1
|
Alexander AG, Relf M, Bosworth HB, Mmbaga BT, Muiruri C. Disclosure of HIV Status to Sexual Partners Among People With HIV in Singida Regional Referral Hospital of Tanzania: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2024; 35:397-408. [PMID: 39105516 PMCID: PMC11346699 DOI: 10.1097/jnc.0000000000000486] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/07/2024]
Abstract
ABSTRACT HIV status nondisclosure to sexual partners remains a major challenge in Tanzania's health system. This hospital-based, descriptive, cross-sectional study design recruited 380 people living with HIV (PLWH) to assess voluntary HIV status disclosure to sexual partners, the associated factors, and outcomes among PLWH in Tanzania. Approximately 78% ( n = 297) of the study participants reported disclosing their HIV status to their sexual partners. Adjusted multivariable logistic regression analysis revealed that HIV status disclosure to sexual partners was significantly associated with living with a sexual partner (adjusted odds ratio [AOR] = 3.91, 95% CI [1.43-10.72]), knowledge of HIV disclosure (AOR = 11.71, 95% CI [2.88-47.63]), known serostatus of the sexual partner (AOR = 40.20, 95% CI [15.31-105.56]), and HIV disclosure-related stigma (AOR = 0.92, 95% CI [0.85-0.99]). Addressing these significant factors will maximize the magnitude of voluntary disclosure to sexual partners.
Collapse
Affiliation(s)
- Alex Gabagambi Alexander
- Alex Gabagambi Alexander, MD, MSc, is a Medical Doctor and a Clinical Researcher at Kilimanjaro Clinical Research Institute, Moshi, Republic of Tanzania, and is a Former Graduate Student at the Duke University Population Health Sciences, Durham, North Carolina, USA. Michael Relf, PhD, RN, AACRN, ANEF, FAAN, is a Professor of Nursing and Global Health, Duke University and the Associate Dean for Global and Community Health Affairs, Duke University School of Nursing, Durham, North Carolina, USA. Hayden B. Bosworth, BA, MS, PhD, is a Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center, Durham, North Carolina, USA, is a Vice Chair of Research and Professor of Population Health Sciences at Duke University, Durham, North Carolina, USA, and is a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center, Durham, North Carolina, USA. Blandina T. Mmbaga, MD, MMED, PhD, is a Pediatrician at Kilimanjaro Christian Medical Center (KCMC), Lecturer at the Kilimanjaro Christian Medical University College of the Tumaini University Makumira (KCMUC), Associate Professor, and Director of the Kilimanjaro Clinical Research Institute, Moshi, Republic of Tanzania. Charles Muiruri, BSC, MPH, PhD, is a Health Services Researcher, Assistant Professor at the Duke Department of Population Health Sciences, Assistant Research Professor in the Duke Global Health Institute, Durham, North Carolina, USA and is an Adjunct Lecturer at the Kilimanjaro Christian Medical University College, Moshi, Republic of Tanzania
| | - Michael Relf
- Alex Gabagambi Alexander, MD, MSc, is a Medical Doctor and a Clinical Researcher at Kilimanjaro Clinical Research Institute, Moshi, Republic of Tanzania, and is a Former Graduate Student at the Duke University Population Health Sciences, Durham, North Carolina, USA. Michael Relf, PhD, RN, AACRN, ANEF, FAAN, is a Professor of Nursing and Global Health, Duke University and the Associate Dean for Global and Community Health Affairs, Duke University School of Nursing, Durham, North Carolina, USA. Hayden B. Bosworth, BA, MS, PhD, is a Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center, Durham, North Carolina, USA, is a Vice Chair of Research and Professor of Population Health Sciences at Duke University, Durham, North Carolina, USA, and is a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center, Durham, North Carolina, USA. Blandina T. Mmbaga, MD, MMED, PhD, is a Pediatrician at Kilimanjaro Christian Medical Center (KCMC), Lecturer at the Kilimanjaro Christian Medical University College of the Tumaini University Makumira (KCMUC), Associate Professor, and Director of the Kilimanjaro Clinical Research Institute, Moshi, Republic of Tanzania. Charles Muiruri, BSC, MPH, PhD, is a Health Services Researcher, Assistant Professor at the Duke Department of Population Health Sciences, Assistant Research Professor in the Duke Global Health Institute, Durham, North Carolina, USA and is an Adjunct Lecturer at the Kilimanjaro Christian Medical University College, Moshi, Republic of Tanzania
| | - Hayden B. Bosworth
- Alex Gabagambi Alexander, MD, MSc, is a Medical Doctor and a Clinical Researcher at Kilimanjaro Clinical Research Institute, Moshi, Republic of Tanzania, and is a Former Graduate Student at the Duke University Population Health Sciences, Durham, North Carolina, USA. Michael Relf, PhD, RN, AACRN, ANEF, FAAN, is a Professor of Nursing and Global Health, Duke University and the Associate Dean for Global and Community Health Affairs, Duke University School of Nursing, Durham, North Carolina, USA. Hayden B. Bosworth, BA, MS, PhD, is a Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center, Durham, North Carolina, USA, is a Vice Chair of Research and Professor of Population Health Sciences at Duke University, Durham, North Carolina, USA, and is a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center, Durham, North Carolina, USA. Blandina T. Mmbaga, MD, MMED, PhD, is a Pediatrician at Kilimanjaro Christian Medical Center (KCMC), Lecturer at the Kilimanjaro Christian Medical University College of the Tumaini University Makumira (KCMUC), Associate Professor, and Director of the Kilimanjaro Clinical Research Institute, Moshi, Republic of Tanzania. Charles Muiruri, BSC, MPH, PhD, is a Health Services Researcher, Assistant Professor at the Duke Department of Population Health Sciences, Assistant Research Professor in the Duke Global Health Institute, Durham, North Carolina, USA and is an Adjunct Lecturer at the Kilimanjaro Christian Medical University College, Moshi, Republic of Tanzania
| | - Blandina T. Mmbaga
- Alex Gabagambi Alexander, MD, MSc, is a Medical Doctor and a Clinical Researcher at Kilimanjaro Clinical Research Institute, Moshi, Republic of Tanzania, and is a Former Graduate Student at the Duke University Population Health Sciences, Durham, North Carolina, USA. Michael Relf, PhD, RN, AACRN, ANEF, FAAN, is a Professor of Nursing and Global Health, Duke University and the Associate Dean for Global and Community Health Affairs, Duke University School of Nursing, Durham, North Carolina, USA. Hayden B. Bosworth, BA, MS, PhD, is a Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center, Durham, North Carolina, USA, is a Vice Chair of Research and Professor of Population Health Sciences at Duke University, Durham, North Carolina, USA, and is a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center, Durham, North Carolina, USA. Blandina T. Mmbaga, MD, MMED, PhD, is a Pediatrician at Kilimanjaro Christian Medical Center (KCMC), Lecturer at the Kilimanjaro Christian Medical University College of the Tumaini University Makumira (KCMUC), Associate Professor, and Director of the Kilimanjaro Clinical Research Institute, Moshi, Republic of Tanzania. Charles Muiruri, BSC, MPH, PhD, is a Health Services Researcher, Assistant Professor at the Duke Department of Population Health Sciences, Assistant Research Professor in the Duke Global Health Institute, Durham, North Carolina, USA and is an Adjunct Lecturer at the Kilimanjaro Christian Medical University College, Moshi, Republic of Tanzania
| | - Charles Muiruri
- Alex Gabagambi Alexander, MD, MSc, is a Medical Doctor and a Clinical Researcher at Kilimanjaro Clinical Research Institute, Moshi, Republic of Tanzania, and is a Former Graduate Student at the Duke University Population Health Sciences, Durham, North Carolina, USA. Michael Relf, PhD, RN, AACRN, ANEF, FAAN, is a Professor of Nursing and Global Health, Duke University and the Associate Dean for Global and Community Health Affairs, Duke University School of Nursing, Durham, North Carolina, USA. Hayden B. Bosworth, BA, MS, PhD, is a Deputy Director of the Center of Innovation to Accelerate Discovery and Practice Transformation (ADAPT) at the Durham VA Medical Center, Durham, North Carolina, USA, is a Vice Chair of Research and Professor of Population Health Sciences at Duke University, Durham, North Carolina, USA, and is a Professor of Medicine, Psychiatry, and Nursing at Duke University Medical Center, Durham, North Carolina, USA. Blandina T. Mmbaga, MD, MMED, PhD, is a Pediatrician at Kilimanjaro Christian Medical Center (KCMC), Lecturer at the Kilimanjaro Christian Medical University College of the Tumaini University Makumira (KCMUC), Associate Professor, and Director of the Kilimanjaro Clinical Research Institute, Moshi, Republic of Tanzania. Charles Muiruri, BSC, MPH, PhD, is a Health Services Researcher, Assistant Professor at the Duke Department of Population Health Sciences, Assistant Research Professor in the Duke Global Health Institute, Durham, North Carolina, USA and is an Adjunct Lecturer at the Kilimanjaro Christian Medical University College, Moshi, Republic of Tanzania
| |
Collapse
|
2
|
Mmotsa TM, Magasana V, Nsibande DF, Buthelezi M, Dassaye R, Rodriguez VJ, Jones DL, Goga AE, Ngandu NK. Mixed-methods cross-sectional study of the prevention of vertical HIV transmission program users unaware of male partner's HIV status, in six South African districts with a high antenatal HIV burden. BMC Public Health 2023; 23:1988. [PMID: 37828512 PMCID: PMC10571358 DOI: 10.1186/s12889-023-16921-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 10/06/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Elimination of vertical HIV Transmission (VHT) and maternal deaths are global health priorities. Male involvement is one of the most important factors that influences women's decisions, including the uptake of Prevention of vertical HIV transmission (P-VHT). We sought to understand not knowing a male partner's HIV status (MPHIVs) amongst women using services to prevent vertical HIV transmission in six South African districts with high antenatal HIV burden. METHODS A mixed-methods cross-sectional study was conducted in six South African districts, and data collected through face-to-face interviews with women and focus group discussions (FGDs) with women or male partners. The quantitative data were analyzed using STATA SE-17.0 and an inductive approach was used for qualitative data analysis. RESULTS Overall, 28.7% of women were unaware of their MPHIVs, while 25.3% and 46.0% knew the MPHIVs was positive or negative, respectively. In multivariable logistic regression, single marital status and unplanned pregnancy increased the odds of not knowing a MPHIVs while a woman's disclosure of her HIV status to the male partner reduced the odds. FDGs highlighted complexities around MPHIVs disclosure, e.g., reluctance to test for HIV and potential interventions including healthcare worker (HCW) assisted HIV disclosure. CONCLUSION User-informed interventions to address MPHIVs non-disclosure amongst women of child-bearing age, particularly those at risk of unstable sexual partners and unplanned pregnancies, should be strengthened.
Collapse
Affiliation(s)
- Tshiamo M Mmotsa
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Vuyolwethu Magasana
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Duduzile F Nsibande
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Mbongeleni Buthelezi
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Reshmi Dassaye
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Violeta J Rodriguez
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
- Department of Psychology (Clinical/Community Division), University of Illinois at Urbana-Champaign, Champaign, IL, United States of America
| | - Deborah L Jones
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Ameena E Goga
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Pretoria, Pretoria, South Africa
| | - Nobubelo K Ngandu
- HIV and other Infectious Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa.
| |
Collapse
|
3
|
Diura-Vere O, Mokgatle MM, Oguntibeju OO. Sexual Behaviour and Attitudes towards Safe Sex of Youth Receiving Antiretroviral Care at Public Health Facilities in Palapye District, Botswana. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3790. [PMID: 36900803 PMCID: PMC10001564 DOI: 10.3390/ijerph20053790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 02/15/2023] [Accepted: 02/18/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND Sexual behaviour of HIV-infected youths is very important in determining the direction of the HIV epidemic, as these youths are reservoirs of HIV and can propagate its transmission if they engage in risky sexual behaviours. However, support structures for secondary prevention are weak even in healthcare settings. There is a need to understand the sexual behaviour of these youths and, in turn, tailor appropriate secondary prevention strategies, hence the current study was designed to assess sexual behaviour and attitudes towards safe sex of youth receiving antiretroviral care at public health facilities in Palapye district, Botswana. METHOD This quantitative, descriptive cross-sectional survey was used to describe the sexual behaviour and attitudes towards safe sex and identify factors associated with risky sexual behaviours among HIV-infected youths aged between 15 and 19 years receiving antiretroviral therapy (ART) care from public healthcare facilities in Palapye District, Botswana. RESULTS A total of 188 youths participated in this study, 56% being females while 44% were males. We reported that 15.4% had ever had sex. At their last sexual encounter, more than half of the youths (51.7%) had not used condoms. More than a third of the participants were under the influence of alcohol during their last sexual experience. Generally, the youths had good attitudes towards safe sex, as most youths said they would prioritise protecting their sexual partners and themselves from HIV and STIs. Alcohol use, substance use and not considering religion as important were strongly associated with having ever had sex. CONCLUSIONS A significant proportion of HIV-infected youths are sexually active, whereas their preventive practices such as condom use are poor despite good attitudes towards safe sex. Alcohol use, substance use and not perceiving religion as important were associated with risky sexual behaviours.
