Factors associated with disclosure of HIV status among a cohort of individuals on antiretroviral therapy in British Columbia, Canada

Attitudes to disclosure of HIV-serostatus to new sexual partners and sexual behaviours among HIV-diagnosed gay, bisexual and other men who have sex with men in the UK

We assessed attitudes to disclosure to new sexual partners and association with sexual behaviours among HIV-diagnosed gay, bisexual, and other men who have sex with men (GBMSM) in the UK Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study in 2011-12. Among 1373 GBMSM diagnosed with HIV for ≥3 months and reporting sex in the past three months (84% on antiretroviral therapy (ART), 75% viral load (VL) ≤50c/mL), 56.3% reported higher sexual disclosure ("agree" or "tend to agree" with "I'd expect to tell a new partner I'm HIV-positive before we have sex"). GBMSM on ART with self-reported undetectable VL had lower disclosure than those on ART without self-reported undetectable VL and those not on ART. Higher sexual disclosure was associated with higher prevalence of CLS in the past three months; this was due to its association with CLS with other HIV-positive partners. Higher sexual disclosure was more common among GBMSM who had CLS with other HIV-positive partners only (72.1%) compared to those who had higher-risk CLS with HIV-serodifferent partners (55.6%), other CLS with HIV-serodifferent partners (45.9%), or condom-protected sex only (47.6%). Findings suggest mutual HIV-disclosure and HIV-serosorting were occurring in this population. Knowledge of VL status may have impacted on disclosure to sexual partners.

Status and associated characteristics of HIV disclosure among people living with HIV/AIDS in Liangshan, China: A cross-sectional study

Human immunodeficiency virus (HIV) disclosure is a prerequisite to get access to antiretroviral therapy (ART) and social support. Increased disclosure of HIV status has been shown to reduce mother-to-child transmission and high-risk sexual behaviors. Limited studies were conducted to get an insight into HIV disclosure among people living with HIV/acquired immune deficiency syndrome (AIDS) (PLWHA) in Liangshan.Our study aimed to investigate the status and associated characteristics of HIV disclosure among PLWHA in Liangshan.We conducted a cross-sectional study using a stratified, convenience sampling method from August to December in 2017. All of the participants were from Liangshan, a typical impoverished mountainous area which also has a long history of drug production and drug trade. Each participant completed a structured questionnaire including HIV disclosure status, demographic and HIV-related characteristics, social support, and perceived HIV-related stigma. We performed a binary regression analysis to detect associated characteristics of HIV disclosure among PLWHA in Liangshan.A final sample size of 318 participants was included in this study. The overall prevalence of HIV disclosure was 83.6% (266/318). In binary logistic regression analysis, PLWHA who had higher educational levels, and got infected by sexual transmission were less likely to disclose their HIV status (both P < .05). HIV nondisclosure was correlated with a higher level of perceived HIV-related stigma (P < .01).The prevalence of HIV disclosure was relatively low in Liangshan. Healthcare workers are suggested to conduct more counseling and education to promote safe sexual behaviors and reduce perceived stigma among PLWHA, then enhance HIV serostatus disclosure.

A generalized additive model to disentangle age and diagnosis-specific cohort effects in psychological and behavioral outcomes in people living with HIV: the French cross-sectional ANRS-VESPA2 survey

BACKGROUND

Unlike their younger counterparts, some of today's older HIV patients were diagnosed before the advent of highly active antiretroviral therapy (HAART). The psychosocial and behavioral outcomes of people living with HIV (PLWH) have been widely studied, and associated factors are well known. However, their evolution both in terms of age and diagnosis-specific cohort effects is not well understood.

METHODS

Data from the ANRS-VESPA2 cross-sectional survey, representative of French PLWH, were used to investigate whether psychosocial and behavioral outcomes such as quality of life, need for support and HIV status disclosure, evolve under both the influence of patients' age and diagnosis-specific cohort effects. A semi-parametric generalized additive model (GAM) was employed. The physical and mental components of health-related quality of life, the need for material and moral support, and HIV-status disclosure, constituted our outcomes.

RESULTS

Non-linear diagnosis-specific cohort effects were found for physical and mental QoL and HIV-status disclosure. Overall, physical QoL was better in recently diagnosed patients than in those diagnosed in the early 1980s. An increasing influence of diagnosis-specific cohort effects between 1983 and 1995 was observed. No cohort effects were noticeable between 1996 and 2000, while an increasing influence was apparent for patients diagnosed with HIV from 2000 to 2011 (year of study). For mental QoL, the only increase was observed in participants diagnosed with HIV between 1983 and 2000. The relationship between diagnosis-specific cohort effects and HIV status disclosure was negative overall: participants diagnosed after 2000 were much less likely to disclose than those diagnosed before 1995. The effect of age was significantly associated with all outcomes, with a non-linear influence on mental QoL and with the need for material/moral support.

