011;13(1):74-89. Leblanc J, Côté J, Pagé MG, Piquet H, Simon T, Crémieux AC, et al. Implementation of nurse‐driven HIV screening targeting key populations in emergency departments: a multilevel analysis from the DICI‐VIH trial. 2019;16(6):444-53. Calderon Viera BS. Relación entre el nivel de conocimiento y actitudes frente a las infecciones de transmisión sexual-VIH/SIDA en estudiantes de Clínica Integral de la escuela profesional de Odontología de la ULADECH Católica, distrito de Chimbote, provincia del Santa, departamento de Áncash, 2021. Figueroa Medrano LP, Xochiahua Díaz L, Figueroa Damían RJBmHIM. Características clínicas y epidemiológicas de pacientes pediátricos con infección por VIH/SIDA: informe de 124 pacientes. 2001:771-9. Smith LR, Fisher JD, Cunningham CO, Amico KRJApc, STDs. Understanding the behavioral determinants of retention in HIV care: a qualitative evaluation of a situated information, motivation, behavioral skills model of care initiation and maintenance. 2012;26(6):344-55. Flores Galaz MMJAdip. Comunicación y conflicto:¿ Qué tanto impactan en la satisfacción marital? 2011;1(2):216-32. Rodríguez MM, Morales S, Arroyo I, Meza ML, García RO, Damian RFJPyRH. Niveles de estrés en pacientes mexicanas embarazadas seropositivas al VIH. 2018;32(4):155-9. Flores Isaac MT, Laureano J, Mejía Mendoza ML. Significado y percepción frente al VIH/SIDA en mujeres rurales parejas de migrantes, Jalisco, México. 2015. Elkington KS, Bauermeister JA, Zimmerman MAJJoy, adolescence. Psychological distress, substance use, and HIV/STI risk behaviors among youth. 2010;39:514-27. Napper LE, Fisher DG, Reynolds GLJA, Behavior. Development of the perceived risk of HIV scale. 2012;16:1075-83. MEJÍA RN. Terapia de aceptación y compromiso en personas con VIH y sintomatología afectiva: Tesis para obtener el grado de doctor en psicología). http://cuved. unam. mx …; 2020. McIntosh RC, Rosselli M. Stress and coping in women living with HIV: a meta-analytic review. AIDS Behav. 2012;16(8):2144-59. Himelhoch S, Medoff DR, Oyeniyi G. Efficacy of group psychotherapy to reduce depressive symptoms among HIV-infected individuals: a systematic review and meta-analysis. AIDS patient care and STDs. 2007;21(10):732-9. Moore DJ, Fazeli PL, Moore RC, Woods SP, Letendre SL, Jeste DV, et al. Positive psychological factors are linked to successful cognitive aging among older persons living with HIV/AIDS. 2018;22:1551-61. Vigod S, Hussain-Shamsy N, Grigoriadis S, Howard LM, Metcalfe K, Oberlander TF, et al. A patient decision aid for antidepressant use in pregnancy: study protocol for a randomized controlled trial. Trials. 2016;17(1):110. Dandjinou M, Sheehy O, Bérard A. Antidepressant use during pregnancy and the risk of gestational diabetes mellitus: a nested case-control study. BMJ Open. 2019;9(9):e025908. Molyneaux E, Trevillion K, Howard LM. Antidepressant treatment for postnatal depression. Jama. 2015;313(19):1965-6. Additional Declarations No competing interests reported. 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In Mexico, the National Survey of Psychiatric Epidemiology (ENEP) in 2012, refers that 9.2% of the general population suffered an affective disorder at some point in life, the highest frequency was observed in women (10.4%) while in men (5.4%) (\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e). In pregnancy, the prevalence of depression is higher compared to the general population (22 to 37%), GAD is less frequent (8 to 10%); however, comorbidity between both disorders may cause a worsening of anxiety symptoms (\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). In other order of ideas, marital satisfaction during pregnancy may experience fluctuations due to such psycho-emotional conditions, at the same time, the physical and hormonal changes of the woman, as well as the alteration in the dynamics of the relationship with the partner supposed factors that violate the well-being and marital satisfaction, putting at risk the stability of the couple relationship (\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e).\u003c/p\u003e\n\u003ch3\u003eEMOTIONAL DYSREGULATION IN PREGNANT WOMEN LIVING WITH HIV\u003c/h3\u003e\n\u003cp\u003eFor pregnant patients recently diagnosed with HIV, it is crucial to consider the impact generated by the social representation of the disease, the cultural and psychological stigma associated with the diagnosis, as well as the lack of support networks due to conflicts in personal, family, and partner relationships, and how this affects treatment adherence (\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eLack of support networks as well as inefficient interpersonal relationships may increase the probability of experiencing symptoms of psychological distress (\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). The presence of anxiety and depressive traits are often prevalent in this population. These assume serious consequences for the quality of life of the mother and the well-being of the baby; therefore, early diagnosis of these disorders allows for timely and effective psychological and/or psychiatric interventions, thus protecting the physical-mental health of the mother and her child (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eHistorically, pregnancy and motherhood have been represented as processes that involve a series of psychosocial changes in women's lives (\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e). These experiences represent opportunities, challenges in bond formation, as well as gratification in child-rearing (\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e). These representations are often limited to specific sociocultural contexts, which do not only consider physical and/or psychological conditions in the difficulty of diagnosis and treatment of anxiety and depression during pregnancy (\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnxiety is a complex emotional state characterized by an unpleasant feeling of worry, nervousness, or fear, accompanied by psychosomatic changes. It can arise as an adaptive response to stressful or traumatic situations in a person's life (\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). During pregnancy, anxiety is a common experience that can be influenced mainly by factors related to gestation and motherhood. This condition not only affects the mother but can also have repercussions on the development of the fetus (low birth weight, preterm delivery, preeclampsia, thinning of the cerebral cortex, increased amygdala size) and the emotional health of the newborn (\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e). Anxiety is often related to specific concerns. Physical appearance, method of pregnancy resolution, fear of having a child with congenital malformations and/or developmental disability, risk of miscarriage