Collapse
Affiliation(s)
- Onai Diura-Vere
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Mathildah M. Mokgatle
- Department of Public Health, School of Health Care Sciences, Sefako Makgatho Health Sciences University, Ga-Rankuwa 0208, South Africa
| | - Oluwafemi O. Oguntibeju
- Department of Biomedical Sciences, Faculty of Health and Wellness Sciences, Cape Peninsula University of Technology, Bellville 7535, South Africa
| |
Collapse
|
4
|
Mosisa G, Mulisa D, Oluma A, Bayisa L, Merdassa E, Bayisa D, Tamiru A, Tolossa T, Chala Diriba D, Fetensa G, Wakuma B. HIV sero-status disclosure and associated factors among HIV positive women in East Africa: Systematic review and meta-analysis. Implications for prevention of mother-to-child HIV transmission. Front Public Health 2022; 10:919410. [PMID: 36483255 PMCID: PMC9723243 DOI: 10.3389/fpubh.2022.919410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Accepted: 10/31/2022] [Indexed: 11/23/2022] Open
Abstract
Background Women's HIV-positive disclosure plays a pivotal role to achieve the goal of preventing mother-to-child transmission (PMTCT) among pregnant women in particular. Although several primary studies were conducted in the different countries of East Africa, no study concluded the prevalence of women's HIV status disclosure and associated factors in East Africa. Therefore, the current study aimed to assess the pooled prevalence of disclosure status and associated factors among women in East Africa. Objectives To assess the pooled prevalence of HIV sero-status disclosure and associated factors among women in East Africa. Methods HINARI, PubMed, and Cochrane Library databases were searched. The data were extracted using a Microsoft Excel spreadsheet and STATA v 14.1 was used for the analysis. The Funnel plots and Egger's statistical test was used to check publication bias. Heterogeneity was assessed by conducting sensitivity and subgroup analyses. Result The pooled prevalence of sero-status disclosure among women in East Africa was 73.77% (95%CI 67.76, 79.77). Knowing partner's sero-status (OR = 10.04(95%CI 3.36, 31.84), married (OR = 2.46 (95%CI 1.23, 4.89), smooth relationship (OR = 3.30 (95%CI 1.39, 7.84), and discussion on HIV before the test (OR = 6.96 (95%CI 3.21, 15.05) were identified determinants of HIV sero-status disclosure. Conclusion The current systematic and meta-analysis revealed that nearly one-fourth of women had not disclosed HIV sero-status to at least one individual. Knowing the partner's HIV sero-status, being married, having a smooth relationship, and discussing on HIV before the test were determinants of disclosure status. Therefore, disclosure of HIV-positive sero-status among women living with HIV needs to be strengthened.
Collapse
Affiliation(s)
- Getu Mosisa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Mulisa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Adugna Oluma
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Lami Bayisa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Emiru Merdassa
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Diriba Bayisa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Afework Tamiru
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Tadesse Tolossa
- Department of Public Health, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
- Deakin Health Economics, School of Health and Social Development, Institute for Health Transformation, Deakin University, Geelong, VIC, Australia
| | - Dereje Chala Diriba
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Getahun Fetensa
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| | - Bizuneh Wakuma
- School of Nursing and Midwifery, Institutes of Health Sciences, Wollega University, Nekemte, Ethiopia
| |
Collapse
|
5
|
Lukyamuzi Z, Nabisere RM, Nakalega R, Atuhaire P, Kataike H, Ssuna B, Baroudi M, Kiweewa FM, Musoke P, Butler LM. Community Health Workers Improve HIV Disclosure Among HIV-Affected Sexual Partners in Rural Uganda: A Quasi-Experimental Study. GLOBAL HEALTH, SCIENCE AND PRACTICE 2022; 10:e2100631. [PMID: 36316143 PMCID: PMC9622292 DOI: 10.9745/ghsp-d-21-00631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Accepted: 08/23/2022] [Indexed: 05/26/2023]
Abstract
BACKGROUND We evaluated the efficacy of a community health worker (CHW)-led intervention in supporting disclosure among adults living with HIV in heterosexual relationships. METHODS We conducted a quasi-experimental study with 2 arms allocated by geographically determined clusters and adjusted for between-group differences among adults living with HIV in the greater Luwero region of Uganda who had never disclosed their status to their current primary sexual partners. Clusters were allocated to either a CHW-led intervention or a control arm. In both arms, participants were consecutively recruited. As opposed to receiving routine care for the control arm, participants in the intervention arm received additional CHW disclosure support. The overall follow-up was 6 months, and the primary outcome was disclosure to the sexual partner. Data were analyzed using a clustered modified Poisson regression model with robust standard errors to determine independent factors associated with disclosure. RESULTS Of the 245 participants who enrolled, 230 (93.9%) completed the study, and 112 (48.7%) of those were in the intervention arm. The median age was 30 (interquartile range=25-37) years, the majority were women (76.5%), and most (80%) did not know their partners' HIV status at study entry. At the end of follow-up, the overall disclosure prevalence was 74.4% (95% confidence interval [CI]=68.2, 79.9) and participants in the intervention arm were 51% more likely to disclose compared to those in the control (adjusted relative ratio [aRR]=1.51; 95% CI=1.28, 1.77). Men were 24% (aRR=1.24; 95% CI=1.07, 1.44) more likely to disclose compared to women, and membership in an HIV/AIDS association increased disclosure by 18% (aRR=1.18; 95% CI=1.01, 1.39). CONCLUSION CHW support improved disclosure among adults living with HIV in heterosexual relationships when compared to routine care. Therefore, CHW-led mechanisms may be utilized in increasing disclosure among adults living with HIV in heterosexual relationships in rural settings.
Collapse
Affiliation(s)
- Zubair Lukyamuzi
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda.
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Ruth Mirembe Nabisere
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Rita Nakalega
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Patience Atuhaire
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Hajira Kataike
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Bashir Ssuna
- Uganda Tuberculosis Implementation Research Consortium, Kampala, Uganda
- Department of Clinical Epidemiology and Biostatistics, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mazen Baroudi
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
| | - Flavia Matovu Kiweewa
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Philippa Musoke
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | - Lisa M Butler
- Institute for Collaboration on Health, Intervention, and Policy, University of Connecticut, Storrs, CT, USA
| |
Collapse
|
6
|
Konkor I, Antabe R, Mkandawire P, McIntosh MD, Lawson ES, Husbands W, Wong J, Luginaah I. Knowledge of sexual partner's HIV serostatus and the practice of safer sex among heterosexual men of African descent in London, Ontario. ETHNICITY & HEALTH 2022; 27:375-387. [PMID: 32115995 DOI: 10.1080/13557858.2020.1734776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Accepted: 02/18/2020] [Indexed: 06/10/2023]
Abstract
Objective: Poor knowledge of sexual partners' HIV status is a major contributing factor in the heterosexual spread of HIV in Canada. This study examined knowledge of sexual partner's HIV serostatus and the practice of safer sex among self-identified heterosexual African, Caribbean and Black (ACB) men in London, Ontario.Design: A cross-sectional data was collected from 156 heterosexual ACB men in London. The negative log-log link function was fitted to estimate the relationship between knowledge of sexual partner's HIV status and condom use among ACB men.Results: Findings show that ACB men who know their sexual partner's HIV status are less likely to use condoms compared to men who do not know the serostatus of their sexual partner, controlling for other theoretically relevant covariates. In addition, the findings show that sexually active, single ACB men are less likely to use condoms. On the other hand, ACB men with higher education, employed and with income over 60 thousand dollars a year have a higher likelihood of using condoms.Conclusions: Heterosexual ACB men who used condoms even when they did not know their sexual partners' HIV status could be explained as a resilience-building strategy in response to their increasing HIV vulnerabilities. Heterosexual ACB men's use of condoms is further associated with socioeconomic factors including income, employment and education that need to be addressed for an improved safer sex.
Collapse
Affiliation(s)
- Irenius Konkor
- Department of Geography, Western University, London, Canada
| | - Roger Antabe
- Department of Geography, Western University, London, Canada
| | - Paul Mkandawire
- Institute of Interdisciplinary Studies, Carleton University, Ottawa, Canada
| | | | - Erica S Lawson
- Department of Women's Studies, Western University, London, Canada
| | | | - Josephine Wong
- Daphne Cockwell School of Nursing, Ryerson University, Toronto, Canada
| | - Isaac Luginaah
- Department of Geography, Western University, London, Canada
| |
Collapse
|
7
|
Humphries H, Knight L, Mehou-Loko C, Mdladla M, Phakathi S, Mazibuko S, Abdool Karim Q. Exploring discrepant knowledge of partner sexual behaviour to inform self-risk assessment in a high HIV burdened district in rural KwaZulu-Natal. Glob Public Health 2021; 17:2054-2069. [PMID: 34488554 DOI: 10.1080/17441692.2021.1969672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Understanding the sexual relationships of young women is critical for preventing HIV infections. This study aimed to describe the sexual behaviour of partners, comparing the accuracy of sexual health knowledge between partners. The study took place in 2017 in KwaZulu-Natal, South Africa. Purposive sampling was used to select 18-27-year-old sexually active women. Consenting female participants completed a structured and semi-structured interview, while consenting male sexual partners identified through the female participant completed a structured questionnaire on sexual health information. Using a reflexive inductive approach and thematic analysis, we identified key discrepancies in the assumptions partners make about each other's sexual health information. Twenty-three sexual dyads were identified and four key discrepancies were identified: Age: partners either over or underestimated the age of their partners, HIV status: where partners were unaware of, or incorrectly assumed their partner's status, Lack of awareness of partner's concurrent relationships and more general knowledge of the partner's sexual health behaviours. Discussions about sexual health are mediated by relationship length, type of partner, power and perceived fidelity. While it is possible to undertake dyadic level research, ethical tensions remain. Sex-positive and egalitarian sexual health interventions that target the individual, as well as the sexual relationship, are needed.
Collapse
Affiliation(s)
- Hilton Humphries
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Lucia Knight
- School of Public Health, University of the Western Cape, Bellville, South Africa.,School of Public Health & Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Celia Mehou-Loko
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Makhosazana Mdladla
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sthembile Phakathi
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Sindisiwe Mazibuko
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| | - Quarraisha Abdool Karim
- Centre for the AIDS Programme of Research in South Africa (CAPRISA), Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa
| |
Collapse
|
8
|
Goodwin T, Gregson S, Maswera R, Moorhouse L, Nyamukapa C. Understanding the determinants and consequences of HIV status disclosure in Manicaland, Zimbabwe: cross-sectional and prospective analyses. AIDS Care 2021; 33:1577-1594. [PMID: 33813969 DOI: 10.1080/09540121.2021.1883507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Few longitudinal studies have measured trends and effects of disclosure over ART scale-up in general-population samples. We investigated levels, determinants and outcomes of disclosure to relatives and partners in a large general-population cohort in Zimbabwe. Trends in disclosure levels from 2003 to 2013 were analysed, and multivariable logistic regression was used to identify determinants. Longitudinal analyses were conducted testing associations between disclosure and prevention/treatment-related outcomes. Disclosure to anyone increased from 79% to 100% in men and from 63% to 98% in women from 2003 to 2008; but declined to 89% in both sexes in 2012-2013. More women than men disclosed to relatives (67.8% versus 44.4%; p < 0.001) but fewer women disclosed to partners (85.3% versus 95.0%; p < 0.001). In 2012-2013,secondary/higher education, being single, and experience of stigma were associated with disclosure to relatives in both sexes. Partner characteristics and HIV-group attendance were associated with disclosure to partners for women. Reactions to disclosure were generally supportive but less so for females than males disclosing to partners (92.0% versus 97.4%). Partner disclosure was weakly associated (p < 0.08) with having had a CD4 count or taken ART at follow-up in females. To conclude, this study shows disclosure is vital to HIV prevention and treatment, and programmes to facilitate disclosure should be re-invigorated.
Collapse
Affiliation(s)
| | - Simon Gregson
- Imperial College London, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| | | | | | - Constance Nyamukapa
- Imperial College London, London, UK.,Biomedical Research and Training Institute, Harare, Zimbabwe
| |
Collapse
|
9
|
Sun W, Zhou Y, Chen WT, Huang F, Sun M, Shen L, Gao Y, Zhang Q, Ma S, Shiu C, Zhang L, Lu H. Disclosure experience among COVID-19-confirmed patients in China: A qualitative study. J Clin Nurs 2021; 30:783-792. [PMID: 33349988 PMCID: PMC9205648 DOI: 10.1111/jocn.15616] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 11/29/2022]
Abstract
AIM To understand COVID patients' experiences of and perspectives on disclosure of their illness and to explore and describe the factors affecting disclosure decisions among COVID patients in China. BACKGROUND Disease disclosure is a critical component of prevention and control of a virus outbreak, and this is especially true during the COVID-19 pandemic. Understanding COVID patients' experiences and perspectives on disclosure could play a vital role in COVID management. DESIGN A qualitative study. METHODS A semi-structured interview guide was used to conduct qualitative in-depth interviews from April to June 2020. All the interviews were audio-recorded and transcribed, and then, a thematic analysis was conducted. The Standards for Reporting Qualitative Research (SRQR) were applied to this study. RESULTS A total of 26 COVID-confirmed patients were recruited for the in-depth interviews. Four themes emerged from the thematic analysis on disclosure: persons disclosed to, reasons for disclosure, reasons for nondisclosure and impact of disclosure. The participants disclosed their COVID diagnosis to different groups, including family, close friends, community members and workplace contacts. The main reasons for disclosure included the following: government policy, social responsibility, gaining support and fear of being blamed for nondisclosure. However, some participants decided not to disclose to some groups for fear of facing stigma and discrimination or to protect family members from discrimination. Despite the potential benefits of obtaining support after disclosure, many participants did experience stigma and discrimination, privacy exposure, psychological distress and social isolation. CONCLUSIONS An individual's decision as to whether to disclose their COVID-positive status is affected by many factors. To prevent the spread of COVID-19 and reduce the potential risks of disclosure, such as discrimination and privacy exposure, a balanced intervention should be designed to protect COVID patients and to secure any contact tracing. Therefore, the chances of discrimination could be decreased and patients' confidentiality could be protected. RELEVANCE TO CLINICAL PRACTICE As the number of COVID patients increases, disclosure of an individual's infectious status is encouraged by health departments. Despite the potential benefits of disclosure, discrimination and privacy exposure should not be ignored. A disclosure protocol is necessary to ensure patients' privacy regarding their COVID status.
