Socioeconomic vulnerability, social protection, and hiv outcomes among pregnant and lactating women in Zimbabwe

Abstract Background Pregnant and lactating women with HIV are particularly vulnerable to the intersecting effects of HIV and poverty. In Zimbabwe, socioeconomic vulnerability among young women increases the risk of HIV acquisition and compromises treatment outcomes. Analyzing measures of poverty is therefore essential to identifying socioeconomic factors that impact maternal and child health outcomes in this population. This analytical cross-sectional study examined the relationship between socioeconomic vulnerability and HIV-related health outcomes among pregnant and lactating women in Zimbabwe. Methods We surveyed 600 pregnant and lactating women living with HIV receiving care at community health centers across Zimbabwe. The survey captured sociodemographic and self-reported clinical data. Using generalized estimating equations, we assessed associations between viral load non-suppression, antiretroviral (ARV) treatment interruption, delayed presentation to antenatal care, and socioeconomic covariates including poverty level and participation in social protection programs. Analyses were performed using STATA BE version 17.0. Results Among participants, 74.5% ( n = 447) were lactating and 25.5% ( n = 153) were pregnant. Over half (54.2%, n = 325) reported at least one unmet social need; 47.2% ( n = 283) experienced food insecurity, 26.2% ( n = 157) lacked transportation funds, and 23.7% ( n = 142) lacked money for user fees or related health costs. Nearly half (49.5%, n = 297) reported using negative financial coping strategies such as taking loans, selling assets, or withdrawing savings. Intimate partner violence was significantly associated with viral load non-suppression (RR 2.4, 95% CI 1.5–4.0, p < 0.05). Receipt of social protection benefits was associated with ARV treatment interruption (RR 2.3, 95% CI 1.3–4.2, p < 0.05), while dissaving was associated with delayed antenatal care presentation (RR 1.8, 95% CI 1.4–2.3, p < 0.05). Conclusions Unmet social needs, poverty, and adverse financial coping strategies were associated with suboptimal HIV outcomes among pregnant and lactating women in Zimbabwe. Although social protection interventions aim to mitigate these vulnerabilities, their complex effects warrant further investigation to optimize design and implementation.