and/or spontaneous gestational loss or the possibility of sudden infant death (\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e), and fear of vertical transmission (\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eDepression is a complex and multifactorial condition characterized by a predominant mood of sadness, hopelessness, or emptiness, leading to a loss of interest or pleasure in activities of daily living (\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e). At the beginning of the depressive state before pregnancy can further magnify symptomatology and affect adherence to pharmacological treatment before or during conception (\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e). Among the multiple causes of depression during pregnancy include traumatic experiences, brain chemical imbalances, chronic stress, and a history of abuse or violence, both intimate partner and intrafamilial or social (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e). This condition can negatively impact the quality of life of the mother and/or the fetus or newborn (\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e), increasing the risk of complications such as preterm delivery, low birth weight, and emotional problems (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). Other risk factors include low socioeconomic and educational status, being a single mother, lack of partner support, multiple parenting, experiences of previous physical, psychological, or sexual violence, unresolved grief, and social isolation, with a greater impact on HIV cases (\u003cspan additionalcitationids=\"CR21\" citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e). These conditions not only leave implicit the importance of the gestational medical approach but also the emotional and social challenges faced by such a population (\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e, \u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eAnxiety and depression are conditions that can coexist and exacerbate each other during pregnancy (\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e). The emotional changes and worries generated by both anxiety and depression can hinder communication and emotional connection between expectant parents, which can result in conflict or tension in the couple's relationship and impact marital satisfaction (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e).\u003c/p\u003e \u003cdiv id=\"Sec3\" class=\"Section2\"\u003e \u003ch2\u003eMARITAL SATISFACTION\u003c/h2\u003e \u003cp\u003eMarital satisfaction is defined as the quality of the interpersonal relationship between partners or spouses, which is closely linked to the sense of psychological and emotional well-being within the couple\u0026rsquo;s relationship (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e). This includes a series of behaviors aimed at maintaining the physical, mental, and emotional well-being of both partners, as well as feelings of acceptance, security, protection, and mutual support (\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e). These behaviors and feelings may stem from positive parenting, family support, trust, and loyalty in their couple relationship. On the one hand, women tend to have affectionate and pleasant behaviors toward their husbands (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In contrast, husbands attach greater importance to protective and providing behaviors through practical and useful actions of their wives (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e). In turn, the positive perception of oneself and one's partner is crucial to evaluate and identify whether the relationship satisfies individual needs. This promotes a state of peace (emotional stability) and balance in daily life, facilitating effective conflict resolution, the ability to reach agreements, and fostering mutual respect (\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e). Even if the relationship is satisfactory, sometimes it is likely to experience incompatibility or imbalance in the exercise of power in the couple (\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). If it becomes a permanent form of interaction, it could cause dissatisfaction and lead to marital separation. In contrast, marital dissatisfaction is associated with a series of negative factors, such as family violence, alcoholism, addictions, and other causes (\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e). By failing to meet the psycho-emotional needs of the partners, conflicts, and tensions can arise that negatively affect the well-being of both partners (\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e). Marital satisfaction or dissatisfaction can affect other areas such as the relationship with children, job stability, general well-being, health care, and quality of life (\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e, \u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e, \u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eMarital satisfaction during pregnancy represents a phase of transformation or challenges for the couple\u0026rsquo;s relationship (\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e). The influence of factors such as physical and emotional changes are preponderant at this stage in women. The success of the relationship during pregnancy will depend on how the couple copes and adapts to the challenges that arise secondary to this event. Assertive communication, mutual support, and participation in each other's needs are related to improved marital satisfaction during pregnancy (\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eMARITAL SATISFACTION, PREGNANCY LIVING WITH HIV\u003c/h3\u003e\n\u003cp\u003ePregnant women living with HIV present high levels of stress, which can exacerbate the course of the disease and the couple's relationship. It has been identified that a significant percentage of these women experience anxiety and depression during pregnancy (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e), which negatively impacts mothers by generating conflicts in their family and couple relationships (\u003cspan additionalcitationids=\"CR37\" citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e). The social representation of the disease hinders its evolution due to the stigma that revolves around it, complicating the detection and treatment of related anxiety and emotional symptoms, as this condition acts as a risk factor that can influence decision-making regarding health improvement and treatment adherence (\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e). In addition, the duration of the couple's relationship, having children with the infected person, concern about the risk of contagion, lack of understanding of individual needs, as well as low socioeconomic