Collapse
Affiliation(s)
- Wenxiu Sun
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Ying Zhou
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Wei-Ti Chen
- School of Nursing, University of California Los Angeles, Los Angeles, CA, USA
| | - Feifei Huang
- School of Nursing, Fujian Medical University, Fuzhou, China
| | - Meiyan Sun
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Lei Shen
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Yan Gao
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Qing Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Siyue Ma
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Chengshi Shiu
- Department of Social Work, National Taiwan University, Taipei, Taiwan
| | - Lin Zhang
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| | - Hongzhou Lu
- Shanghai Public Health Clinical Center, Fudan University, Shanghai, China
| |
Collapse
|
10
|
Loll D, Fleming PJ, Stephenson R, King EJ, Morhe E, Manu A, Hall KS. Factors associated with reproductive autonomy in Ghana. CULTURE, HEALTH & SEXUALITY 2021; 23:349-366. [PMID: 32301400 DOI: 10.1080/13691058.2019.1710567] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 12/27/2019] [Indexed: 06/11/2023]
Abstract
Reproductive autonomy is essential for women to achieve reproductive rights and freedom. However, the factors associated with reproductive autonomy in various contexts have not been explored. The aim of this analysis was to understand the socio-demographic, reproductive history and social context variables associated with two validated reproductive autonomy sub-scales among 516 young Ghanaian women age 15 to 24. We used multiple linear regression modelling to test associations between covariates of interest and the communication sub-scale and decision-making sub-scale. Covariates included age, educational attainment, ethnic group, employment, religion, religious attendance, relationship type, previous pregnancy, previous abortion, social support for adolescent sexual and reproductive health, and social stigma towards adolescent sexual and reproductive health. Results from final models demonstrated that factors associated with the communication scale included education (p = 0.008), ethnic group (p = 0.039), and social support for adolescent sexual and reproductive health (B = 0.12, p = 0.003). Factors associated with the decision-making scale included ethnic group (p = 0.002), religion (p = 0.003), religious attendance (p = 0.043), and previous pregnancy (p = 0.008). Communication reproductive autonomy and decision-making reproductive autonomy were associated with different factors, providing insight into potential intervention approaches and points. Social support for adolescent sexual and reproductive health was associated with increases in young women's abilities to communicate with their partners about sexual and reproductive health issues including sex, contraceptive use and fertility.
Collapse
Affiliation(s)
- Dana Loll
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Paul J Fleming
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Rob Stephenson
- Department of Systems, Population, and Leadership, School of Nursing, Center for Sexuality and Health Disparities, University of Michigan, Ann Arbor, MI, USA
| | - Elizabeth J King
- Department of Health Behavior and Health Education, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Emmanuel Morhe
- Komfo Anokye Teaching Hospital, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - Adom Manu
- Department of Population, Family, and Reproductive Health, School of Public Health, University of Ghana, Accra, Ghana
| | - Kelli Stidham Hall
- Department of Behavioral Sciences and Health Education, Rollins School of Public Health, Emory University, Atlanta, GA, USA
| |
Collapse
|
11
|
Endalamaw A, Assefa Y, Geremew D, Belete H, Dachew BA, Belachew A, Animaw W, Habtewold TD, Wilson R. Disclosure of HIV seropositivity to sexual partner in Ethiopia: A systematic review. WOMEN'S HEALTH 2021; 17:17455065211063021. [PMID: 34844482 PMCID: PMC8640980 DOI: 10.1177/17455065211063021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Introduction: In Ethiopia, the burden of HIV/AIDS is a public health issue that requires significant control of transmission. Once an infection has been established, determinants influence people living with HIV to disclose or not their HIV-positive status to sexual partners. This study assessed the proportion and associated factors of people living with HIV’s disclosure status to sexual partners. Methods: CRD42020149092 is the protocol’s registration number in the PROSPERO database. We searched PubMed, Scopus, African Journals Online, and Google Scholar databases. For the subjective and objective assessment of publication bias, we used a funnel plot and Egger’s regression test, respectively. The I2 statistic was used to assess variation across studies. Meta-analysis of weighted inverse variance random-effects model was used to estimate the pooled proportion. We conducted subgroup and sensitivity analyses to investigate the cause of heterogeneity and the impact of outliers on the overall estimation, respectively. A trend analysis was also performed to show the presence of time variation. Results: The percentage of people living with HIV who disclosed their HIV-positive status to sexual partners was 76.03% (95% confidence interval: 68.78, 83.27). Being on antiretroviral therapy (adjusted odds ratio = 6.19; 95% confidence interval: 2.92, 9.49), cohabiting with partner (adjusted odds ratio = 4.48; 95% confidence interval: 1.24, 7.72), receiving HIV counseling (adjusted odds ratio = 3.94; 95% confidence interval: 2.08, 5.80), having discussion prior to HIV testing (adjusted odds ratio = 4.40; 95% confidence interval: 2.11, 6.69), being aware of partner’s HIV status (adjusted odds ratio = 6.08; 95% confidence interval: 3.05, 9.10), positive relationship with partner (adjusted odds ratio = 4.44; 95% confidence interval:1.28, 7.61), and being member of HIV association (adjusted odds ratio = 3.70; 95% confidence interval: 2.20, 5.20) had positive association with HIV status disclosure. Conclusion: In Ethiopia, more than one-fourth of adults living with HIV did not disclose their HIV-positive status to sexual partners. HIV-positive status disclosure was influenced by psychosocial factors. A multidimensional approach is required to increase seropositive disclosure in Ethiopia.
Collapse
Affiliation(s)
- Aklilu Endalamaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Yibeltal Assefa
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Demeke Geremew
- Department of Immunology, School of Biomedical and Laboratory Sciences, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Habte Belete
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- School of Public Health, The University of Queensland, Brisbane, QLD, Australia
| | - Berihun Assefa Dachew
- School of Public Health, Curtin University, Perth, WA, Australia
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Amare Belachew
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
- School of Population Health, Australian National University, Canberra, ACT, Australia
| | - Worku Animaw
- College of Medicine and Health Sciences, Bahir Dar University, Bahir Dar, Ethiopia
| | - Tesfa Dejenie Habtewold
- Department of Epidemiology and Psychiatry, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Quantitative Economics, School of Business and Economics, Maastricht University, Maastricht, The Netherlands
| | - Rhonda Wilson
- Department of Clinical Research, Faculty of Health Sciences, University of Southern Denmark, Odense, Denmark
- Faculty of Health, University of Canberra Hospital, Canberra, ACT, Australia
| |
Collapse
|
12
|
Mengwai K, Madiba S, Modjadji P. Low Disclosure Rates to Sexual Partners and Unsafe Sexual Practices of Youth Recently Diagnosed with HIV; Implications for HIV Prevention Interventions in South Africa. Healthcare (Basel) 2020; 8:healthcare8030253. [PMID: 32756349 PMCID: PMC7551467 DOI: 10.3390/healthcare8030253] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 07/16/2020] [Accepted: 07/17/2020] [Indexed: 01/20/2023] Open
Abstract
The study investigated the motivation to disclose or the decision to withhold one’s HIV serostatus to one’s partners and assessed the implications of non-disclosure on young peoples’ sexual behaviour and access to treatment. This was a cross-sectional survey conducted with 253 youth aged 18–25 years receiving antiretroviral therapy in a health district in North West Province, South Africa. The majority were female (75%), the mean time since the HIV diagnosis was 22 months, 40% did not know their partner’s HIV status, 32% had more than two sexual partners, and 63% had not used a condom during the last sexual act. The prevalence of disclosure was 40%, 36% delayed disclosure for over a year, and most disclosed to protect the partner from HIV transmission, to receive support, and to be honest and truthful. The prevalence of non-disclosure was high, as 60% withheld disclosure due to fear of abandonment, stigma and discrimination, accusations of unfaithfulness, and partner violence. Over half (55%) had no intentions to disclose at all. The lower disclosure rates imply that HIV transmission continues to persist among sexual partners in these settings. The findings suggest that high levels of perceived stigma impact on disclosure and HIV treatment, which increases the risk of on-going HIV transmission among youth receiving long-term antiretroviral therapy (ART) in South Africa.
Collapse
|
13
|
Salomon T, Gomes I, Ozahata MC, Valente Moreira CH, Lorenzo Oliveira CD, Gonçalez TT, Duarte ME, Miranda C, de Freitas Carneiro Proietti AB, Sabino E, de Almeida Neto C, Custer B. Social and behavioral characteristics of male blood donors and their sexual partners: an analysis to define risk subsets. Transfusion 2019; 59:2584-2592. [PMID: 31158312 PMCID: PMC6679786 DOI: 10.1111/trf.15388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Revised: 05/15/2019] [Accepted: 05/16/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND Men who have sex with men in Brazil are deferred from donation for 1 year since their last sexual contact. Legal proceedings in front of the Brazilian Supreme Court could compel blood collection agencies to discontinue use of sexual orientation questions. METHODS Data from male participants in a completed HIV risk factor case-control study were used to evaluate whether it is possible to differentiate donors at lower and higher risk for HIV using two analytical approaches: latent class and random forest analyses. RESULTS Male blood donors were divided into three distinct risk profile classes. Class 1 includes donors who are heterosexual (96.4%), are HIV negative (88.7%), have a main partner (99.4%), and practice unprotected sex (77.8%). Class 2 includes donors who are men who have sex with men /bisexuals' (100.0%), are HIV positive (97.4%), and were not aware of their sexual partners' HIV status (80.3%). Class 3 includes donors who are heterosexual (84.1%), practice unprotected vaginal/anal heterosexual sex (66.8% vs. 40.9%), and were both HIV positive and HIV negative (49.5% vs. 50.5%). We also found that asking donors about their partner(s)' HIV serostatus could replace asking about donors' sexual orientation and types of partners with relatively minor shifts in sensitivity (0.76 vs. 0.58), specificity (0.89 vs. 0.94), and positive predictive value (0.85 vs. 0.88). CONCLUSION Sexual orientation questions on the donor questionnaire could be replaced without great loss in the sensitivity, specificity, and positive predictive value. Social and sexual behaviors of donors and their partners are proxies for HIV risk and can help to develop modified questions that will need controlled trials to be validated.
Collapse
Affiliation(s)
- Tassila Salomon
- Hemominas, Minas Gerais – Brazil,Institute of Tropical Medicine, University of São Paulo, Brazil
| | - Isabel Gomes
- Faculdade Ciências Médicas – Belo Horizonte – Minas Gerais – Brazil
| | | | | | | | | | | | | | | | - Ester Sabino
- Institute of Tropical Medicine, University of São Paulo, Brazil
| | - Cesar de Almeida Neto
- Fundação Pró-Sangue - Hemocentro de São Paulo, São Paulo, Brazil,Disciplina de Ciências Médicas da Faculdade de Medicina da Universidade de São Paulo, São Paulo, Brazil
| | - Brian Custer
- Vitalant Research Institute and University of California San Francisco
| | | |
Collapse
|
14
|
Damian DJ, Ngahatilwa D, Fadhili H, Mkiza JG, Mahande MJ, Ngocho JS, Msuya SE. Factors associated with HIV status disclosure to partners and its outcomes among HIV-positive women attending Care and Treatment Clinics at Kilimanjaro region, Tanzania. PLoS One 2019; 14:e0211921. [PMID: 30865633 PMCID: PMC6415788 DOI: 10.1371/journal.pone.0211921] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/22/2019] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Sub Saharan Africa continues to be the epicenter of HIV with 70% of people living with HIV globally. Women form nearly 60% of those living with HIV. Studies have shown disclosure of one's HIV status is important in HIV prevention, in increasing partners who are tested and getting into care early as well as in improving retention in PMTCT and ART programs. This study aimed to determine the prevalence, factors and outcomes of HIV status disclosure to partners among HIV-positive women attending HIV care-and-treatment clinics (CTCs) at Kilimanjaro region, northern Tanzania. METHODS A cross-sectional study was conducted from January to June 2014 in 3 out of the 7 districts of Kilimanjaro region. The study population was HIV-positive women aged 15-49, who were attending for routine HIV care at 19 selected clinics. Face-to-face interviews were conducted with consenting women to collect necessary information. Multivariate logistic regression analyses were used to determine the independent predictors of HIV status disclosure to partner. RESULTS A total of 672 HIV-positive women in Moshi municipal, Hai and Mwanga districts were enrolled. Of them, 609 HIV-positive women reported to have a regular partner. Prevalence of serostatus disclosure to partners was 66%. Of the 400 who had disclosed; 56% did so within the first month of knowing their HIV status. In a multiple logistic regression model, HIV serostatus disclosure was higher among women who: were married/cohabiting (AOR = 4.16, 95% CI: 2.39-7.25; p<0.001), currently on ART (AOR = 2.06, 95% CI: 1.11-3.82; p = 0.020), and who reported had ever communicated with partners on number of children (AOR = 1.85, 95% CI: 1.15-2.98; p = 0.010) and contraceptives use (AOR = 2.01, 95% CI: 1.27-3.20; p = 0.208). Most of the women (81%) who disclosed their HIV status to did not reported negative outcomes. CONCLUSION In this setting still a third of the HIV-positive women (34%) fail to disclose their HIV- serostatus to partners. Interventions to impart skills in communication and negotiation between partners may help in improving disclosure of HIV. Efforts to involve men in general sexual and reproductive health including couple counseling and testing will contribute in improving disclosure and communication on HIV among partners.
Collapse
Affiliation(s)
- Damian J. Damian
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
- Community Health Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
- * E-mail:
| | - Diana Ngahatilwa
- Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Hatibu Fadhili
- Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Johnston G. Mkiza
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Michael J. Mahande
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - James S. Ngocho
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| | - Sia E. Msuya
- Department of Epidemiology and Biostatistics, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
- Community Health Department, Kilimanjaro Christian Medical Centre (KCMC), Moshi, Tanzania
- Department of Community Health, Institute of Public Health, Kilimanjaro Christian Medical University College (KCMUCo), Moshi, Tanzania
| |
Collapse
|
15
|
HIV Disclosure: HIV-positive status disclosure to sexual partners among individuals receiving HIV care in Addis Ababa, Ethiopia. PLoS One 2019; 14:e0211967. [PMID: 30768642 PMCID: PMC6415764 DOI: 10.1371/journal.pone.0211967] [Citation(s) in RCA: 49] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Accepted: 01/24/2019] [Indexed: 11/19/2022] Open
Abstract
Introduction Disclosure of HIV status to sexual partners can help HIV prevention efforts and enable HIV positive people to receive social support, as well as increasing access and adherence to treatment. This study was conducted to determine the rate, processes, outcomes, and correlates of HIV status disclosure to sexual partners among HIV positive individuals. Method A cross-sectional study was conducted between September and November 2015 at two HIV outpatient clinics in Addis Ababa, Ethiopia. Data were collected using an interviewer- administered semi-structured questionnaire. Logistic analysis was used to determine the independent correlates of serostatus disclosure. Results Of 742 participants, (371 men and 371 women), 727 (98%) were on antiretroviral therapy and 676 (91.1%) had at least one sexual partner since their HIV diagnosis, of whom 558 (82.5%) had disclosed their HIV status to their most recent sexual partner. Of those who reported having disclosed their status to their most recent sexual partner, 82 (14.7%) had at least one unprotected sexual encounter with the partner, after HIV diagnosis but prior to disclosure. The most commonly reported initial outcome of disclosure was gaining emotional and/or financial support. Some (11.3%) also reported that their disclosure immediately initiated their partner for HIV testing. Negative outcomes to disclosure, such as stigma and discrimination, were more common among females (26.2%) compared to males (12.7%). In the multiple regression analysis, disclosure was associated with greater condom use, greater social support, knowing the partner’s HIV status, having a good relationship with the partner, and cohabiting with the partner. Conclusion HIV disclosure was common amongst participants, although sometimes delayed, with possible consequences for onward transmission. Fear of negative outcomes, such as verbal abuse and physical violence, were major barriers to disclosure. Efforts to support disclosure have the potential to contribute to HIV control and prevention by encouraging safer sexual practice, initiating partners for HIV testing, and enhancing support for people living with HIV.
