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Alzahrani NS, Almarwani AM. The effect of HIV on patients' lives: a phenomenological qualitative study. Int J Qual Stud Health Well-being 2024; 19:2315634. [PMID: 38340013 PMCID: PMC10860465 DOI: 10.1080/17482631.2024.2315634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/04/2024] [Indexed: 02/12/2024] Open
Abstract
INTRODUCTION Human immunodeficiency virus (HIV) infection poses a significant threat to the immune system, compromising the body's ability to combat diseases and infections. The Ministry of Health in Saudi Arabia reported an HIV incidence rate of 3 cases per 10,000 individuals. This study aimed to gain insight into the lived experience of Saudi patients living with HIV. METHODS Employing a qualitative phenomenological approach, this study conducted in-depth interviews with 16 HIV patients (10 men, 6 women) between January 2023 and May 2023. RESULTS Thematic data analysis highlighted three overarching themes and four subthemes. "Fear of the Future" encompassed subthemes including the fear of infecting a family member, fear of marriage, fear of employment recruitment, and fear of scandals. "Hopelessness" reflected the profound emotional state experienced by patients. "Overcoming Adversity" captured the resilience and strength demonstrated by individuals facing the challenges of living with HIV. CONCLUSION Saudi patients diagnosed with HIV encounter numerous obstacles in their daily lives. The fear of the future, including concerns such as infecting family members, marriage prospects, employment opportunities, and potential social repercussions, significantly impacts their overall well-being. By understanding the lived experience of HIV patients in Saudi Arabia, healthcare providers and policymakers can better support and enhance the quality of life for this population.
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Affiliation(s)
- Naif S. Alzahrani
- Department of Medical Surgical Nursing, College of Nursing, Taibah University, Medina, Saudi Arabia
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Miwa T, Wakabayashi C, Hayashi K, Tanuma J, Ikeda K, Yokomaku Y, Ikushima Y. Investigating the Moderating Effect of HIV Status Disclosure on the Link Between Discrimination Experience and Psychological Distress Among People Living with HIV in Japan Infected Through Sexual Contact. Int J Behav Med 2024:10.1007/s12529-024-10304-3. [PMID: 38942978 DOI: 10.1007/s12529-024-10304-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/10/2024] [Indexed: 06/30/2024]
Abstract
BACKGROUND There is a scarcity of research on the potential impact of disclosing HIV status to friends and family in moderating the adverse effects of discrimination on the mental health of people living with HIV (PLWH). This study assessed the experiences of discrimination and HIV status disclosure among PLWH in Japan, and evaluated their potential associations with psychological distress. METHOD Data were derived from a nationwide cross-sectional survey of PLWH conducted in Japan between 2019 and 2020. The interaction effects of HIV-related discrimination and HIV status disclosure on the psychological distress were examined using logistic and linear regression analyses. RESULTS The median age of the 804 respondents was 46 years old. Most respondents were male and 85.4% (687/804) identified as homosexuals or bisexuals. A total of 12.7% (102/804) of the respondents reported that they had recently experienced discrimination because of their HIV status. Experience of HIV-related discrimination was independently associated with high psychological distress (adjusted OR 2.02; 95% CI, 1.15-3.57), and HIV status disclosure to friends partially weakened the association between discrimination and the level of psychological distress (regression coefficient -3.115; p = 0.004). CONCLUSION While measures that aim to end discrimination remain vital, increasing the opportunities of PLWH to communicate with friends they feel comfortable disclosing their HIV status may also be helpful in protecting their mental health.
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Affiliation(s)
- Takeshi Miwa
- Department of Health Sciences, Saitama Prefectural University, 820 Sannomiya, Koshigaya-shi, Saitama, 343-8540, Japan.