and educational level, in conjunction with family and social prejudices, act as additional risk factors (\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e). These elements can generate dysfunctions in the couple's relationship due to the stigmas associated with the diagnosis, lack of commitment, and little or no emotional support from the partner, which harms marital satisfaction (\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eUnderstanding this problem is crucial to planning and improving the early intervention of mental health services that comprehensively address the specific needs of these women; from the use of specific assessment instruments, the development of effective coping strategies, and the implementation of therapeutic interventions that help, prevent, and promote psycho-emotional well-being in this population (\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e). The present study aimed to analyze and identify the relationship between traits of anxiety, depression, and marital satisfaction, comparing two groups: normal-evolutionary pregnant women and pregnant women living with HIV.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003eAn observational, cross-sectional, prospective, analytical, and comparative was performed at the National Institute of Perinatology during the years 2019 to 2022. The study was approved by the Institute's research and ethics committee (Reg. 2017-3-128) under the standards established by the Declaration of Helsinki on research involving human subjects.\u003c/p\u003e \u003cp\u003eThird-trimester pregnant women between 18 and 50 years old were invited to participate in her prenatal follow-up. The patients who met the inclusion criteria and who agreed to participate in the study after signing a written informed consent form were divided into two groups based on the criterion of presence/absence of HIV.\u003c/p\u003e\n\u003ch3\u003eEvaluation of mental state\u003c/h3\u003e\n\u003cp\u003eA semi-structured clinical history was taken from the participants to collect sociodemographic data and to track the clinical data, after which the psychometric battery designed for the evaluation of clinical variables was applied.\u003c/p\u003e \u003cp\u003eFor the measurement of trait anxiety and state anxiety traits, the Trait-State Anxiety Inventory (STAI) was used, which consists of 40 standardized items for the Mexican population (\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e), the cut-off points used were: 47 points for trait anxiety and 43 points for state anxiety (\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e). In the evaluation of depression traits, the Beck Depression Inventory (BDI-II) validated for the Mexican population was used, which consists of 21 items (\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e) whose cut-off points are: 0\u0026ndash;9 absence, 10\u0026ndash;16 mild depression, 17\u0026ndash;29 moderate depression, and greater than 30 severe depression (\u003cspan citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e). Finally, for the evaluation of marital satisfaction (MSS Spanish version), the instrument validated for the Mexican population was used, consisting of 48 dichotomous items (\u003cspan citationid=\"CR47\" class=\"CitationRef\"\u003e47\u003c/span\u003e), to measure the degree of satisfaction of couples, where the cut-off points are identified as follows: satisfaction in those couples who obtain scores lower than 187; on the contrary, scores higher than 188 are dissatisfied couples.\u003c/p\u003e \u003cp\u003eFrom the evaluation of the study, those patients who were diagnosed with anxiety, depression and/or marital dissatisfaction had access to psychological care by the Neurosciences department.\u003c/p\u003e \u003cdiv id=\"Sec7\" class=\"Section2\"\u003e \u003ch2\u003eStatistical Analysis\u003c/h2\u003e \u003cp\u003eFor the analysis of the sociodemographic variables, measures of central tendency were used. In the case of clinical variables: obstetric history, state-trait anxiety, depression, and marital satisfaction, parametric statistics of Chi-square, and Student's t-test were used. The clinical variables were correlated with Spearman's Rho.\u003c/p\u003e \u003c/div\u003e"},{"header":"Results","content":"\u003cp\u003e \u003cb\u003ePopulation Description.\u003c/b\u003e Sixty patients were recruited and were evenly distributed in both groups based on HIV diagnosis or absence. In the case of patients living with HIV the mean age was 29.53 years, their highest level of education was high school, most were engaged in housekeeping and mostly living in union with their partners (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). In the case of women without HIV (Control), the mean age was 32.77 years, with a high school education, but mostly dedicated to housekeeping and living in a union or marriage (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic variables.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+HIV\u003c/p\u003e \u003cp\u003eMean\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-HIV\u003c/p\u003e \u003cp\u003eMean\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAge (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e29.53\u0026plusmn;5.588\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.77\u0026plusmn;7.113\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.055\u003c/b\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8.77\u0026plusmn;3.287\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e13.00\u0026plusmn;2.865\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eEducation (years)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eElementary school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"5\" rowspan=\"6\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiddle school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh school\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional Technician\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUniversity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostgraduate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOccupation\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHousekeeper\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e0.002\u003c/b\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eStudent\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMerchant\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEmployee\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eProfessional\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnemployed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eRelationship\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e0.011\u003c/b\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLiving together\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTo split up\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDivorce\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAlcohol and tobacco\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAlcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.184\u003c/em\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eTobacco\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.542\u003c/em\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDrugs\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarijuana\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e5\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003e0.129\u003c/em\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCocaine\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCrack\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003e\u0026dagger;\u003c/b\u003e \u003cem\u003eStudent T-test, P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eǂ\u003c/b\u003e = \u003cem\u003eChi-square, P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSociodemographic variables (continue).\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+HIV\u003c/p\u003e \u003cp\u003eMean\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-HIV\u003c/p\u003e \u003cp\u003eMean\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003eRoute of transmission\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eUnknown\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"4\" rowspan=\"5\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePerinatal\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eBy perforation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSexual\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eWithout contagion\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e30\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eCouple knows the diagnosis\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eYes\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eHIV\u0026thinsp;+\u0026thinsp;couples\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSi\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNo\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e21\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eWho infected it (sexual borne)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCurrent couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cb\u003e\u0026lt;\u0026thinsp;0.001\u003c/b\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePrevious couple\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c3\" namest=\"c1\"\u003e \u003cp\u003e\u003cb\u003eOBSTETRICAL HISTORY\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e2.77\u0026plusmn;1.431\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1.77\u0026plusmn;0.774\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.001\u003c/b\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1.37\u0026plusmn;1.273\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.90\u0026plusmn;0.995\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.119\u003c/em\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.30\u0026plusmn;0.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.30\u0026plusmn;0.596\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e1.000\u003c/em\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiscarriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.33\u0026plusmn;0.547\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.33\u0026plusmn;0.479\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e1.000\u003c/em\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.10\u0026plusmn;0.305\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.03\u0026plusmn;0.183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.309\u003c/em\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003e\u0026dagger;\u003c/b\u003e \u003cem\u003eStudent T-test, P-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eǂ\u003c/b\u003e = \u003cem\u003eChi-square, P value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eIn the obstetric history, most of the patients living with HIV delivered vaginally (euthyroid delivery), with a low prevalence of miscarriages, deaths and cesarean section (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e). As for the control group, most of the patients were primigravidae (X̄= 1.77 gestations), so there is no information on the route of pregnancy resolution, history of gestational losses, miscarriages or termination by cesarean section.\u003c/p\u003e \u003cp\u003eReferent to drug addictions, alcoholism was the most frequent in both groups, followed by tobacco use; concerning narcotic drug use (marijuana, cocaine) the incidence was higher in patients living with HIV. Their partners presented a similar behavioral pattern; as for the control group, only a pattern of social alcoholism was observed in both patients and their partners (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eReferent to the route of transmission of the infection, the most frequent was sexual (n\u0026thinsp;=\u0026thinsp;20), 8 of them did not know the route of infection. About the partners of the patients studied, 17 knew the diagnosis and 9 of them were HIV seropositive (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e \u003cb\u003eEvaluation of mental status.\u003c/b\u003e According to the results generated by the psychometric analyses, it was observed that both groups presented very similar levels of depression (T-test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.754) and trait anxiety (T-test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.693) and state (T-test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.526). In women living with HIV, they presented greater marital dissatisfaction compared to the control group (T-test, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.051) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e2\u003c/span\u003e). In both groups, the central concern is about the health status of the product.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eMental status assessment.