Collapse
|
16
|
Bhushan NL, Golin CE, McGrath N, Maman S, Tsidya M, Chimndozi L, Wesevich A, Hoffman IF, Hosseinipour MC, Miller WC, Rosenberg NE. The impact of HIV couple testing and counseling on social support among pregnant women and their partners in Lilongwe, Malawi: an observational study. AIDS Care 2019; 31:199-206. [PMID: 30182730 PMCID: PMC6322660 DOI: 10.1080/09540121.2018.1510102] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2018] [Accepted: 08/01/2018] [Indexed: 12/20/2022]
Abstract
Couples HIV testing and counseling (couple counseling) promotes safer sexual behaviors, increases communication between couples, and decreases HIV transmission. However, the impact of couple counseling on social support, critical for persons living with HIV, has not been examined. Ninety couples with a recently tested HIV-positive pregnant woman (female-positive couples) and 47 couples with a recently tested HIV-negative pregnant woman (female-negative couples) were enrolled in an observational study at an antenatal clinic in Malawi. Each couple member was assessed immediately before and one month after couple counseling for partner, family, and peer social support using the Multidimensional Scale of Perceived Social Support. Before couple counseling, social support was lower among women than men in both female-positive couples (β = -10.00, p < .01) and female-negative couples (β = -8.43, p < .01). After couple counseling, social support increased for women in female-positive couples (β = 4.01, p < .01) and female-negative couples (β = 4.69, p < .01) but not for men in either type of couple. Couple counseling could be an effective strategy to increase social support for women, including those with recent HIV diagnoses.
Collapse
Affiliation(s)
- Nivedita L Bhushan
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
- b School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Carol E Golin
- b School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
- c School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Nuala McGrath
- d Faculty of Medicine and Faculty of Social, Human, and Mathematical Sciences , University of Southampton , Southampton , UK
| | - Suzanne Maman
- b School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Mercy Tsidya
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
| | - Limbikani Chimndozi
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
| | - Austin Wesevich
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
| | - Irving F Hoffman
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
- c School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - Mina C Hosseinipour
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
- c School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| | - William C Miller
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
- b School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
- c School of Medicine , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
- e Division of Epidemiology , The Ohio State University , Columbus , OH , USA
| | - Nora E Rosenberg
- a UNC Project , University of North Carolina at Chapel Hill , Lilongwe , Malawi
- b School of Public Health , University of North Carolina at Chapel Hill , Chapel Hill , NC , USA
| |
Collapse
|
17
|
HIV Disclosure Among Pregnant Women Initiating ART in Cape Town, South Africa: Qualitative Perspectives During the Pregnancy and Postpartum Periods. AIDS Behav 2018; 22:3945-3956. [PMID: 30196332 DOI: 10.1007/s10461-018-2272-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
For women enrolled in prevention of mother-to-child transmission (PMTCT) programs, non-disclosure of their HIV status can be a significant barrier to sustained HIV care engagement. To explore decision-making surrounding HIV disclosure among HIV-infected pregnant women, we conducted repeated in-depth interviews during pregnancy and postpartum with 20 women recruited from a PMTCT clinic in Cape Town, South Africa. Three domains were examined using thematic analysis: (1) disclosure experiences, (2) challenges associated with partner disclosure, and (3) implications of nondisclosure. All women had disclosed to someone by the time of the baby's birth, typically limiting their disclosure to trusted individuals. Only half of participants disclosed to the father of the child. Nondisclosure, particularly to partners, was a significant source of worry and stress. Women used pregnancy as an explanation for using medication and attending frequent clinic appointments, and recognized impending challenges in the postpartum period when this excuse would no longer apply. Results suggest that PMTCT programs have a key role to play in helping individuals to make decisions about HIV disclosure, and assisting patients to navigate the disclosure process, especially with partners.
Collapse
|
18
|
Characterizing the Patterns of HIV Disclosure to Clients Among South African Female Sex Workers in Port Elizabeth. AIDS Behav 2018; 22:3924-3932. [PMID: 29968141 DOI: 10.1007/s10461-018-2199-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Female sex workers (FSW) in South Africa are disproportionately affected by HIV, yet little is known about their HIV-status disclosure with clients. Among 410 FSW participating in a cross-sectional study, 213 were HIV positive and aware of their status prior to enrollment. Among FSW aware of their HIV-status, 35% (74/213) reported disclosing their HIV-status to paying clients, whereas 75% (118/158) of those with regular, non-paying partners disclosed to them. In a multivariable analysis, disclosure to clients was associated with more years of education, disclosure to non-paying partners, and meeting clients at established sex work venues, whereas a history of sexual violence was associated with less disclosure. There was also evidence of mutual disclosure with clients, however disclosure was not associated with condom use with clients or being on antiretrovirals. Safer working environments may improve FSW HIV disclosure practices, however disclosure must also be linked with protective behaviors in this population.
Collapse
|
19
|
Brittain K, Mellins CA, Remien RH, Phillips T, Zerbe A, Abrams EJ, Myer L. Patterns and Predictors of HIV-Status Disclosure Among Pregnant Women in South Africa: Dimensions of Disclosure and Influence of Social and Economic Circumstances. AIDS Behav 2018; 22:3933-3944. [PMID: 30155586 DOI: 10.1007/s10461-018-2263-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
HIV-status disclosure may improve psychosocial health and adherence to antiretroviral therapy (ART), but existing insights suffer from methodological limitations. We explored disclosure over time during pregnancy and postpartum among 1347 HIV-positive women in Cape Town. Among 995 women diagnosed HIV-positive before the pregnancy and entering antenatal care (median age 30 years), 95% had disclosed to ≥ 1 individual. In Mokken scale analysis, we observed two separate dimensions of disclosure: disclosure to a male partner, and disclosure to family/community members. Among 352 women diagnosed during the pregnancy and initiating ART (median age 27 years), 61% disclosed to a male partner and 71% to a family/community member by 12 months after diagnosis. Relationship status modified the impact of pregnancy intentions and poverty on disclosure to a male partner. These unique data provide important insights into dimensions of disclosure during pregnancy and postpartum, and suggest that women's social and economic circumstances are central determinants of disclosure.
Collapse
Affiliation(s)
- Kirsty Brittain
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa.
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Robert H Remien
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA
| | - Tamsin Phillips
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| | - Allison Zerbe
- Mailman School of Public Health, ICAP, Columbia University, New York, NY, USA
| | - Elaine J Abrams
- Mailman School of Public Health, ICAP, Columbia University, New York, NY, USA
- College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - Landon Myer
- Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
- Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa
| |
Collapse
|
20
|
Li H, Li X, Zhang L, Chow E. Effects of multiple types of stigma on the probability of HIV disclosure to sex partners: a systematic review. Sex Health 2018; 13:516-529. [PMID: 27491829 DOI: 10.1071/sh16089] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 06/28/2016] [Indexed: 11/23/2022]
Abstract
Previous review studies explored factors related to the process of HIV disclosure. However, none of these review studies specifically focused on the effects of stigma on HIV disclosure to sex partners. A comprehensive systematic review of empirical studies on the effects of stigma on HIV disclosure to sex partners was conducted until December 2014. Twenty-seven articles published in English-language journals were selected, and study characteristics and findings were evaluated. Inconsistent findings in the assessment of impacts of stigma on HIV disclosure to sex partners were documented. Three underlying plausible reasons were identified, and these included: (1) different types of stigma may have different effects on HIV disclosure to sex partners; (2) studies used different measurement strategies; and (3) varied personal backgrounds and health factors that can mitigate, facilitate or moderate the effect of stigma on HIV disclosure to sex partners. Studies with precise definition measurements of specific types of stigma used them appropriately in a matching context to provide more consistent research results. This review identifies the need for further investigation into how the HIV disclosure process is shaped by particular types of stigma, types of sex partners and demographic characteristics of people living with HIV/AIDS.
Collapse
Affiliation(s)
- Haochu Li
- School of Public Health, Shandong University, 44 Wen Hua Xi Road, Jinan, Shandong Province 250012, China
| | - Xiaoming Li
- Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC 29208, USA
| | - Lei Zhang
- Research Center for Public Health, School of Medicine, Tsinghua University, Beijing, 100062, China
| | - Eric Chow
- Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic. 3004, Australia
| |
Collapse
|
21
|
Factors Affecting Intention to Disclose HIV Status among Adult Population in Sarawak, Malaysia. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:2194791. [PMID: 30186334 PMCID: PMC6116389 DOI: 10.1155/2018/2194791] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 07/16/2018] [Indexed: 11/19/2022]
Abstract
Background Disclosure of HIV-positive status is an essential prerequisite for the prevention and care of person living with HIV/AIDS as well as to tackle hidden epidemic in the society. Objective To determine the intention to disclose the HIV/AIDS status among adult population in Sarawak, Malaysia, and factors affecting thereof. Methods This cross-sectional community-based study was conducted among adult population aged 18 years and above in Sarawak, Malaysia. A gender-stratified multistage cluster sampling technique was adopted to select the participants. A total of 900 respondents were successfully interviewed by face-to-face interview using interview schedule. Stepwise binary logistic regression models were fitted in SPSS version 22.0 to identify the factors associated with the disclosure of HIV/AIDS status. A p value less than 0.05 was considered as statistically significant. Results The mean (SD) age of male and female respondents was 41.57 (13.45) and 38.99 (13.09) years, respectively. A statistically significant difference of intention to disclosure of HIV status was found between males and females (p < 0.05). A stepwise binary logistic regression analysis revealed that age, occupation, knowledge on HIV transmission, and content of discussion about HIV/AIDS appeared to be potential predictors for male respondents to disclose HIV status, while ethnicity and content of discussion on HIV/AIDS were found to be important predictors among the female respondents (p < 0.05). Conclusion and Recommendation Though the study did not depict the national prevalence of disclosure of HIV/AIDS status, the findings of the study would provide an important basic information for programme intervention, policy, and future research agenda.
Collapse
|
22
|
Mbichila TH, Chagomerana M, Tang JH, Haddad LB, Hosseinipour MC, Tweya H, Phiri S. Partnership duration and HIV serodisclosure among people living with HIV/AIDS in Lilongwe, Malawi. Int J STD AIDS 2018; 29:987-993. [PMID: 29743000 DOI: 10.1177/0956462418769730] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
HIV serodisclosure to sexual partners is an important aspect of HIV prevention, treatment, and care. We investigated the association between partnership duration and serodisclosure among HIV-infected individuals in Lilongwe, Malawi. We analyzed data from a cross-sectional study of individuals attending one of two antiretroviral therapy (ART) clinics in Lilongwe. Clients aged 18-45 years and sexually active within the past six months were eligible. Logistic regression was used to estimate the odds ratio (OR) and 95% confidence interval (CI) for the association between partnership duration ≤1 year and serodisclosure. Five hundred and sixty-two participants completed the survey: 308 (55%) women and 254 (45%) men. Median age was 35 years (IQR 30-40), 90% were married, 88% were on ART, and 95% had serodisclosed to their partner. Marital status, knowledge of partner serostatus, and ART use were significantly associated with serodisclosure. Participants in a relationship for ≤1 year were significantly less likely to disclose their serostatus to their partners compared to those in a relationship for >1 year (OR = 0.18, 95% CI: 0.06, 0.58). Couple-based interventions that encourage serodisclosure among partners within their first year of relationship should be developed to decrease HIV transmission, encourage treatment and support.
Collapse
Affiliation(s)
| | | | - Jennifer H Tang
- 1 The University of North Carolina Project-Lilongwe, Lilongwe, Malawi.,2 Department of Obstetrics and Gynecology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Lisa B Haddad
- 3 Department of Gynecology and Obstetrics, Emory University School of Medicine, Atlanta, GA, USA
| | - Mina C Hosseinipour
- 1 The University of North Carolina Project-Lilongwe, Lilongwe, Malawi.,4 Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Hannock Tweya
- 5 Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi
| | - Samuel Phiri
- 4 Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.,5 Lighthouse Trust, Kamuzu Central Hospital, Lilongwe, Malawi.,6 Department of Public Health, College of Medicine, School of Public Health and Family Medicine, University of Malawi, Blantyre, Malawi.,7 Department of Global Health, University of Washington, Seattle, WA, USA
| |
Collapse
|
23
|
Osuafor GN, Maputle S, Ayiga N, Mturi AJ. Condom use among married and cohabiting women and its implications for HIV infection in Mahikeng, South Africa. JOURNAL OF POPULATION RESEARCH 2017. [DOI: 10.1007/s12546-017-9195-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
24
|
Li L, Luo S, Rogers B, Lee SJ, Tuan NA. HIV Disclosure and Unprotected Sex Among Vietnamese Men with a History of Drug Use. AIDS Behav 2017; 21:2634-2640. [PMID: 27990586 DOI: 10.1007/s10461-016-1648-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Additional barriers to self-disclosure of HIV status exist for people living with HIV (PLH) with a history of drug use. The objectives of this study were to explore the extent of HIV disclosure, sexual practice patterns and the relationships between HIV disclosure and unprotected sex among Vietnamese male PLH with a history of drug use. We used cross-sectional data of a sample of 133 PLH collected from a randomized controlled intervention trial in Vietnam. More than one-quarter of the participants reported not disclosing their HIV status to any sexual partners. Self-reported rates of condom use were 67.8, 51.1 and 32.6% with regular, casual, and commercial partners, respectively. Unprotected sex, testing positive for heroin, and fewer years since HIV diagnosis were significantly associated with lower level of HIV disclosure. Future intervention programs should focus on the complex interplay among HIV disclosure, drug use, and unprotected sexual practices in this vulnerable population.