CONCLUSIONS

Psychosocial and behavioral outcomes are complex processes which can be explained in different ways by a combination of the clinical and social contexts which PLWH are exposed to at the time of diagnosis, and by developmental characteristics. A greater understanding of these processes could inform healthcare policy-making for specific HIV generations and different HIV age groups.

Social support, stigma, and HIV disclosure among parents living with HIV in Guangxi, China

Both stigma and social support have been identified to be associated with HIV status disclosure among people living with HIV. This study aimed to examine cross-sectional associations of perceived social support and multiple types of stigma with both disclosure to various target groups and timing of disclosure among parents living with HIV (PLHIV) in Guangxi, China. Cross-sectional data from 1254 PLHIV in Guangxi, China were analyzed. Measures included demographics, disclosure to specific groups (steady partner/spouse, children, family and others) and timing of disclosure, perceived social support, and three types of HIV-related stigma (perceived, internalized, and enacted stigma). Logistic regression analyses were performed to identify the associations of interest. The participants who reported higher levels of perceived social support were more likely to have disclosed to steady partner/spouse, family or others. Those who experienced enacted stigma were more likely to have disclosed to children or family. Those who were married/cohabitating were more likely to have disclosed to steady partner/spouse, and less likely to have disclosed to children, family or others. Older PLHIV were less likely to have disclosed to steady partner/spouse, or family. Those who had a job were more likely to have disclosed to steady partner/spouse. Perceived social support appeared not to be associated with timing of disclosure. Those who disclosed within a shorter time after diagnosis were more likely to be women or have disclosed to steady partner/spouse, and less likely to have higher perceived stigma or have disclosed to family. Interventions are needed to help reduce the negative effect of perceived stigma at both family and community levels and to help enhance perceived social support in general and emotional support in particular among PLHIV, especially males and older adults.

Mutual HIV status disclosure is associated with consistent condom use in public sector ART clients in Free State province, South Africa: a short report

Risky sexual behaviour in PLWHA on antiretroviral therapy threatens both prevention and treatment efforts, but disclosure promises to support safer sexual practices. This paper investigates the association between HIV self-disclosure and consistent condom use in a cohort of public sector patients on antiretroviral (ARV) treatment. Using data from the FEATS cohort study, logistic regression analysis shows that knowledge of your partner's HIV status is positively associated with consistent condom use (OR 2.73, 95% CI 1.37-5.43, p = 0.004) and so too mutual HIV disclosure (OR 3.38, 95% CI 1.60-7.18, p = 0.001). Prevention and treatment programmes, through couple HIV counselling and testing (CHCT) and other assistance programmes, should focus on supporting the mutual disclosure of HIV status among PLWHA on ARV treatment.

Non-Disclosure of HIV Status and Associations with Psychological Factors, ART Non-Adherence, and Viral Load Non-Suppression Among People Living with HIV in the UK

Disclosure of HIV status to family, friends, and a stable partner may be linked to improved health outcomes for people living with HIV. This study assessed whether non-disclosure is associated with psychological symptoms, non-adherence to antiretroviral therapy (ART), and viral load (VL) non-suppression. A total of 3258 HIV-diagnosed individuals in the UK completed the confidential ASTRA study questionnaire (2011–2012). Participants reported whether they told anyone they had HIV; to which confidant(s) (friends, family, work colleagues, stable partner) and to what extent (none, some, most/all). The prevalence and factors associated with non-disclosure were assessed. Associations between non-disclosure and the following factors were established using modified Poisson regression with adjustment for socio-demographic factors (gender, age group, ethnicity), HIV-related factors (time since HIV diagnosis, ART status), and clinic: low social support (score ≤ 12 on modified Duke-UNC FSSQ); depression and anxiety symptoms (≥10 on PHQ-9 and GAD-7 respectively); self-reported ART non-adherence in past 2 weeks/3 months; VL non-suppression (clinic-recorded VL > 50 copies/mL among those who started ART ≥ 6 months ago). Among 3233 participants with disclosure data, the prevalence of non-disclosure to anyone was 16.6 % (n/N = 61/367) among heterosexual men, 15.7 % (98/626) among women, and 5.0 % (113/2240) among MSM. MSM were more likely to disclose to some/all friends compared to family (85.8 vs. 59.9 %) while heterosexuals were less likely to disclose to friends than family (44.1 vs. 61.1 % for men, 57.5 vs. 67.1 % for women). Among 1,631 participants with a stable partner, non-disclosure to a stable partner was 4.9 % for MSM, 10.9 % for heterosexual men, and 13.0 % for women. In adjusted analyses, older age (≥60 years), non-white ethnicity, more recent HIV diagnosis, and not having a stable partner were significantly associated with overall non-disclosure for MSM and heterosexual individuals. The prevalence of low social support was 14.4 %, of depression and anxiety symptoms 27.1 and 22.0 %, respectively, of ART non-adherence 31.8 %, and of viral load non-suppression on ART 9.8 %. There was no evidence that non-disclosure overall (versus disclosure to anyone) was associated with low social support, depression or anxiety symptoms, ART non-adherence or VL non-suppression among MSM or heterosexual individuals. However, compared to MSM who disclosed to ‘none’ or ‘some’ friends and family, MSM who disclosed to ‘most or all’ of their friends and family were more likely to have symptoms of depression (adjusted PR = 1.4, 95 % CI 1.2–1.7), anxiety (1.3, 1.1–1.6), and to report ART non-adherence (1.3, 1.1–1.5). In this large multicentre study of people living with HIV in the UK, non-disclosure was overall low, but higher for heterosexual individuals compared to MSM. Non-disclosure was not associated with higher prevalence of adverse health measures.