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003e+HIV\u003c/p\u003e \u003cp\u003eMean\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-HIV\u003c/p\u003e \u003cp\u003eMean\u0026plusmn;\u003cem\u003eSD\u003c/em\u003e\u003c/p\u003e \u003cp\u003e\u003cem\u003en\u003c/em\u003e\u0026thinsp;=\u0026thinsp;30\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003eP value\u003c/em\u003e\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnxiety State (STAI-S)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e36.43\u0026plusmn;13.299\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e38.47\u0026plusmn;11.279\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.526\u003c/em\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow [\u0026lt;\u0026thinsp;29]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003e0.084\u003c/em\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium [30\u0026ndash;44]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh [\u0026gt;\u0026thinsp;45]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e8\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eAnxiety Trait (STAI-T)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e38.50\u0026plusmn;12.426\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.57\u0026plusmn;7.899\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.693\u003c/em\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLow [\u0026lt;\u0026thinsp;29]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e7\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"2\" rowspan=\"3\"\u003e \u003cp\u003e\u003cem\u003e0.290\u003c/em\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMedium [30\u0026ndash;44]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e20\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eHigh [\u0026gt;\u0026thinsp;45]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e9\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eDepression (BDI-II)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11.93\u0026plusmn;12.814\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e11.03\u0026plusmn;9.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.754\u003c/em\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAbsentee [0\u0026ndash;9]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"3\" rowspan=\"4\"\u003e \u003cp\u003e\u003cem\u003e0.292\u003c/em\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMild [10\u0026ndash;16]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eModerate [17\u0026ndash;29]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e4\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeep [\u0026gt;\u0026thinsp;30]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e\u003cb\u003eMarital Satisfaction (MSS)\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e172.20\u0026plusmn;35.715\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e153.53\u0026plusmn;36.765\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e\u003cem\u003e0.051\u003c/em\u003e \u003cb\u003e\u0026dagger;\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSatisfaction [\u0026lt;\u0026thinsp;187]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e24\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\" morerows=\"1\" rowspan=\"2\"\u003e \u003cp\u003e\u003cem\u003e0.091\u003c/em\u003e \u003cb\u003eǂ\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDissatisfaction [\u0026gt;\u0026thinsp;188]\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e6\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003e\u0026dagger;\u003c/b\u003e \u003cem\u003eStudent T-test, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003ctr\u003e\u003ctd colspan=\"4\"\u003e\u003cb\u003eǂ\u003c/b\u003e \u003cem\u003eChi-square test, p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.05\u003c/em\u003e\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelations matrix between sociodemographic variables and mental status assessment.\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"13\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c10\" colnum=\"10\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c11\" colnum=\"11\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c12\" colnum=\"12\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c13\" colnum=\"13\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eEducation\u003c/p\u003e \u003cp\u003e(years)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003ePregnancy\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eLabor\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eMiscarriage\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c8\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c9\"\u003e \u003cp\u003e+HIV/-HIV\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c10\"\u003e \u003cp\u003eMarital Satisfaction (MSS)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c11\"\u003e \u003cp\u003eDepression (BDI-II)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c12\"\u003e \u003cp\u003eAnxiety State (STAI-S)\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c13\"\u003e \u003cp\u003eAnxiety Trait (STAI-T)\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"11\" nameend=\"c13\" namest=\"c3\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eEducation (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.036\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"10\" nameend=\"c13\" namest=\"c4\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePregnancy\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.223\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.371\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"9\" nameend=\"c13\" namest=\"c5\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eLabor\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.091\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e-0.276\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.576\u003c/b\u003e\u003csup\u003e**\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"8\" nameend=\"c13\" namest=\"c6\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMiscarriage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.343\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.065\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.209\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.187\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c13\" namest=\"c7\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDeath\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.002\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.114\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e0.269\u003c/b\u003e\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.117\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.145\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"6\" nameend=\"c13\" namest=\"c8\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCesarean\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.244\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.017\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.171\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.151\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.045\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e.0183\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"5\" nameend=\"c13\" namest=\"c9\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e+HIV/-HIV\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u003cb\u003e0.597\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u003cb\u003e-0.376\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.182\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.024\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.134\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.000\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"4\" nameend=\"c13\" namest=\"c10\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMarital Satisfaction (MSS)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e-0.123\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e0.084\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.032\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.063\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e-0.157\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.050\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e\u003cb\u003e-0.271\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"3\" nameend=\"c13\" namest=\"c11\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eDepression (BDI-II)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.169\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.175\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.042\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e\u003cb\u003e0.256\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e-0.118\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.053\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.007\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e\u003cb\u003e-0.336\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colspan=\"2\" nameend=\"c13\" namest=\"c12\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety State (STAI-S)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u003cb\u003e0.270\u003c/b\u003e\u003csup\u003e\u003cb\u003e*\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e0.080\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e0.177\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.095\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.068\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.230\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.067\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.242\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.523\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e\u0026nbsp;\u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAnxiety Trait (STAI-T)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e0.100\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e-0.037\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e-0.158\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e-0.060\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e0.056\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e0.075\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c8\"\u003e \u003cp\u003e0.047\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c9\"\u003e \u003cp\u003e0.021\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c10\"\u003e \u003cp\u003e-0.196\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c11\"\u003e \u003cp\u003e\u003cb\u003e0.596\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c12\"\u003e \u003cp\u003e\u003cb\u003e0.613\u003c/b\u003e\u003csup\u003e\u003cb\u003e**\u003c/b\u003e\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c13\"\u003e \u003cp\u003e1\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003ctfoot\u003e \u003ctr\u003e\u003ctd colspan=\"13\"\u003eInterpretative results of sociodemographic variables and psychological tests. Spearman Rho (ρ), \u003cem\u003ep-\u003c/em\u003evalue * \u0026lt;0.05 and ** \u0026lt;0.001\u003c/td\u003e\u003c/tr\u003e \u003c/tfoot\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cb\u003eClinical correlations\u003c/b\u003e. A positive correlation was observed between the variables of age with a history of miscarriages (ρ\u0026thinsp;=\u0026thinsp;0.34, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.007), symptoms of depression (ρ\u0026thinsp;=\u0026thinsp;0.25, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.048), and anxiety-state (ρ\u0026thinsp;=\u0026thinsp;0.27, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.037). As for years of schooling, negative correlations were observed with history of pregnancy (ρ= -0.37, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.003) and number of births (ρ= -0.27, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.033).\u003c/p\u003e \u003cp\u003eAs part of the shared symptomatology in mood and anxiety traits, positive correlations were observed between depression and the variables of state anxiety (ρ\u0026thinsp;=\u0026thinsp;0.52, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001) and Trait Anxiety (ρ\u0026thinsp;=\u0026thinsp;0.59, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001). In turn, there was a positive correlation between state and trait anxiety (ρ\u0026thinsp;=\u0026thinsp;0.61, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e \u003cp\u003eSeropositivity status has a negative correlation with marital satisfaction (ρ= -0.27, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.036) which is possibly related to increased depressive symptoms (ρ= -0.33, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eHuman immunodeficiency virus (HIV) infection is a public health problem. Women living with HIV are of reproductive age, which implies that their pregnancy may be compromised. The diagnosis is known on most occasions during prenatal control, this constitutes a challenge for mothers at the psychological, social, and family levels (\u003cspan additionalcitationids=\"CR49\" citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR50\" class=\"CitationRef\"\u003e50\u003c/span\u003e). The effects generate uncertainty affecting effective communication with the people around them, by adopting avoidant behavior due to emotional, family, and social stigma (\u003cspan citationid=\"CR51\" class=\"CitationRef\"\u003e51\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e). In our study, this behavior is reproduced with what is reported in the literature, by adopting an avoidant behavior generating deterioration in communication with their environment. In these women, we detected traits of psychological distress and in some cases symptoms of anxiety and depression.