Collapse
|
25
|
Demographic, clinical and behavioural determinants of HIV serostatus non-disclosure to sex partners among HIV-infected pregnant women in the Eastern Cape, South Africa. PLoS One 2017; 12:e0181730. [PMID: 28837563 PMCID: PMC5570311 DOI: 10.1371/journal.pone.0181730] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 07/06/2017] [Indexed: 11/19/2022] Open
Abstract
Objectives Drawing from a baseline sample of a cohort study, the study examines the extent and correlates of serostatus non-disclosure to sex partners and family members, and reasons for non-disclosure among HIV-infected pregnant women in the Eastern Cape Province, South Africa. Methods This longitudinal cohort study recruited 1709 pregnant women living with HIV who attended three of the largest maternity centres in the Eastern Cape, South Africa, for delivery between September 2015 and May 2016. Relevant items on demographics, serostatus awareness, disclosure to sex partners and family members, and lifestyle behaviours were obtained using structured interviews. Age-stratified binary logistic regression models were used to determine the significant correlates of non-disclosure among the participants. Results A higher rate of HIV serostatus non-disclosure to sex partners (25.6%) in comparison to family members (20%) was reported by the participants. Younger age, not living with partners and alcohol use were significantly associated with non-disclosure of HIV serostatus to sex partners. Non-disclosure of HIV serostatus to sex partners was significantly (p<0.05) associated with poor adherence to the highly active anti-retroviral therapy (HAART), failure to keep clinic appointments and high viral load at the delivery of the baby. Perceived fear of intimate partner violence, fear of rejection, guilt of not disclosing at the onset of the relationship, sex partner’s non-disclosure of HIV serostatus, and guilt of unfaithfulness were some of the reasons for non-disclosure of HIV serostatus to sex partners. Conclusions Non-disclosure of HIV serostatus is a public health concern with serious implications for both mother-to-child transmission, as well as horizontal transmission, in our setting. Strategic efforts toward ending the epidemic of HIV and AIDS in South Africa should address the sociocultural and behavioural determinants of non-disclosure.
Collapse
|
26
|
Maeri I, El Ayadi A, Getahun M, Charlebois E, Akatukwasa C, Tumwebaze D, Itiakorit H, Owino L, Kwarisiima D, Ssemmondo E, Sang N, Kabami J, Clark TD, Petersen M, Cohen CR, Bukusi EA, Kamya M, Havlir D, Camlin CS. "How can I tell?" Consequences of HIV status disclosure among couples in eastern African communities in the context of an ongoing HIV "test-and-treat" trial. AIDS Care 2017; 28 Suppl 3:59-66. [PMID: 27421052 PMCID: PMC5751752 DOI: 10.1080/09540121.2016.1168917] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
People living with HIV/AIDS anticipate HIV-related stigma and fear disclosure to intimate partners. Yet, disclosure is critical to reducing HIV transmission and improving care engagement. This qualitative study characterized HIV disclosure experiences and normative beliefs among couples in communities participating in an HIV test-and-treat trial in Kenya and Uganda (Sustainable East Africa Research in Community Health, NCT#01864603). In-depth interviews were conducted with care providers (n = 50), leaders (n = 32) and members (n = 112) of eight communities. Data were analyzed using grounded theoretical approaches and Atlas.ti software. Findings confirmed gender differences in barriers to disclosure: while both men and women feared blame and accusation, women also feared violence and abandonment (“I did not tell my husband because [what if] I tell him and he abandons me at the last moment when I am in labor?”). Positive consequences included partner support for increased care-seeking and adherence (“My husband keeps on reminding me ‘have you taken those drugs?’”) Yet negative consequences included partnership dissolution, blame, and reports of violence (“some men beat their wives just because of that [bringing HIV medications home]”). Among HIV-infected individuals in discordant relationships, men more often reported supportive spouses (“we normally share [HIV-risk-reduction strategies] since I have been infected and she is HIV negative”), than did women (“my husband refused to use condoms and even threatened to marry another wife”). Care providers lent support for HIV-positive women who wanted to engage partners in testing but feared negative consequences: “They engaged the two of us in a session and asked him if we could all test.” Findings demonstrate differing experiences and support needs of women and men living with HIV in eastern Africa, with HIV-positive women in discordant couples particularly vulnerable to negative consequences of disclosure. Efforts to strengthen capacity in health systems for gender-sensitive clinician- or counselor-assisted disclosure should be accelerated within test-and-treat efforts.
Collapse
Affiliation(s)
- Irene Maeri
- a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya
| | - Alison El Ayadi
- b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA
| | - Monica Getahun
- b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA
| | - Edwin Charlebois
- c Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA
| | | | | | | | - Lawrence Owino
- a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya
| | | | | | - Norton Sang
- a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya
| | - Jane Kabami
- d Infectious Diseases Research Collaboration , Kampala , Uganda
| | - Tamara D Clark
- f Department of HIV, Infectious Disease and Global Medicine , University of California , San Francisco , CA , USA
| | - Maya Petersen
- g Divisions of Biostatistics and Epidemiology, School of Public Health , University of California , Berkeley , CA , USA
| | - Craig R Cohen
- b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA
| | - Elizabeth A Bukusi
- a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya
| | - Moses Kamya
- d Infectious Diseases Research Collaboration , Kampala , Uganda.,h School of Medicine, Makerere University College of Health Sciences , Kampala , Uganda
| | - Diane Havlir
- f Department of HIV, Infectious Disease and Global Medicine , University of California , San Francisco , CA , USA
| | - Carol S Camlin
- b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA.,c Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA
| | | |
Collapse
|
27
|
Hunter-Adams J, Zerbe A, Philips T, Rini Z, Myer L, Petro G, Abrams E. The dimensionality of disclosure of HIV status amongst post-partum women in Cape Town, South Africa. AJAR-AFRICAN JOURNAL OF AIDS RESEARCH 2017; 16:101-107. [PMID: 28565973 DOI: 10.2989/16085906.2017.1311932] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Disclosure of HIV status to sexual partners and others has been presented as positive health behaviour and is widely encouraged by antiretroviral treatment (ART) programmes, providers and policies. However, disclosure is also highly contextual and its positive effects are not universal. We explore the dimensions of disclosure amongst post-partum women who initiated ART during pregnancy in Cape Town, South Africa. Forty-seven semi-structured interviews with post-partum women were conducted as part of the Maternal Child Health-Antiretroviral Therapy (MCH-ART) study. Primary elements of disclosure were coded and interpreted according to dominant themes and subthemes. Disclosure was commonplace in the sample, ranging from widely disclosing status (rare); to disclosing to some family, friends and partners; to tacit disclosure, where participants took medication in front of others without explicitly discussing their status. Women described reasons for non-disclosure in terms of not being ready, fear of negative reactions (including violence and loss of financial support), and fear of their status being widely known. Self-reported adherence was uniformly high throughout the range of disclosure. Even those who made special efforts to avoid disclosure, such as attending clinics distant from their homes, reported good adherence. Those who disclosed experienced a range of responses to their disclosure, from support to shunning. Despite access to ART, stigma remained a persistent feature in descriptions of disclosure, particularly in relation to partner disclosure. Our findings suggest that disclosure is not always positive and adherence can be maintained within a wide range of disclosure behaviours. It is important that clinic settings allow women to retain control over their disclosure process.
Collapse
Affiliation(s)
- Jo Hunter-Adams
- a Health Economics Unit, Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa.,b Centre for Infectious Diseases Epidemiology & Research, Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Allison Zerbe
- c ICAP , Mailman School of Public Health Columbia University , New York , USA
| | - Tamsin Philips
- b Centre for Infectious Diseases Epidemiology & Research, Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa.,d Division of Epidemiology & Biostatistics, Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Zanele Rini
- b Centre for Infectious Diseases Epidemiology & Research, Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Landon Myer
- b Centre for Infectious Diseases Epidemiology & Research, Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa.,e Division of Epidemiology & Biostatistics, Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa
| | - Greg Petro
- f Department of Obstetrics & Gynaecology , New Somerset Hospital and University of Cape Town , Cape Town , South Africa
| | - Elaine Abrams
- g ICAP, Mailman School of Public Health and College of Physicians and Surgeons , Columbia University , New York , USA
| |
Collapse
|
28
|
Ashaba S, Kaida A, Coleman JN, Burns BF, Dunkley E, O'Neil K, Kastner J, Sanyu N, Akatukwasa C, Bangsberg DR, Matthews LT, Psaros C. Psychosocial challenges facing women living with HIV during the perinatal period in rural Uganda. PLoS One 2017; 12:e0176256. [PMID: 28459866 PMCID: PMC5411062 DOI: 10.1371/journal.pone.0176256] [Citation(s) in RCA: 58] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2016] [Accepted: 04/07/2017] [Indexed: 01/08/2023] Open
Abstract
The complexities of navigating pregnancy while living with HIV predispose women to additional stress. Finding ways to minimize psychosocial challenges during the perinatal period may maximize the well-being of mothers living with HIV and their children. The goal of this study was to explore psychosocial challenges experienced by women living with HIV (WLWH) during pregnancy and the postpartum. We conducted individual in-depth interviews with 20 WLWH recruited from an HIV treatment cohort study in Mbarara, Uganda as part of a larger study exploring perinatal depression. We conducted content analyses to identify themes related to challenges of WLWH during pregnancy and the postpartum. Participants had a median age of 33 years [IQR: 28-35], a median of 3 living children [IQR: 2-5], and 95% had achieved HIV-RNA suppression. Challenges were organized around the following themes: HIV -related stigma from health professionals, HIV status disclosure dilemma, unintended pregnancy and intimate partner violence, HIV and environmental structural barriers and distress and fear related to maternal and child health. Stigma centered on discrimination by health care professionals and personal shame associated with being pregnant as a WLWH. This led to difficulty engaging in HIV care, particularly when coupled with structural barriers, such as lack of transportation to clinic. Participants experienced intimate partner violence and lacked support from their partners and family members. Distress and fear about the health and uncertainty about the future of the unborn baby due to maternal deteriorating physical health was common. The perinatal period is a time of stress for WLWH. Challenges experienced by WLWH may compromise successful engagement in HIV care and may reduce quality of life for women and their children. Strategies aimed at alleviating the challenges of WLWH should involve the larger structural environment including partners, family and community member as well as policy makers, funders and program implementers to work together for the common cause. These consolidated efforts may not only lower the risk of psychological distress but has potential to create long lasting solutions to benefit the wider community.
Collapse
Affiliation(s)
- Scholastic Ashaba
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Jessica N Coleman
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, United States of America
| | - Bridget F Burns
- Division of Global Health, Massachusetts General Hospital (MGH), Boston, United States of America
| | - Emma Dunkley
- Faculty of Health Sciences, Simon Fraser University, Vancouver, Canada
| | - Kasey O'Neil
- Division of Global Health, Massachusetts General Hospital (MGH), Boston, United States of America
| | - Jasmine Kastner
- Research Institute, McGill University Health Centre, Montreal, Canada
| | - Naomi Sanyu
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - Cecilia Akatukwasa
- Department of Psychiatry, Mbarara University of Science and Technology, Mbarara, Uganda
| | - David R Bangsberg
- Oregon Health Sciences University-Portland State University School of Public Health, Portland, OR, United States of America
| | - Lynn T Matthews
- Division of Global Health, Massachusetts General Hospital (MGH), Boston, United States of America
- Division of Infectious Disease, Massachusetts General Hospital (MGH), Boston, United States of America
| | - Christina Psaros
- Behavioral Medicine Program, Department of Psychiatry, Massachusetts General Hospital (MGH), Boston, United States of America
- Harvard Medical School, Boston, MA
| |
Collapse
|
29
|
Hayes-Larson E, Hirsch-Moverman Y, Saito S, Frederix K, Pitt B, Maama BL, Howard AA. Prevalence, patterns, and correlates of HIV disclosure among TB-HIV patients initiating antiretroviral therapy in Lesotho. AIDS Care 2017; 29:978-984. [PMID: 28100068 DOI: 10.1080/09540121.2017.1280124] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Disclosure of HIV-positive status has important implications for patient outcomes and preventing HIV transmission, but has been understudied in TB-HIV patients. We assessed disclosure patterns and correlates of non-disclosure among adult TB-HIV patients initiating ART enrolled in the START Study, a mixed-methods cluster-randomized trial conducted in Lesotho, which evaluated a combination intervention package (CIP) versus standard of care. Interviewer-administered questionnaire data were analyzed to describe patterns of disclosure. Patient-related factors were assessed for association with non-disclosure to anyone other than a health-care provider and primary partners using generalized linear mixed models. Among 371 participants, 95% had disclosed their HIV diagnosis to someone other than a health-care provider, most commonly a spouse/primary partner (76%). Age, TB knowledge, not planning to disclose TB status, greater perceived TB stigma, and CIP were associated with non-disclosure in unadjusted models (p < .1). In adjusted models, all point estimates were similar and greater TB knowledge (adjusted odds ratio [aOR] 0.59, 95% confidence interval [CI] 0.39-0.90) and CIP (aOR 0.20, 95% CI 0.05-0.79) remained statistically significant. Among 220 participants with a primary partner, 76% had disclosed to that partner. Significant correlates of partner non-disclosure (p < .1) in unadjusted analyses included being female, married/cohabitating, electricity at home, not knowing if partner was HIV-positive, and TB knowledge. Adjusted point estimates were largely similar, and being married/cohabitating (aOR 0.03, 95% CI 0.01-0.12), having electricity at home (aOR 0.38, 95% CI 0.17-0.85) and greater TB knowledge (aOR 0.76, 95% CI 0.59-0.98) remained significant. In conclusion, although nearly all participants reported disclosing their HIV status to someone other than a health-care provider at ART initiation, nearly a quarter of participants with a primary partner had not disclosed to their partner. Additional efforts to support HIV disclosure (e.g., counseling) may be needed for TB-HIV patients, particularly for women and those unaware of their partners' status.