- Positive Living and Community Empowerment Tokyo (PLACE TOKYO), 4-11-5-403 Takadanobaba, Shinjuku-ku, Tokyo, 169-0075, Japan.
| | - Chihiro Wakabayashi
- Department of Health Sciences, Saitama Prefectural University, 820 Sannomiya, Koshigaya-shi, Saitama, 343-8540, Japan
| | - Kanna Hayashi
- Faculty of Health Sciences, Simon Fraser University, Blusson Hall, Room 11300, 8888 University Drive, Burnaby, BC, V5A 1S6, Canada
| | - Junko Tanuma
- Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Kazuko Ikeda
- Center Hospital of the National Center for Global Health and Medicine, 1-21-1 Toyama, Shinjuku-ku, Tokyo, 162-8655, Japan
| | - Yoshiyuki Yokomaku
- Department of Infectious Diseases & Immunology, Clinical Research Center, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku, Nagoya, Aichi, 460-0001, Japan
| | - Yuzuru Ikushima
- Positive Living and Community Empowerment Tokyo (PLACE TOKYO), 4-11-5-403 Takadanobaba, Shinjuku-ku, Tokyo, 169-0075, Japan
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Warner M, Gibbs J, Blandford A. Shifting Norms and Value Conflicts: Exploring the Effects of HIV Status Disclosure Fields in Sex-Social Apps. ARCHIVES OF SEXUAL BEHAVIOR 2024; 53:1575-1589. [PMID: 38302851 PMCID: PMC10954906 DOI: 10.1007/s10508-023-02801-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Revised: 12/22/2023] [Accepted: 12/23/2023] [Indexed: 02/03/2024]
Abstract
Sex-social applications used by men who have sex with men (MSM) often provide options to disclose HIV status to encourage more positive language and reduce stigma. Yet, little research has sought to understand how in-app disclosure fields impact on disclosure motivation. We interviewed MSM living with HIV and those who self-reported being HIV-negative ( N = 27 ) in the UK and applied a hierarchical model of motivation to interpret our data. We found conflicting motivations for disclosure and point to HIV status disclosure fields having shifted disclosure norms, limiting their perceived optionality. Moreover, the pairwise and location-aware nature of these apps fails to support narrative forms of disclosure, reducing motivation. We highlight an opportunity to support users in disclosing by linking apps more explicitly to the social narratives developed through public health campaigns. This could reduce the required effort to explain "the science" behind different treatment and prevention options and promote a more consistent narrative.
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Affiliation(s)
- Mark Warner
- Computer Science Department, University College London, 169 Euston Road, London, NW1 2AE, UK.
| | - Jo Gibbs
- Mortimer Market Centre, University College London, London, UK
| | - Ann Blandford
- Computer Science Department, University College London, London, UK
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Masa R, Zimba M, Zimba G, Zulu G, Zulu J, Operario D. The Association of Emotional Support, HIV Stigma, and Home Environment With Disclosure Efficacy and Perceived Disclosure Outcomes in Young People Living With HIV in Zambia: A Cross-Sectional Study. J Assoc Nurses AIDS Care 2024; 35:17-26. [PMID: 37994517 PMCID: PMC10842355 DOI: 10.1097/jnc.0000000000000442] [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: 11/24/2023]
Abstract
ABSTRACT This study examined the association of various forms of social support, attitudes toward living at home, and HIV stigma experiences with HIV self-disclosure efficacy and perceived negative disclosure outcomes. We analyzed cross-sectional data from 120 young people with HIV (YPWH) aged 18-21 years receiving outpatient care in Eastern Province, Zambia. Perceived negative disclosure outcomes and disclosure self-efficacy were measured using an adapted version of the Adolescent HIV Disclosure Cognitions and Affect Scale. Explanatory variables included parental or caregiver support, emotional support, instrumental support, HIV stigma experiences, and attitudes toward living at home. Findings suggest that YPWH's confidence in their ability to self-disclose their HIV status and their assessment of negative outcomes associated with HIV disclosure are influenced by emotional support, experiences of HIV stigma, and the quality of the home environment.