\u003c/p\u003e \u003cp\u003eIn women who presented features of psychological distress, it has been identified that residence within urbanized areas, access to health services, adequate management of information, and presence of social and family support are a protective factor (\u003cspan additionalcitationids=\"CR54\" citationid=\"CR53\" class=\"CitationRef\"\u003e53\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR55\" class=\"CitationRef\"\u003e55\u003c/span\u003e). This coincides with our population who despite residing in suburban areas, have problems of marginalization which conditions a low socioeconomic level, and limited access to specialized health services, and relevant information. In addition, the development of traits of psychological distress, as well as symptoms of anxiety and depression can be influenced by other factors such as lack of a partner, ineffective assertive communication, little or no perception of marital satisfaction, lack of emotional, social and economic support or attention from their partner in HIV-negative women (\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e, \u003cspan citationid=\"CR52\" class=\"CitationRef\"\u003e52\u003c/span\u003e, \u003cspan citationid=\"CR56\" class=\"CitationRef\"\u003e56\u003c/span\u003e). In the face of HIV infection, the formalization of a sentimental relationship that modifies marital status is a protective factor. On the other hand, the couple's serodiscordant does not allow assertive communication between them, generates mutual uncertainty by generating instability in the couple's relationship, and deteriorates marital satisfaction which can lead to breakup. In turn, these phenomena can trigger family stigmatization and domestic violence.\u003c/p\u003e \u003cp\u003eFor the prevention and treatment of psychological distress or other mental disorders during the perinatal stage, effective coping is necessary. This approach should address the origin of the problems by encouraging patients to make use of their resources to resolve such conditions, adapting appropriately to their social, family, and couple environment (\u003cspan citationid=\"CR57\" class=\"CitationRef\"\u003e57\u003c/span\u003e, \u003cspan citationid=\"CR58\" class=\"CitationRef\"\u003e58\u003c/span\u003e). Even though effective coping consists of psychotherapy and/or psychopharmacological treatment, cognitive-behavioral therapy is the most important tool in pregnant women. Only in case there is no improvement in the symptomatology of psychological distress, psychopharmacological therapy can be chosen (\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e, \u003cspan citationid=\"CR59\" class=\"CitationRef\"\u003e59\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eThe exacerbation of anxiety and depression symptoms in patients living with HIV may be due to the perception of their disease and the process of coping with it even when psychotherapy was applied after diagnosis situation that is a limitation in our study, contrary to others who initiated treatment upon suspicion of HIV infection (\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e, \u003cspan citationid=\"CR60\" class=\"CitationRef\"\u003e60\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eBecause the study population admitted was referred from another hospital center it is difficult to perform assessments before HIV diagnosis for the identification of predisposing traits to psychological distress and coping. Based on our results, we suggest that it is necessary to provide psychotherapeutic support to patients living with HIV from the early stages of pregnancy and, if necessary, to provide joint care with the perinatal psychiatry service.\u003c/p\u003e \u003cp\u003eBased on the intensity and severity of the symptomatology of psychological distress, anxiety, or depression, pharmacological treatment is indicated without restriction. Even when patients may have chronic degenerative diseases, both treatments are administered together. It has been shown that psychopharmacological treatment only presents side effects during the adaptation period compared to the benefit that can be provided by the control of anxiety and perinatal depression (\u003cspan additionalcitationids=\"CR62\" citationid=\"CR61\" class=\"CitationRef\"\u003e61\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR63\" class=\"CitationRef\"\u003e63\u003c/span\u003e). This benefit should be prioritized in this population.\u003c/p\u003e \u003cp\u003eOur results broaden the perspective of an integrative treatment in pregnant women living with HIV, by emphasizing the importance of providing them with personal tools for the development of effective coping with the disease, social and family esteem; in this way, generating efficient support networks, search for adequate solutions, psychotherapeutic accompaniment for the strengthening of the couple's relationship. The identification of features of psychological discomfort, anxiety, and depression allows the suggestion of psychological screening interventions in the possibility of a positive diagnosis that would work as a protective factor during the beginning of the perinatal period. Screening would avoid late referral of the patient to mental health personnel. We suggest that it is pertinent to develop algorithms or criteria that allow the identification of the mental health needs of patients by both psychology and psychiatry, forming comprehensive care. Additionally, screening in first-level health institutions or the possibility of attending through technological tools such as telemedicine, facilitates the timely care of patients in an early manner.\u003c/p\u003e"},{"header":"Conclusions","content":"\u003cp\u003eHIV status during pregnancy increases the possibility of presenting trait anxiety and depression, a condition that is related to greater marital dissatisfaction.\u003c/p\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eMSS\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMarital Satisfaction Scale\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eGAD\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eGeneralized Anxiety Disorder\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003ePWLWH\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003ePregnant women living with HIV\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eEMEP\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eNational Survey of Psychiatric Epidemiology, M\u0026eacute;xico\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTAI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eState-Trate Anxiety Inventory\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTAI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eT-State-Trate Anxiety Inventory-Trait\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eSTAI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eS-State-Trate Anxiety Inventory-State\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003eBDI\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eII-Beck Depression Inventory\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent.\u003c/strong\u003e The Ethics Committee from Instituto Nacional de Perinatolog\u0026iacute;a approved the research results, Research Number 2017-3-128. Informed consent was obtained from all individual participants included in the study; we do not include participants under 18 years. This study and all their protocols were evaluated by the Research, Ethics and Biosafety committees of Instituto Nacional de Perinatolog\u0026iacute;a; all methods were carried out under Helsinki Declaration and local research guidelines.