Collapse
Affiliation(s)
- Eleanor Hayes-Larson
- a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA.,b Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Yael Hirsch-Moverman
- a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA.,b Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Suzue Saito
- a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA.,b Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Koen Frederix
- a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Blanche Pitt
- a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA
| | - Bridget Llang Maama
- c National Tuberculosis Control Programme, Lesotho Ministry of Health , Maseru , Lesotho
| | - Andrea A Howard
- a ICAP, Mailman School of Public Health, Columbia University , New York , NY , USA.,b Department of Epidemiology , Mailman School of Public Health, Columbia University , New York , NY , USA
| |
Collapse
|
30
|
FACTORS ASSOCIATED WITH HIV VOLUNTARY DISCLOSURE TO ONE'S STEADY SEXUAL PARTNER IN MALI: RESULTS FROM A COMMUNITY-BASED STUDY. J Biosoc Sci 2017; 48:51-65. [PMID: 26627886 DOI: 10.1017/s0021932014000546] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Despite the widespread dissemination of HIV information through public awareness campaigns in Mali, disclosing seropositivity to one's steady sexual partner (SSP) remains difficult for people living with HIV (PLHIV). Disclosure is a public health concern with serious implications and is also strongly linked to the quality of life of PLHIV. This study aimed to analyse factors associated with voluntary HIV disclosure to one's SSP, using a community-based cross-sectional study on 300 adult PLHIV in contact with a Malian community-based organization working in the field of AIDS response. A 125-item questionnaire was administered by trained personnel to study participants between May and October 2011. Analysis was restricted to the 219 participants who both reported having a SSP and answered to the question on disclosure to their SSP. A weighted multivariate logistic regression was used to determine variables independently associated with disclosure. In total, 161 participants (73%) reported HIV disclosure to their SSP. Having children (odds ratio [95% confidence interval]: 4.52 [1.84-11.12]), being accompanied to the survey site (3.66 [1.00-13.33]), knowing others who had publicly declared their seropositivity (3.12 [1.59-6.12]), having higher self-esteem (1.55 [1.09-2.19]) and using means other than anti-retroviral treatment to treat HIV (0.33 [0.11-1.00]) were independently associated with disclosure. This study identified several factors that should be considered for the design of interventions aimed at facilitating disclosure if/when desired in this cultural context.
Collapse
|
31
|
Abstract
Despite growing interest in HIV disclosure, most theoretical frameworks and empirical studies focus on individual and social factors affecting the process, leaving the contribution of interpersonal factors relatively unexplored. HIV transmission and disclosure often occur within a couple however, and this is where disclosure has the most scope as a HIV transmission intervention. With this in mind, this study explores whether perceived relationship quality influences HIV disclosure outcomes. Ninety-five UK individuals with HIV participated in a cross-sectional survey. Retrospective data were collected on their perceived relationship quality prior to disclosing their HIV positive status, and on disclosure outcomes. Perceived relationship quality was found to significantly affect disclosure outcomes. Positive qualities in the relationship were associated with positive outcomes, whereas negative qualities were associated with negative outcomes. Results further confirmed that this association was not merely correlational, but demonstrated predictive power. Relationship quality might act as either a risk or a resilience factor in the disclosure process, and thus warrants greater attention in future research.
Collapse
|
32
|
Simbayi LC, Zungu N, Evans M, Mehlomakulu V, Kupamupindi T, Mafoko G, Zuma K. HIV Serostatus Disclosure to Sexual Partners Among Sexually Active People Living with HIV in South Africa: Results from the 2012 National Population-Based Household Survey. AIDS Behav 2017; 21:82-92. [PMID: 26767538 DOI: 10.1007/s10461-015-1278-5] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/29/2022]
Abstract
This paper explores the prevalence and correlates of HIV seropositive status disclosure to sexual partners by people living with HIV (PLHIV) in South Africa. Secondary analysis of the 2012 South African National HIV Prevalence, Incidence and Behaviour Survey was conducted on data obtained from 934 sexually active PLHIV aged 15 years and older who responded to the question about HIV seropositive status disclosure. Overall, a large majority of respondents (77.1 %) reported disclosing their HIV-positive status to all their current sex partners. Multiple regression analysis, after adjustments for sex, marital status and locality type, revealed that those who were living together, going steady, and those who were single were all 60 % [adjusted odds ratio (AOR) = 0.4, 95 % CIs 0.20-0.78; AOR = 0.4, 95 % CIs 0.24-0.77; and AOR = 0.4, 95 % CIs 0.19-1.00, all ps < 0.05] less likely to disclose their HIV positive status to their partners compared to those who were married. Those who lived in rural formal areas were 70 % less likely to disclose their HIV status to their partners compared to those who stayed in urban formal areas (AOR = 0.3, 95 % CI 0.17-0.69, p < 0.001). Those who had correct HIV knowledge and rejection of myths were 2.0 times more likely to disclose their HIV status to their partners compared to those who did not have correct HIV knowledge and rejection of myths (AOR = 2.0, 95 % CI 1.04-3.68, p < 0.05). In conclusion, intervention programmes which help improve HIV seropositive status disclosure are needed by PLHIV who are not married, live in rural formal areas, and have incorrect HIV knowledge and rejection of myths.
Collapse
|
33
|
Trinh TT, Yatich N, Ngomoa R, McGrath CJ, Richardson BA, Sakr SR, Langat A, John-Stewart GC, Chung MH. Partner Disclosure and Early CD4 Response among HIV-Infected Adults Initiating Antiretroviral Treatment in Nairobi Kenya. PLoS One 2016; 11:e0163594. [PMID: 27711164 PMCID: PMC5053490 DOI: 10.1371/journal.pone.0163594] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2016] [Accepted: 09/12/2016] [Indexed: 11/19/2022] Open
Abstract
Background Disclosure of HIV serostatus can have significant benefits for people living with HIV/AIDS. However, there is limited data on whether partner disclosure influences ART treatment response. Methods We conducted a retrospective cohort study of newly diagnosed, ART-naïve HIV-infected adults (>18 years) who enrolled at the Coptic Hope Center in Nairobi, Kenya between January 1st 2009 and July 1st 2011 and initiated ART within 3 months. Analysis was restricted to adults who reported to have either disclosed or not disclosed their HIV status to their partner. Analysis of CD4 response at 6 and 12 months post-ART was stratified by age group. Results Among 615 adults newly initiating ART with partner disclosure data and 12 month follow-up, mean age was 38 years and 52% were male; 76% reported that they had disclosed their HIV-status to their partner. Those who disclosed were significantly younger and more likely to be married/cohabitating than non-disclosers. At baseline, median CD4 counts were similar between disclosure groups. Among younger adults (< 38 years) those who disclosed had higher CD4 recovery than those who did not at 6 months post- ART (mean difference = 31, 95% CI 3 to 58 p = 0.03) but not at 12 months (mean difference = 17, 95% CI -19 to 52, p = 0.4). Among older adults (≥ 38years) there was no observed difference in CD4 recovery at 6 or 12 months between disclosure groups. Conclusion Among younger adults, disclosure of HIV status to partners may be associated with CD4 recovery following ART.
Collapse
Affiliation(s)
- T. Tony Trinh
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- * E-mail:
| | | | | | - Christine J. McGrath
- Department of Obstetrics and Gynecology, University of Texas Medical Branch, Galveston, Texas, United States of America
| | - Barbra A. Richardson
- Department of Biostatistics, University of Washington, Seattle, Washington, United States of America
| | | | - Agnes Langat
- US Center for Disease Control and Prevention, Nairobi, Kenya
| | - Grace C. John-Stewart
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
- Department of Pediatrics University of Washington, Seattle, Washington, United States of America
| | - Michael H. Chung
- Department of Global Health, University of Washington, Seattle, Washington, United States of America
- Department of Epidemiology, University of Washington, Seattle, Washington, United States of America
- Department of Medicine, University of Washington, Seattle, Washington, United States of America
| |
Collapse
|
34
|
Lan CW, Li L, Lin C, Feng N, Ji G. Community Disclosure by People Living With HIV in Rural China. AIDS EDUCATION AND PREVENTION : OFFICIAL PUBLICATION OF THE INTERNATIONAL SOCIETY FOR AIDS EDUCATION 2016; 28:287-298. [PMID: 27427924 PMCID: PMC5069966 DOI: 10.1521/aeap.2016.28.4.287] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
The decision to disclose HIV serostatus is a complex and a challenging task because of potential stigma, blame, and fear associated with HIV infection. Despite continued research on HIV disclosure, literature on HIV disclosure to community is still scarce. The purpose of the study is to describe patterns of HIV status disclosure to community members in a sample of HIV-infected men and women in rural China. This study used the baseline data of a randomized controlled intervention trial for HIV-affected families in China. The data was collected between late 2011 to early 2013. In addition to demographic and HIV-related clinical characteristics, we collected the extent of HIV disclosure to members within the community. We first calculated descriptive statistics and frequencies to describe the demographics of the sample. We then compared the extents of HIV disclosure to different community members. We performed chi-square tests to determine whether the demographic and socioeconomic variables were associated with the extent of HIV disclosure to community. A total of 522 PLH were included in the study. The results show that age and family income are associated with the extent of disclosure of HIV status to members within the community, including neighbor, village leaders, people in the village, and coworkers. More disclosures were found among older age groups. People with less family income tend to disclose more to the community than those with higher family income. There is a need to explore the association of HIV disclosure to the community to help realize the public health and personal implications of disclosure. Our results underscore the potential benefits of age and socioeconomic status-specific interventions in the efforts to dispel barriers to HIV status disclosure to the community.
Collapse
Affiliation(s)
- Chiao-Wen Lan
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, California
| | | | - Chunqing Lin
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, California
| | - Nan Feng
- Semel Institute for Neuroscience and Human Behavior, Center for Community Health, University of California at Los Angeles, Los Angeles, California
| | - Guoping Ji
- Anhui Provincial Center for Disease Control and Prevention, Hefei, China
| |
Collapse
|
35
|
Early antiretroviral therapy initiation in west Africa has no adverse social consequences: a 24-month prospective study. AIDS 2016; 30:1677-82. [PMID: 27003034 DOI: 10.1097/qad.0000000000001100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Based on social indicators collected within the TEMPRANO-ANRS12136 trial, we assessed the social consequences of early antiretroviral therapy (ART) initiation in west Africa. We did not observe any significant differences in the levels or the time trends of various social indicators, including union status, HIV disclosure and HIV-related discrimination, between early and deferred ART initiation. Early ART does not carry detectable adverse social consequences that could impair its clinical and preventive benefits.
Collapse
|
36
|
Li H, Chen X, Yu B. Disclosure appraisal mediating the association between perceived stigma and HIV disclosure to casual sex partners among HIV+ MSM: a path model analysis. AIDS Care 2016; 28:722-5. [PMID: 27009408 DOI: 10.1080/09540121.2016.1140884] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
HIV stigma is widely believed to be related to HIV disclosure. However, there is a dearth of studies examining the mechanisms that link stigma to disclosure. This is a specific study to assess the relationship between perceived stigma and HIV disclosure to casual sex partners based on a social cognitive theory. HIV+ men who have sex with men (MSM) from two US cities (N = 297) completed questionnaires administered using audio computer-assisted self-interviewing. Path modeling analysis was used to assess the theory-based structural relationships. Perceived stigma was negatively associated with attitudes, intention and behavior of HIV disclosure to casual sex partners. The association was fully mediated by disclosure appraisal, including disclosure outcome expectations, costs and self-efficacy. Findings of this study add new knowledge regarding HIV stigma and disclosure, and provide timely data supporting more effective behavioral interventions to encourage HIV disclosure among MSM.
Collapse
Affiliation(s)
- Haochu Li
- a School of Public Health , Shandong University , Jinan , People's Republic of China.,b UNC Project-China, Institute for Global Health & Infectious Diseases, University of North Carolina at Chapel Hill , NC , USA
| | - Xinguang Chen
- c Department of Epidemiology, College of Public Health and Health Professionals , University of Florida , Gainesville , FL , USA
| | - Bin Yu
- c Department of Epidemiology, College of Public Health and Health Professionals , University of Florida , Gainesville , FL , USA
| |
Collapse
|
37
|
Matthews LT, Smit JA, Moore L, Milford C, Greener R, Mosery FN, Ribaudo H, Bennett K, Crankshaw TL, Kaida A, Psaros C, Safren SA, Bangsberg DR. Periconception HIV Risk Behavior Among Men and Women Reporting HIV-Serodiscordant Partners in KwaZulu-Natal, South Africa. AIDS Behav 2015; 19:2291-303. [PMID: 26080688 PMCID: PMC4926315 DOI: 10.1007/s10461-015-1050-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
HIV-infected men and women who choose to conceive risk infecting their partners. To inform safer conception programs we surveyed HIV risk behavior prior to recent pregnancy amongst South African, HIV-infected women (N = 209) and men (N = 82) recruited from antenatal and antiretroviral clinics, respectively, and reporting an uninfected or unknown-HIV-serostatus pregnancy partner. All participants knew their HIV-positive serostatus prior to the referent pregnancy. Only 11 % of women and 5 % of men had planned the pregnancy; 40 % of women and 27 % of men reported serostatus disclosure to their partner before conception. Knowledge of safer conception strategies was low. Around two-thirds reported consistent condom use, 41 % of women and 88 % of men reported antiretroviral therapy, and a third of women reported male partner circumcision prior to the referent pregnancy. Seven women (3 %) and two men (2 %) reported limiting sex without condoms to peak fertility. None reported sperm washing or manual insemination. Safer conception behaviors including HIV-serostatus disclosure, condom use, and ART at the time of conception were not associated with desired pregnancy. In light of low pregnancy planning and HIV-serostatus disclosure, interventions to improve understandings of serodiscordance and motivate mutual HIV-serostatus disclosure and pregnancy planning are necessary first steps before couples or individuals can implement specific safer conception strategies.
