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

HIV-related stigma negatively impacts the health of people who are living with HIV. Stigma may also affect sero-discordant couples where one partner is living with HIV, but the other is not. However, we know little about how HIV-related stigma and couple relationship quality jointly affect depression and anxiety in both the individual and their partner. We analyzed dyadic data from 491 sero-discordant pregnant couples in southwestern Kenya collected during 2019-2022 using Actor-Partner Interdependence Model (APIM) methods. Controlling for relationship quality, HIV-related stigma perceived by both women and men was detrimental to their own mental health as well as to their partner's mental health. High relationship quality was associated with better mental health of couple members, independent of stigma, but reporting high relationship quality did not significantly buffer the negative effect that stigma had on mental health. The partner effects of women's and men's relationship quality were sometimes in opposite directions: women's reports of higher relationship quality were negatively associated with men's depressive symptoms; however, men's reports of higher relationship quality were positively associated with higher depressive symptoms in women. These results suggest that interventions should support sero-discordant couples to resist and reduce HIV-related stigma as well as build positive couple relationships.