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication.\u003c/strong\u003e The informed consent also includes all subjects for publication of identifying information, results and/or images in an online open-access publication. All authors allows to publish of results of the current research.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData Availability Statement.\u003c/strong\u003e The data and psychometric instruments are available to obtain access to raw data you must contact Mar\u0026iacute;a del Pilar Meza-Rodr\u0026iacute;guez by email: [email protected] upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eThe authors declare no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding.\u003c/strong\u003e The research leading to these results received funding from Instituto Nacional de Perinatolog\u0026iacute;a under grant agreement number 2017-3-128.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026rsquo; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConceptualization:\u0026nbsp;\u003c/strong\u003eMario de Jes\u0026uacute;s Meing\u0026uuml;er-Cuevas, Mar\u0026iacute;a del Pilar Meza-Rodr\u0026iacute;guez and Claudia S\u0026aacute;nchez-Bravo.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethodology:\u0026nbsp;\u003c/strong\u003eMario de Jes\u0026uacute;s Meing\u0026uuml;er-Cuevas, Miroslava Avila-Garc\u0026iacute;a and Javier Mancilla-Ram\u0026iacute;rez.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFormal analysis:\u0026nbsp;\u003c/strong\u003eMiroslava Avila-Garc\u0026iacute;a, Ricardo Figueroa-Dami\u0026aacute;n and Noem\u0026iacute; Guadalupe Plazola-Camacho.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting \u0026ndash; original draft preparation:\u0026nbsp;\u003c/strong\u003eMario de Jes\u0026uacute;s Meing\u0026uuml;er-Cuevas and Miroslava Avila-Garc\u0026iacute;a.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eWriting \u0026ndash; review and editing:\u0026nbsp;\u003c/strong\u003eMario de Jes\u0026uacute;s Meing\u0026uuml;er-Cuevas, Miroslava Avila-Garc\u0026iacute;a, Mar\u0026iacute;a del Pilar Meza-Rodr\u0026iacute;guez and Javier Mancilla-Ram\u0026iacute;rez.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding acquisition:\u0026nbsp;\u003c/strong\u003eMar\u0026iacute;a del Pilar Meza-Rodr\u0026iacute;guez.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003cstrong\u003e.\u0026nbsp;\u003c/strong\u003eWe thank RNC Virginia Elena Santill\u0026aacute;n Palomo and the invaluable staff member of our HIV clinic care program.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor information\u003c/strong\u003e. Mario de Jes\u0026uacute;s Meing\u0026uuml;er-Cuevas was a postgraduate student of the Maestr\u0026iacute;a en Ciencias de la Salud in the Escuela Superior de Medicina of Instituto Politecnico Nacional in Mexico City.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003edel Pilar Meza-Rodr\u0026iacute;guez M, Ram\u0026iacute;rez JM, Garza SJ, Morales NGPC, Palomo VES, Arroyo ICJREdPI. Factores psicol\u0026oacute;gicos asociados a la planificaci\u0026oacute;n familiar postparto en mujeres VIH positivas. 2020;23(3):1105.\u003c/li\u003e\n\u003cli\u003eBerenzon S, Lara MA, Robles R, Medina-Mora MEJSpdM. Depresi\u0026oacute;n: estado del conocimiento y la necesidad de pol\u0026iacute;ticas p\u0026uacute;blicas y planes de acci\u0026oacute;n en M\u0026eacute;xico. 2013;55(1):74-80.\u003c/li\u003e\n\u003cli\u003eLasheras G, Echeverria I, Farr\u0026eacute;-Sender B, Gelabert E, Roca A, Serrano-Drozdowskyj EJRdpycdlVJdSMPPyP. 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Jama. 2015;313(19):1965-6.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Emotional disorder, couple relationship, anxiety disorder, mental health, women health, AIDS, perinatal diseases.","lastPublishedDoi":"10.21203/rs.3.rs-5411994/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5411994/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eIntroduction:\u003c/h2\u003e \u003cp\u003eIn Mexico, the National Survey of Psychiatric Epidemiology (ENEP) in 2012, refers that 9.2% of the general population suffered an affective disorder at some point in life, the highest frequency was observed in women (10.4%) while in men (5.4%). In pregnancy, the prevalence of depression is higher compared to the general population (22 to 37%). Marital satisfaction during pregnancy may experience fluctuations due to such psycho-emotional conditions, at the same time, the physical and hormonal changes of the woman, as well as the alteration in the dynamics of the relationship with the partner suppose factors that violate the well-being and marital satisfaction, putting at risk the stability of the couple relationship.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eCross-sectional, observational, descriptive study that included pregnant women with HIV who presented traits of anxiety and depression. A psychometric battery was applied consisting of: State-Trait Anxiety Inventory (STAI), Beck Depression Inventory II (BDI-II), and the Marital Satisfaction Scale (MSS Spanish version).\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003e60 patients were recruited and divided into 2 groups (HIV\u0026thinsp;+\u0026thinsp;and HIV-). Anxiety and depression levels were similar in both groups (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026gt;\u0026thinsp;0.05) but HIV\u0026thinsp;+\u0026thinsp;patients showed lower marital satisfaction (\u003cem\u003ep\u003c/em\u003e\u0026thinsp;=\u0026thinsp;0.051) related to the increase of depressive traits (ρ= -0.33, \u003cem\u003ep\u003c/em\u003e\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\u003ch2\u003eConclusions\u003c/h2\u003e \u003cp\u003eHIV status during pregnancy may increase the possibility of presenting trait/state anxiety traits and depression, a condition related to major marital dissatisfaction.\u003c/p\u003e\u003ch2\u003eClinical Trial Number:\u003c/h2\u003e \u003cp\u003e2017-3-128.\u003c/p\u003e","manuscriptTitle":"Anxiety, depression, and their relationship with marital satisfaction in Mexican pregnant women living with HIV","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-12-11 08:34:43","doi":"10.21203/rs.3.rs-5411994/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"1182f1e6-71ec-401f-9faa-627431466356","owner":[],"postedDate":"December 11th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-05-13T13:23:47+00:00","versionOfRecord":[],"versionCreatedAt":"2024-12-11 08:34:43","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-5411994","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5411994","identity":"rs-5411994","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}