Collapse
Affiliation(s)
- L T Matthews
- Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA, 02114, USA.
| | - J A Smit
- MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
- School of Pharmacy and Pharmacology, Faculty of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - L Moore
- MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - C Milford
- MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - R Greener
- MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - F N Mosery
- MatCH Research [Maternal, Adolescent and Child Health Research], Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - H Ribaudo
- Center for Biostatistics in AIDS Research, Harvard School of Public Health, Boston, MA, USA
| | - K Bennett
- Bennett Statistical Consulting, Inc., Ballston Lake, NY, USA
| | - T L Crankshaw
- Health Economics and HIV and AIDS Research Division (HEARD), University of KwaZulu-Natal, Durban, South Africa
| | - A Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
| | - C Psaros
- Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - S A Safren
- Behavioral Medicine, Department of Psychiatry, Massachusetts General Hospital, Boston, MA, USA
| | - D R Bangsberg
- Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA, 02114, USA
| |
Collapse
|
38
|
Muhindo R, Nakalega A, Nankumbi J. Predictors of couple HIV counseling and testing among adult residents of Bukomero sub-county, Kiboga district, rural Uganda. BMC Public Health 2015; 15:1171. [PMID: 26603280 PMCID: PMC4659154 DOI: 10.1186/s12889-015-2526-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 11/18/2015] [Indexed: 12/22/2022] Open
Abstract
Background Studies have shown that couple HIV counseling and testing (CHCT) increased rates of sero-status disclosure and adoption of safer sexual behaviors with better linkage to treatment and care. However, current evidence suggests that new HIV infections are occurring among heterosexual couples in stable relationships where the majority of the individuals are not aware of their partner’s serostatus. This study examined the predictors of CHCT uptake among married or cohabiting couples of Bukomero sub-county Kiboga district in Uganda. Methods This cross-sectional correlational study was conducted among 323 individuals who were either married or cohabiting, aged 18–49 years. Participants were enrolled from randomly selected households in Bukomero sub-county. Data were collected using an interviewer-administered questionnaire on socio-demographics, self-rating on awareness of CHCT benefits, couple discussion about HIV testing and CHCT practices. Couples were compared between those who had reported to have tested as a couple and those who had not. Binary logistic regression was performed to determine the adjusted odds ratio [aOR] and 95 % confidence intervals [CI] for CHCT uptake and the other independent variables. Results Of the participants 288 (89.2 %) reported to have ever taken an HIV test only 99 (34.4 %) did so as a couple. The predictors of testing for HIV as a couple were discussing CHCT with the partner (adjusted odds ratio 4.95[aOR], 95 % confidence interval [CI]:1.99–12.98; p < 0.001), awareness of CHCT benefits (aOR 3.23; 95 % CI 1.78–5.87; p < 0.001) and having time to test as a couple (aOR 2.61; 95 % CI 1.22–5.61; p <0.05). Conclusion Uptake of HIV counseling and testing among couples was low. Discussing CHCT with partner, awareness of CHCT benefits, and availability of time to test as a couple were predictive of CHCT uptake. Thus CHCT campaigns should emphasize communication and discussion of HIV counseling and testing among partners.
Collapse
Affiliation(s)
- Richard Muhindo
- Department of Nursing, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| | | | - Joyce Nankumbi
- Department of Nursing, College of Health Sciences, Makerere University, P.O Box 7072, Kampala, Uganda.
| |
Collapse
|
39
|
Emmanuel W, Edward N, Moses P, William R, Geoffrey O, Monicah B, Rosemary M. Condom Use Determinants and Practices Among People Living with HIV in Kisii County, Kenya. Open AIDS J 2015; 9:104-11. [PMID: 26668671 PMCID: PMC4676051 DOI: 10.2174/1874613601509010104] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 08/21/2015] [Accepted: 08/26/2015] [Indexed: 11/22/2022] Open
Abstract
The male condom remains the single, most efficient and available technology to reduce sexual transmission of HIV as well as sexually transmitted infections. This study sought to establish condom use determinants and practices among people living with HIV (PLHIVs) in Kisii County, Kenya. We interviewed 340 PLHIVs and 6 health workers. Although most PLHIVs had correct knowledge and approved condoms as effective for HIV prevention, consistent use and condom use at last sex were notably low especially among PLHIVs aged 18 - 24, those who depended on remittances from kin as main source of income, as well as during sex with secondary and casual partners. This study notes that knowledge on various benefits of using condoms is associated with enhanced condom use practices. Non-disclosure of HIV status to secondary and casual partners remains a key barrier to condom use among PLHIVs Our observations highlight the need to further promote condom use among specific PLHIVs socio-demographic groups who continue to exhibit low condom use rates.
Collapse
Affiliation(s)
| | - Neyole Edward
- Department of Disaster Preparedness and Engineering Management, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | - Poipoi Moses
- Department of Educational Psychology, Masinde Muliro University of Science and Technology, Kakamega, Kenya
| | | | - Otomu Geoffrey
- County Health Directorate, Kisii County Government, Kisii Kenya
| | - Bitok Monicah
- Ministry of Health, The National Government, Nairobi, Kenya
| | | |
Collapse
|
40
|
Conserve DF, Groves AK, Maman S. Effectiveness of interventions promoting HIV serostatus disclosure to sexual partners: a systematic review. AIDS Behav 2015; 19:1763-72. [PMID: 25645328 DOI: 10.1007/s10461-015-1006-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Disclosure of HIV serostatus to sexual partners is mandated within certain states in the United States and other countries. Despite these laws implemented and public health efforts to increase disclosure, rates of disclosure to sexual partners among people living with HIV (PLWH) remain low, suggesting the need for interventions to assist PLWH with the disclosure process. We conducted a systematic review of studies testing whether HIV serostatus disclosure interventions increase disclosure to sexual partners. We searched six electronic databases and screened 484 records. Five studies published between 2005 and 2012 met inclusion criteria and were included in this review. Results showed that three of the HIV serostatus disclosure-related intervention studies were efficacious in promoting disclosure to sexual partners. Although all three studies were conducted in the United States the intervention content and measurements of disclosure across the studies varied, so broad conclusions are not possible. The findings suggest that more rigorous HIV serostatus disclosure-related intervention trials targeting different populations in the United States and abroad are needed to facilitate disclosure to sexual partners.
Collapse
Affiliation(s)
- Donaldson F Conserve
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27509, USA.
| | - Allison K Groves
- Department of Sociology, Center on Health, Risk and Society, American University, Washington, DC, USA
| | - Suzanne Maman
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, NC, 27509, USA
| |
Collapse
|
41
|
Kiweewa FM, Bakaki PM, McConnell MS, Musisi M, Namirembe C, Nakayiwa F, Kusasira F, Nakintu D, Mubiru MC, Musoke P, Fowler MG. A cross-sectional study of the magnitude, barriers, and outcomes of HIV status disclosure among women participating in a perinatal HIV transmission study, "the Nevirapine Repeat Pregnancy study". BMC Public Health 2015; 15:988. [PMID: 26420040 PMCID: PMC4588248 DOI: 10.1186/s12889-015-2345-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2015] [Accepted: 09/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV status disclosure is a difficult emotional task for HIV-infected persons and may create the opportunity for both social support and rejection. In this study, we evaluated the proportions, patterns, barriers and outcomes of HIV- 1 status disclosure among a group of women in Uganda. METHODS An exit interview was conducted one year post-partum for 85 HIV-infected women who participated in a study of HIV-1 transmission rates among NVP-experienced compared with NVP-naïve women in "The Nevirapine Repeat Pregnancy (NVP-RP) Study" at the Makerere University-Johns Hopkins University Research Collaboration, Kampala-Uganda, between June 2004 and June 2006. RESULTS Of the 85 women interviewed, 99 % had disclosed their HIV status to at least one other person. Disclosure proportions ranged between 1 % to employer(s) and 69 % to a relative other than a parent. Only 38 % of the women had disclosed to their sex partners. Women with an HIV-infected baby were more likely than those with an uninfected baby to disclose to their sex partner, OR 4.9 (95 % CI, 2.0 -11.2), and women were less likely to disclose to a partner if they had previously disclosed to another relative than if they had not, OR 0.19 (95 % CI, 0.14-0.52). The most common reasons for non-disclosure included fear of separation from the partner and subsequent loss of financial support 34 %, and not living with the partner (not having opportunities to disclose) 26 %. While most women (67 %) reported getting social support following disclosure, 22 % reported negative outcomes (neglect, separation from their partners, and loss of financial support). Following disclosure of HIV status, 9 % of women reported that their partner (s) decided to have an HIV test. CONCLUSION Results from this study show high overall HIV disclosure proportions and how this disclosure of HIV status can foster social support. However, proportions of disclosure specifically to male sex partners were low, which suggests the need for interventions aimed at increasing male involvement in perinatal care, along with supportive counseling.
Collapse
Affiliation(s)
- Flavia M Kiweewa
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda. .,Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda. .,Makerere University - Johns Hopkins University Research Collaboration, MU-JHU Research Building, Old Mulago Hill Road, P.O. Box 23491, Kampala, Uganda.
| | | | - Michelle S McConnell
- US Department of Health and Human Services, Centers for Disease Control and Prevention, Hanoi, Vietnam.
| | - Maria Musisi
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda.
| | - Constance Namirembe
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda.
| | - Frances Nakayiwa
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda.
| | - Fiona Kusasira
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda.
| | - Dorothy Nakintu
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda.
| | - Michael C Mubiru
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda.
| | - Philippa Musoke
- Makerere University-Johns Hopkins University (MU-JHU) Research Collaboration, Kampala, Uganda. .,Department of Pediatrics and Child Health, Makerere University School of Medicine, University College of Health Sciences, Makerere, Uganda.
| | | |
Collapse
|
42
|
Doherty IA, Myers B, Zule WA, Minnis AM, Kline TL, Parry CD, El-Bassel N, Wechsberg WM. Seek, Test and Disclose: knowledge of HIV testing and serostatus among high-risk couples in a South African township. Sex Transm Infect 2015; 92:5-11. [PMID: 26175479 DOI: 10.1136/sextrans-2014-051882] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 06/20/2015] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES HIV testing and disclosure of results to partners is an important strategy in HIV prevention but is under-researched within heterosexual partnerships. To address this gap, we describe patterns of HIV testing, discrepancies between beliefs and biologically confirmed HIV status of each partner, and characteristics of mutually correct knowledge of HIV status among heterosexual couples in a high-prevalence community. METHODS The study recruited 290 high-risk heterosexual couples in stable relationships from a township in Cape Town, South Africa. Male patrons of shebeens (drinking establishments) were approached to participate with their main partner in an intervention designed to reduce substance use, violence and unsafe sex. All participants were tested for HIV at baseline and asked about their partner's past HIV testing and current status. Using the couple as the unit of analysis, we conducted logistic regression to identify partnership and individual characteristics associated with having mutually correct knowledge of partner's HIV status. RESULTS Half (52%) of women and 41% of men correctly knew whether their partner had ever been tested for HIV. 38% of women, 28% of men and in 17% of couples, both members reported mutually correct knowledge of their partner's HIV status. Correlates of correct knowledge included married/cohabitating (aOR 2.69, 95% CI 1.35 to 5.40), both partners HIV-negative (aOR 3.32 (1.38 to 8.00)), women's acceptance of traditional gender roles (aOR 1.17 (1.01 to 1.40)) and men's relationship satisfaction (aOR 2.22 (1.01 to 4.44)). CONCLUSIONS Findings highlight the need to improve HIV testing uptake among men and to improve HIV disclosure among women in heterosexual partnerships. TRIAL REGISTRATION NUMBER ClinicalTrials.gov registration NCT01121692.
Collapse
Affiliation(s)
- Irene A Doherty
- Substance Abuse Treatment Evaluation & Interventions, RTI International, Research Triangle Park, North Carolina, USA
| | - Bronwyn Myers
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
| | - William A Zule
- Substance Abuse Treatment Evaluation & Interventions, RTI International, Research Triangle Park, North Carolina, USA
| | - Alexandra M Minnis
- Substance Abuse Treatment Evaluation & Interventions, RTI International, Research Triangle Park, North Carolina, USA
| | - Tracy L Kline
- Substance Abuse Treatment Evaluation & Interventions, RTI International, Research Triangle Park, North Carolina, USA
| | - Charles D Parry
- Alcohol, Tobacco & Other Drug Research Unit, South African Medical Research Council, Cape Town, South Africa Department of Psychiatry, Stellenbosch University, Cape Town, South Africa
| | - Nabila El-Bassel
- Columbia University, School of Social Work, New York, New York, USA
| | - Wendee M Wechsberg
- Substance Abuse Treatment Evaluation & Interventions, RTI International, Research Triangle Park, North Carolina, USA Department of Psychology in the Public Interest, North Carolina State University, Raleigh, North Carolina, USA
| |
Collapse
|
43
|
Vu L, Nieto-Andrade B, DiVincenzo A, Rivas J, Firestone R, Wheeler J, Lungo S. Effectiveness of Behavior Change Communications for Reducing Transmission Risks Among People Living with HIV in 6 Countries in Central America. AIDS Behav 2015; 19:1203-13. [PMID: 25284460 PMCID: PMC4503879 DOI: 10.1007/s10461-014-0910-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
This first region-wide study (N = 2,818) aims to estimate prevalence of HIV-related risks (sexual behavior, HIV disclosure, number of sex partners, violence) and factors associated with these risks as well as evaluate a behavior change communications program targeted to PLHIV in 6 countries in Central America. After 2 years, the program achieved moderate coverage, with 21 % of the sample reporting exposure to interpersonal communications (IPC) and 52 % to mass media program components. The odds of condom use, HIV disclosure, and participation in a self-help group increased by 1.4–1.8 times with exposure to mass media. Exposure to IPC increased odds of condom use by 2.7 and participation in self-help groups by 4.4 times. In addition, being in HIV care or taking ART was associated with condom use and HIV-status disclosure. About 30 % experienced physical or sexual violence, and those who did were 4 times less likely to use condoms. Findings suggest that behavioral interventions for PLHIV can reduce HIV-transmission risks and increase access to care.
