Psychological distress is found to be common among HIV-positive pregnant and postpartum mothers in Thailand. Thai mothers with an HIV infection tend to experience stigmatization, depressive symptoms, and suicidal ideation. Depressive symptoms have been found to be linked with a lower quality of life and faster progression to AIDS. Through qualitative and quantitative studies in Thailand, factors related to depressive symptoms among HIV-positive pregnant women have been found to include self-esteem, emotional support, physical symptoms, and Buddhist practises (meditation, doing good deeds, and listening to or watching religious stories). Factors associated with depressive symptoms among HIV-positive postpartum women include self-esteem, a negative perception of infant’s health status, and religious practises.

Due to high rates of depression among HIV-positive pregnant and postpartum women, health-care providers in Thailand should develop a policy and procedures to support routine screenings for depressive symptoms in these populations. Depressive symptoms can first be assessed using a questionnaire, such as the CES-D scale. When a CES-D score of 23 or higher is shown, the patient should be transferred to appropriate practitioners so that a clinical diagnosis can be confirmed and treatment of depression can be administered appropriately. Health-care professionals can also encourage certain religious practises as being beneficial to HIV-positive, pregnant and postpartum, Thai women living in a Buddhist culture, since these practises have been found to be associated with fewer depressive symptoms in both groups.

Increasing self-esteem among the target population will also be beneficial. Action research in Thailand among 10 HIV-positive pregnant Buddhist women revealed that strategies that increased self-esteem among them included counseling, education about HIV infection and the prevention of its transmission, support groups, emotional support, hope, religious practises (e.g., praying, meditation, going to the temple), reading, exercising, and doing errand work (Sawatphanit et al. 2004).

Evidence also shows that self-esteem, as a learned phenomenon, can be strengthened through an individual’s perception of social inclusion (Leary et al. 2004). Therefore, programs that increase a sense of belonging can escalate an HIV-positive mother’s self esteem. Such programs may include support groups, exercise clubs, and other like venues. Health-care professionals should encourage HIV-positive pregnant and postpartum Thai women to join a group of their own personal interest.

Emotional support should also be made available to HIV-positive pregnant Thai women whenever possible. This can be done through counseling within the women’s families so that family members might better express their love and care for these Thai women. Again, emotional support through support groups among Thai mothers with HIV has been found to be beneficial (Liamputtong et al. 2009; see also Chap.​ 15). For HIV-positive postpartum Thai mothers, tangible support should also be encouraged along with emotional support. Newborn care and house chore assistance could help provide these postpartum mothers with sorely needed, even if brief, a respite from such work stress.

When an HIV-positive perinatal Thai woman voices her concern about her own or her infant’s physical symptoms, health-care professionals should seriously respond to the concern. A real cause of such symptoms should be further investigated and treated accordingly. These actions will likely help the woman to have more peace of mind, thereby decreasing her depressive symptoms, and increasing her health overall.

As mentioned earlier, telephone support by an RN was found to be helpful in lessening depressive symptoms among HIV-positive pregnant women in Thailand (Ross et al. 2012b). Thus, emotional and informational telephone support could be expanded to more effectively care for HIV-positive perinatal Thai women. It should be helpful as well if similar telephone support models are developed for and tested among HIV-positive pregnant and postpartum women in other cultures.

Health-care students should also be informed about the psychological distress of HIV-positive pregnant and postpartum Thai women. The helpful strategies mentioned above can be shared with students so that they will be equipped with this knowledge for their future practises.

Finally, further research should be conducted to examine predictors of depressive symptoms among HIV-positive pregnant and postpartum Thai women longitudinally so that definite causation of these predictors can be made. Important predictors that should be included in future research are stigma, self-esteem, different types of social support, support groups, physical symptoms, infant health status, and religious practises. Future research which includes some of these predictors as interventions will be helpful. In addition, research of the emotional and informational benefits of telephone support among HIV-positive pregnant and postpartum Thai women should be explored in a large sample in Thailand as well as other cultures so that the results can be more generalizable. These recommended studies will add new knowledge to the field and advance our practise so that HIV-positive pregnant and postpartum women in Thailand will receive optimal health care through which their psychological needs can be met and their quality of life maximized.