The Association Between HIV Disclosure Status and Perceived Barriers to Care Faced by Women Living with HIV in Latin America, China, Central/Eastern Europe, and Western Europe/Canada

Generally, women are less likely than men to disclose their HIV status. This analysis examined the relationship between HIV disclosure and (1) perceived barriers to care and (2) quality of life (QoL) for women with HIV. The ELLA (EpidemioLogical study to investigate the popuLation and disease characteristics, barriers to care, and quAlity of life for women living with HIV) study enrolled HIV-positive women aged ≥18 years. Women completed the 12-item Barriers to Care Scale (BACS) questionnaire. QoL was assessed using the Health Status Assessment. BACS and QoL were stratified by dichotomized HIV disclosure status (to anyone outside the healthcare system). Multilevel logistic regression analysis was used to identify factors associated with disclosure. Of 1945 patients enrolled from Latin America, China, Central/Eastern Europe, and Western Europe/Canada between July 2012 and September 2013, 1929 were included in the analysis (disclosed, n = 1724; nondisclosed, n = 205). Overall, 55% of patients lived with a husband/partner, 53% were employed, and 88% were receiving antiretroviral therapy. Patients who were with a serodiscordant partner were more likely to disclose (p = 0.0003). China had a disproportionately higher percentage of participants who did not disclose at all (nearly 30% vs. <15% for other regions). Mean BACS severity scores for medical/psychological service barriers and most personal resource barriers were significantly lower for the disclosed group compared with the nondisclosed group (p ≤ 0.02 for all). Compared with the disclosed group, the nondisclosed group reported statistically significantly higher (p ≤ 0.03) BACS item severity scores for 8 of the 12 potential barriers to care. The disclosed group reported better QoL. Overall, HIV nondisclosure was associated with more severe barriers to accessing healthcare by women with HIV.

Prevalence and predictors of facing a legal obligation to disclose HIV serostatus to sexual partners among people living with HIV who inject drugs in a Canadian setting:a cross-sectional analysis

BACKGROUND

In October 2012, the Canadian Supreme Court ruled that people living with HIV must disclose their HIV status before sex that poses a "realistic possibility" of HIV transmission, clarifying that in circumstances where condom-protected penile-vaginal intercourse occurred with a low viral load (< 1500 copies/mL), the realistic possibility of transmission would be negated. We estimated the proportion of people living with HIV who use injection drugs who would face a legal obligation to disclose under these circumstances.

METHODS

: We used cross-sectional survey data from a cohort of people living with HIV who inject drugs. Participants interviewed since October 2012 who self-reported recent penile-vaginal intercourse were included. Participants self-reporting 100% condom use with a viral load consistently < 1500 copies/mL were assumed to have no legal obligation to disclose. Logistic regression identified factors associated with facing a legal obligation to disclose.

RESULTS

We included 176 participants, 44% of whom were women: 94% had a low viral load, and 60% self-reported 100% condom use. If condom use and low viral load were required to negate the realistic possibility of transmission, 44% would face a legal obligation to disclose. Factors associated with facing a legal obligation to disclose were female sex (adjusted odds ratio [OR] 2.19, 95% confidence interval [CI] 1.13-4.24), having 1 recent sexual partner (v. > 1) (adjusted OR 2.68, 95% CI 1.24-5.78) and self-reporting a stable relationship (adjusted OR 2.00, 95% CI 1.03-3.91).