Collapse
Affiliation(s)
- Lung Vu
- Population Services International, 1120 19th Street, NW, STE 600, Washington, DC, 20036, USA,
| | | | | | | | | | | | | |
Collapse
|
44
|
Fladseth K, Gafos M, Newell ML, McGrath N. The impact of gender norms on condom use among HIV-positive adults in KwaZulu-Natal, South Africa. PLoS One 2015; 10:e0122671. [PMID: 25853870 PMCID: PMC4390283 DOI: 10.1371/journal.pone.0122671] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2014] [Accepted: 02/24/2015] [Indexed: 11/18/2022] Open
Abstract
Critical to preventing the spread of HIV is promoting condom use among HIV-positive individuals. Previous studies suggest that gender norms (social and cultural constructions of the ways that women and men are expected to behave) may be an important determinant of condom use. However, the relationship has not been evaluated among HIV-positive women and men in South Africa. We examined gender norms and condom use at last sex among 550 partnerships reported by 530 sexually-active HIV-positive women (372) and men (158) who had sought care, but not yet initiated antiretroviral therapy in a high HIV-prevalence rural setting in KwaZulu-Natal, South Africa between January 2009 and March 2011. Participants enrolled in the cohort study completed a baseline questionnaire that detailed their socio-demographic characteristics, socio-economic circumstances, religion, HIV testing history and disclosure of HIV status, stigma, social capital, gender norms and self-efficacy. Gender norms did not statistically differ between women and men (p = 0.18). Overall, condoms were used at last sex in 58% of partnerships. Although participants disclosed their HIV status in 66% of the partnerships, 60% did not have knowledge of their partner's HIV status. In multivariable logistic regression, run separately for each sex, women younger than 26 years with more equitable gender norms were significantly more likely to have used a condom at last sex than those of the same age group with inequitable gender norms (OR = 8.88, 95% CI 2.95-26.75); the association between condom use and gender norms among women aged 26+ years and men of all ages was not statistically significant. Strategies to address gender inequity should be integrated into positive prevention interventions, particularly for younger women, and supported by efforts at a societal level to decrease gender inequality.
Collapse
Affiliation(s)
- Kristin Fladseth
- London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Mitzy Gafos
- Medical Research Council Clinical Trials Unit, University College London, London, United Kingdom
| | - Marie Louise Newell
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
- Faculty of Medicine and of Social and Human Sciences, University of Southampton, Southampton, United Kingdom
| | - Nuala McGrath
- Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa
- Faculty of Medicine and of Social and Human Sciences, University of Southampton, Southampton, United Kingdom
| |
Collapse
|
45
|
Arrey AE, Bilsen J, Lacor P, Deschepper R. "It's my secret": fear of disclosure among sub-Saharan African migrant women living with HIV/AIDS in Belgium. PLoS One 2015; 10:e0119653. [PMID: 25781906 PMCID: PMC4362755 DOI: 10.1371/journal.pone.0119653] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Accepted: 02/02/2015] [Indexed: 11/29/2022] Open
Abstract
Patients with HIV not only have to deal with the challenges of living with an incurable disease but also with the dilemma of whether or not to disclose their status to their partners, families and friends. This study explores the extent to which sub-Saharan African (SSA) migrant women in Belgium disclose their HIV positive status, reasons for disclosure/non-disclosure and how they deal with HIV disclosure. A qualitative study consisting of interviews with twenty-eight SSA women with HIV/AIDS was conducted. Thematic content analysis was employed to identify themes as they emerged. Our study reveals that these women usually only disclose their status to healthcare professionals because of the treatment and care they need. This selective disclosure is mainly due to the taboo of HIV disease in SSA culture. Stigma, notably self-stigma, greatly impedes HIV disclosure. Techniques to systematically incorporate HIV disclosure into post-test counseling and primary care services are highly recommended.
Collapse
Affiliation(s)
- Agnes Ebotabe Arrey
- Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
- * E-mail:
| | - Johan Bilsen
- Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| | - Patrick Lacor
- Department of Internal Medicine and Infectious Diseases-AIDS Reference Center, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Reginald Deschepper
- Department of Public Health, Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, Brussels, Belgium
| |
Collapse
|
46
|
Okello ES, Wagner GJ, Ghosh-Dastidar B, Garnett J, Akena D, Nakasujja N, Musisi S. Depression, Internalized HIV Stigma and HIV Disclosure. ACTA ACUST UNITED AC 2015. [DOI: 10.4236/wja.2015.51004] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
|
47
|
Pines HA, Patterson TL, Rangel G, Martinez G, Bazzi AR, Ulibarri MD, Syvertsen JL, Martin NK, Strathdee SA. STI/HIV test result disclosure between female sex workers and their primary, non-commercial male partners in two Mexico-US border cities: a prospective study. Sex Transm Infect 2014; 91:207-13. [PMID: 25298381 DOI: 10.1136/sextrans-2014-051663] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Accepted: 09/21/2014] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Disclosure of sexually transmitted infections (STI)/HIV diagnoses to sexual partners is not mandated by public health guidelines in Mexico. To assess the feasibility of couples-based STI/HIV testing with facilitated disclosure as a risk-reduction strategy within female sex workers' (FSW) primary partnerships, we examined STI/HIV test result disclosure patterns between FSWs and their primary, non-commercial male partners in two Mexico-US border cities. METHODS From 2010 to 2013, 335 participants (181 FSWs and 154 primary male partners) were followed for 24 months. At semiannual visits, participants were tested for STIs/HIV and reported on their disclosure of test results from the previous visit. Multilevel logistic regression was used to identify individual-level and partnership-level predictors of cumulative (1) non-disclosure of ≥1 STI test result and (2) non-disclosure of ≥1 HIV test result within couples during follow-up. RESULTS Eighty-seven percent of participants reported disclosing all STI/HIV test results to their primary partners. Non-disclosure of ≥1 STI test result was more common among participants who reported an STI diagnosis as part of the study (adjusted OR=3.05, 95% CI 1.13 to 8.25), while non-disclosure of ≥1 HIV test result was more common among participants in longer-duration partnerships (AOR=1.15 per year, 95% CI 1.03 to 1.28). Drug use before/during sex within partnerships was associated with non-disclosure of both STI (AOR=5.06, 95% CI 1.64 to 15.62) and HIV (AOR=4.51, 95% CI: 1.32 to 15.39) test results. CONCLUSIONS STI/HIV test result disclosure was highly prevalent within FSWs' primary partnerships, suggesting couples-based STI/HIV testing with facilitated disclosure may be feasible for these and potentially other high-risk, socially marginalised couples.
Collapse
Affiliation(s)
- Heather A Pines
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, USA
| | - Thomas L Patterson
- Department of Psychiatry, University of California, San Diego, La Jolla, USA
| | - Gudelia Rangel
- Department of Population Studies, El Colegio de La Frontera Norte, Tijuana, Baja California, México
| | - Gustavo Martinez
- Federación Mexicana de Asociaciones Privadas (FEMAP), Ciudad Juárez, Chihuahua, México
| | - Angela R Bazzi
- Department of Community Health Sciences, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Monica D Ulibarri
- Department of Psychiatry, University of California, San Diego, La Jolla, USA
| | | | - Natasha K Martin
- School of Social and Community Medicine, University of Bristol, Bristol, UK Social and Mathematical Epidemiology Group, London School of Hygiene and Tropical Medicine, London, UK
| | - Steffanie A Strathdee
- Division of Global Public Health, Department of Medicine, University of California, San Diego, La Jolla, USA
| |
Collapse
|
48
|
Colombini M, Mutemwa R, Kivunaga J, Stackpool Moore L, Mayhew SH. Experiences of stigma among women living with HIV attending sexual and reproductive health services in Kenya: a qualitative study. BMC Health Serv Res 2014; 14:412. [PMID: 25239309 PMCID: PMC4261560 DOI: 10.1186/1472-6963-14-412] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2013] [Accepted: 09/15/2014] [Indexed: 11/10/2022] Open
Abstract
Background Researchers have widely documented the pervasiveness of HIV stigma and discrimination, and its impact on people living with HIV. Only a few studies, however, have analysed the perceptions of women living with HIV accessing sexual and reproductive health (SRH) services. This study explores the experiences of stigma of HIV-positive clients attending family planning and post-natal services and implications for service use and antiretroviral therapy (ART) adherence. Our aim was to gain a better understanding of the impact of various dimensions of stigma on service use and ART adherence among HIV clients in order to inform the response of integrated SRH services. Methods In-depth interviews were conducted with 48 women living with HIV attending SRH services in two districts in Kenya. Data were coded using Nvivo 8 and analysed using a thematic analysis approach. Results Findings show that many women living with HIV report high levels of anticipated stigma, resulting in a desire to hide their status from family and friends for fear of being discriminated against. Many women feared desertion following disclosure of their positive status to partners. Consequently some women preferred to hide their status and adhere to HIV treatment in secret. However, the majority of study participants attending postnatal care (PNC) services also revealed that anticipated stigma does not adversely affect their HIV drug uptake and ART adherence, as their drive to live outweighs their fear of stigma. Our findings also seem to suggest a preference for specialist HIV services by some family planning (FP) clients because of better confidentiality and reduced opportunities for unwanted disclosure that could lead to stigma. Conclusions The findings highlight that anticipated stigma leading to low disclosure is widespread and sometimes reinforced by health providers’ actions and facility layout (contributing to enacted stigma). However, the motivation to stay healthy and look after the children appears in many cases to override fears of stigma related to ART adherence in our client-based sample.
Collapse
|
49
|
Lee L, Bastos FI, Bertoni N, Malta M, Kerrigan D. The role of HIV serostatus disclosure on sexual risk behaviours among people living with HIV in steady partnerships in Rio de Janeiro, Brazil. Glob Public Health 2014; 9:1093-106. [PMID: 25223980 DOI: 10.1080/17441692.2014.952655] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Understanding partnership dynamics is a crucial step in the process of HIV serostatus disclosure to partners. This study examines the relational characteristics associated with HIV serostatus disclosure and the role of disclosure on sexual behaviours within steady partnerships among people living with HIV (PLHIV) in Rio de Janeiro, Brazil. The overall study surveyed 900 participants from six large public health facilities to investigate psychosocial and structural factors associated with sexual health and well-being. This analysis focuses on 489 individuals reporting being in steady partnerships, 86% of whom reported HIV serostatus disclosure to steady partners. After adjusting for demographic variables, attitudes towards disclosure, having an HIV-positive partner, living with partner and longer relationships were significantly associated with reported disclosure in multivariable logistic regression. Living with partner was negatively associated with partner concurrency. However, having an HIV-positive partner, sex under the influence of drugs or alcohol and experiencing physical aggression by a steady partner were negatively associated with consistent condom use. Interventions supporting PLHIV to safely and voluntarily disclose to partners may be an effective prevention approach between steady partners; however, partner violence and substance use should be addressed in future work.
Collapse
Affiliation(s)
- Lana Lee
- a Department of Paediatrics , Johns Hopkins School of Medicine , Baltimore , MD , USA
| | | | | | | | | |
Collapse
|
50
|
Matthews LT, Moore L, Crankshaw TL, Milford C, Mosery FN, Greener R, Psaros C, Safren SA, Bangsberg DR, Smit JA. South Africans with recent pregnancy rarely know partner's HIV serostatus: implications for serodiscordant couples interventions. BMC Public Health 2014; 14:843. [PMID: 25124267 PMCID: PMC4246447 DOI: 10.1186/1471-2458-14-843] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 07/24/2014] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND Implementation of safer conception strategies requires knowledge of partner HIV-serostatus. We recruited women and men in a high HIV-prevalence setting for a study to assess periconception risk behavior among individuals reporting HIV-serodiscordant partnerships. We report screening data from that study with the objective of estimating the proportion of individuals who are aware that they are in an HIV-serodiscordant relationship at the time of conception. METHODS We screened women and men attending antenatal and antiretroviral clinics in Durban, South Africa for enrollment in a study of periconception risk behavior among individuals with serodiscordant partners. Screening questionnaires assessed for study eligibility including age 18-45 years (for women) or at least 18 years of age (for men), pregnancy in past year (women) or partner pregnancy in the past 3 years (men), HIV status of partner for recent pregnancy, participant's HIV status, and infected partner's HIV status having been known before the referent pregnancy. RESULTS Among 2620 women screened, 2344 (90%) met age and pregnancy criteria and knew who fathered the referent pregnancy. Among those women, 963 (41%) did not know the pregnancy partner's HIV serostatus at time of screening. Only 92 (4%) reported knowing of a serodiscordant partnership prior to pregnancy. Among 1166 men screened, 225 (19%) met age and pregnancy criteria. Among those men, 71 (32%) did not know the pregnancy partner's HIV status and only 30 (13%) reported knowing of a serodiscordant partnership prior to pregnancy. CONCLUSIONS In an HIV-endemic setting, awareness of partner HIV serostatus is rare. Innovative strategies to increase HIV testing and disclosure are required to facilitate HIV prevention interventions for serodiscordant couples.
Collapse
Affiliation(s)
- Lynn T Matthews
- />Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA 02114 USA
- />Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, USA
| | - Lizzie Moore
- />Maternal, Adolescent and Child Health (MatCH), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Tamaryn L Crankshaw
- />Health Economics and HIV and AIDS Research Division, University of Kwazulu-Natal, Durban, South Africa
| | - Cecilia Milford
- />Maternal, Adolescent and Child Health (MatCH), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Fortunate N Mosery
- />Maternal, Adolescent and Child Health (MatCH), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Ross Greener
- />Maternal, Adolescent and Child Health (MatCH), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| | - Christina Psaros
- />Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - Steven A Safren
- />Department of Psychiatry, Massachusetts General Hospital, Boston, USA
| | - David R Bangsberg
- />Division of Infectious Disease and Center for Global Health, Massachusetts General Hospital, 100 Cambridge Street, 15th Floor, Boston, MA 02114 USA
| | - Jennifer A Smit
- />Maternal, Adolescent and Child Health (MatCH), Faculty of Health Sciences, University of the Witwatersrand, Durban, South Africa
| |
Collapse
|