HIV-related stigma, couple relationship quality, and mental health in sero-discordant pregnant couples in Kenya.

Women's HIV-related stigma was significantly associated with their own depression and anxiety (actor effects).

• Sample consisted of 491 sero-discordant pregnant couples in southwestern Kenya collected during 2019-2022.
• Actor-Partner Interdependence Model (APIM) methods were used to analyze dyadic data.
• Women's stigma actor effects were statistically significant for both depressive symptoms and anxiety outcomes.
• Analyses controlled for couple relationship quality when estimating stigma effects.

Men's HIV-related stigma was significantly associated with their own depression and anxiety (actor effects).

• Both HIV-positive and HIV-negative partners were included in the sero-discordant couples.
• APIM framework allowed simultaneous estimation of actor and partner effects within couples.
• Men's stigma actor effects were statistically significant for both depressive symptoms and anxiety.
• Controlling for relationship quality, HIV-related stigma perceived by both women and men was detrimental to their own mental health.

HIV-related stigma perceived by women was associated with worse mental health in their male partners (partner effects).

• Partner effects indicate that one person's stigma experience impacts the other person's mental health outcomes.
• Women's stigma was significantly associated with men's depressive symptoms and/or anxiety.
• These partner effects persisted after controlling for relationship quality.
• Data were collected from 491 sero-discordant pregnant couples in southwestern Kenya.

HIV-related stigma perceived by men was associated with worse mental health in their female partners (partner effects).

• Men's stigma partner effects were statistically significant for women's mental health outcomes.
• The cross-partner effects of stigma were found for both depression and anxiety measures.
• These effects were independent of relationship quality.
• Findings apply to sero-discordant couples where one partner is living with HIV and the other is not.

Higher couple relationship quality was independently associated with better mental health for couple members, but did not significantly buffer the negative effect of stigma on mental health.

• High relationship quality was associated with better mental health independent of stigma levels.
• The interaction between stigma and relationship quality was not statistically significant, indicating no buffering effect.
• Relationship quality and stigma operated as independent predictors of mental health outcomes.
• This finding suggests that positive couple relationships alone are insufficient to mitigate stigma's harmful mental health effects.

Women's reports of higher relationship quality were negatively associated with men's depressive symptoms, while men's reports of higher relationship quality were positively associated with higher depressive symptoms in women.

• Partner effects of relationship quality were in opposite directions for women and men.
• Women reporting higher relationship quality was linked to fewer depressive symptoms in their male partners.
• Men reporting higher relationship quality was associated with more depressive symptoms in their female partners.
• These gender-differentiated partner effects were found in the context of sero-discordant pregnant couples.
• The authors note these results as a notable asymmetry in how relationship quality cross-partner effects operate by gender.

The study used the Actor-Partner Interdependence Model (APIM) to analyze dyadic data from sero-discordant pregnant couples in Kenya.

• 491 sero-discordant pregnant couples were included in the analysis.
• Data were collected during 2019-2022 in southwestern Kenya.
• APIM methodology allows simultaneous estimation of actor effects (own stigma/relationship quality on own mental health) and partner effects (own stigma/relationship quality on partner's mental health).
• Outcome measures included depressive symptoms and anxiety.
• Couples were sero-discordant, meaning one partner was living with HIV and the other was not.