INTERPRETATION

Almost half the participants in our analytic sample would face a legal obligation to disclose to sexual partners under these circumstances (with an increased burden among women), adding further risk of criminalization within this marginalized and vulnerable community.

Effectiveness of interventions promoting HIV serostatus disclosure to sexual partners: a systematic review

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.

Associations among depression, suicidal behavior, and quality of life in patients with human immunodeficiency virus

AIM: To investigate the potential associations among major depression, quality of life, and suicidal behavior in human immunodeficiency virus (HIV) patients.

METHODS: A detailed MEDLINE search was carried out to identify all articles and book chapters in English published from January 1995 to January 2015.

RESULTS: Based on the main findings, the prevalence of major depressive disorder (MDD) ranged from 14.0% to 27.2%. Furthermore, the prevalence of suicidal ideation varied from 13.6% to 31.0% whereas, attempted suicides were reported to range from 3.9% to 32.7%. Interestingly, various associated risk factors for both depression and suicide were identified in HIV patients. Finally, consistent associations were reported among MDD, suicidal ideation, and poor quality of life in individuals living with HIV.

CONCLUSION: Although additional studies are needed to elucidate this complex association, our results suggest the importance of early detection of both MDD and suicidality in patients living with HIV.

Substance-related coping, HIV-related factors, and mental health among an HIV-positive sexual minority community sample

HIV-positive status poses a unique set of social stressors, especially among lesbian, gay, and bisexual (LGB) persons. Among these difficulties are the internalization of HIV-related stigma and poor mental health. Unfortunately, substance use as a coping mechanism is also common, dependent on other demographic factors, among HIV-positive and LGB samples. The present study integrates these bodies of literature by examining main and interactive effects of HIV-related experiences (i.e., disclosure of HIV-positive status, fear of disclosure, HIV-related victimization, and internalized HIV-related stigma) and substance-related coping with discrimination as they impact mental health (i.e., stress, anxiety, depressive symptoms, and suicide and self-injury proneness). Participants were 216 HIV-positive LGB community members from an urban community medical clinic. Prominent results included: (1) robust negative effects of internalized HIV-related stigma on all mental health indicators when controlling for other HIV-related experiences and (2) a significant interaction in which substance-related coping significantly increases suicide proneness, only for those who have disclosed HIV-positive status to family or friends. Results are discussed with respect to theoretical perspectives of internalized stigma, implications for clinical work with LGB persons of HIV-positive status, and future research.

Examining the role of serostatus disclosure on unprotected sex among people living with HIV

Given the increasing prevalence of HIV, it is important to identify factors associated with safer sex behaviors between people living with HIV and their partners. Utilizing a diverse sample of 242 HIV-infected adults [n=69 men who have sex with men (MSM); n=68 men who have sex with women (MSW); n=105 women who have sex with men (WSM)], we examined the association between serostatus disclosure and unprotected anal or vaginal intercourse (UAVI) and the moderating effect of sexual behavior group on this association. Overall, 88.7% disclosed to their current partner. Approximately 18.8% of MSM, 17.7% of MSW, and 29.5% of WSM reported UAVI. Controlling for age, time since diagnosis, and partner serostatus, we found main effects on UAVI for disclosure and sexual behavior group; specifically, disclosure was inversely related to unprotected sex [AOR=0.09, 95% CI (0.02, 0.43), p<0.001], and MSM were less likely to engage in UAVI relative to WSM [AOR=0.11, 95% CI (0.17, 0.82), p<0.05]. However, the relationship between disclosure and UAVI was not moderated by sexual behavior group. Future strategies that aim to increase disclosure to partners may consider focusing on its value as a means by which to reduce sexual risk behavior.

HIV disclosure as practice and public policy

Responses to the largest surveys of HIV-positive people in Ontario show that most either disclose to or do not have partners who are HIV-negative or of unknown status. Non-disclosure strategies and assumptions are reported by relatively small sets of people with some variation according to employment status, sexual orientation, gender, ethnicity, and having had a casual partner. Interviews with 122 people living with HIV show that disclosure is an undertaking fraught with emotional pitfalls complicated by personal histories of having misread cues or having felt deceived leading up to their own sero-conversion, then having to negotiate a stigmatized status with new people. In gay communities, constructions of the self as individual actors in a marketplace of risk co-exist with the sexual etiquette developed throughout the AIDS era of care of the self and other through safer sex. Among heterosexual populations, notions of responsibility show some divergence by gender. The findings of this study suggest that the heightened pressure of criminal sanction on decision-making about disclosure in personal interactions does not address difficulties in HIV transmission and is unlikely to result in enhanced prevention.