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Affiliation(s)
- Rainier Masa
- Rainier Masa, PhD, is an Associate Professor, School of Social Work University of North Carolina, Chapel Hill, North Carolina, USA. Mathias Zimba, MA, is a Director, Rising Fountains Development Program, Chipata, Zambia. Gilbert Zimba, DipTh, is Project Coordinator, Rising Fountains Development Program, Lundazi, Zambia. Graham Zulu, MSW, is a Research Associate, Global Social Development Innovations, University of North Carolina, Chapel Hill, North Carolina, USA. Joseph Zulu, PhD, is an Associate Professor, School of Public Health, University of Zambia, Lusaka, Zambia. Don Operario, PhD, is a Professor, Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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Harjana NPA, Nita S, Sebayang M, Mukuan OS, Widihastuti AS, Januraga PP. Intimate partner violence and factors influencing HIV status disclosure among women living with HIV in Indonesia: a cross-sectional study. AIDS Care 2023:1-12. [PMID: 38157374 DOI: 10.1080/09540121.2023.2299746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024]
Abstract
The disclosure of HIV status poses challenges, and women living with HIV often face intimate partner violence as a result of revealing their HIV status. This study aims to investigate the prevalence of intimate partner violence and HIV status disclosure among women living with HIV in Indonesia, as well as the factors associated with disclosure. A total of 283 women with HIV participated in an online survey, and descriptive and logistic regression analyses were performed. The findings revealed that women reported experiencing physical (9.54%), sexual (6.01%), mental (23.67%), and economic (14.49%) abuse. HIV status disclosure varied among different individuals, with higher rates observed for partners (71.2%), other family members (65.02%), close friends (37.10%), and lower rates for health workers (1.77%). Factors such as employment status and partner's HIV status influenced disclosure to partners, while the duration of knowing one's HIV status, experiences of intimate partner violence, and perceived barriers influenced disclosure to both family and non-family members. To mitigate the negative consequences of HIV status disclosure, targeted health promotion efforts should prioritize partners, family members, and non-family members, focusing on enhancing knowledge and awareness about HIV, including the impact of violence.
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Affiliation(s)
- Ngakan Putu Anom Harjana
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia
| | - Sally Nita
- Jaringan Indonesia Positif, Jakarta, Indonesia
| | | | | | | | - Pande Putu Januraga
- Department of Public Health and Preventive Medicine, Faculty of Medicine, Udayana University, Denpasar, Indonesia
- Center for Public Health Innovation, Faculty of Medicine, Udayana University, Denpasar, Indonesia
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Smith T, Seeley J, Shahmanesh M, Psaros C, Munikwa C, Ngwenya N. Influences on decision-making about disclosure of HIV status by adolescents and young adults living with HIV in KwaZulu-Natal, South Africa. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:306-315. [PMID: 38117742 DOI: 10.2989/16085906.2023.2277358] [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: 05/01/2023] [Accepted: 10/01/2023] [Indexed: 12/22/2023]
Abstract
Background: Adolescents and young adults living with HIV (AYA) are faced with the challenge of living with a life-long chronic condition. We investigated the influences on the decisions by AYA to disclose their HIV status to family, intimate partners and friends.Methods: Twenty AYA aged between 15 and 24 years were purposely selected through local community-based organisations in eThekwini municipality and uMkhanyakude district in KwaZulu-Natal Province, South Africa. Virtual in-depth interviews were conducted between September 2020 to October 2021 using a topic guide focusing on HIV-status disclosure and the impact of stigma on decision-making capacity. An iterative thematic process was used for analysis.Results: Findings revealed the challenges that AYA experience for disclosure because of stigma and how this impacts their decision-making capacity. Family and friends influenced AYA in processing their discovery of their HIV status offering support needed to manage living with HIV. However, for some AYA disclosing to relatives, friends and intimate partners was difficult because of fears of rejection and recrimination. The act of disclosure was influenced by both internalised and external stigma and the type of relationships and interactions that AYA had with relatives, friends and caregivers.Conclusions: The decision to disclose is challenging for AYA because of the fear of rejection, along with internal and external stigma. The provision of support, whether from family or peers, is important. Enhancing the decision-making capacity of AYA is essential for developing their self-esteem as well as supporting future healthcare choices.
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Affiliation(s)
- Thandeka Smith
- Africa Health Research Institute, Mtubatuba, South Africa
| | - Janet Seeley
- Africa Health Research Institute, Mtubatuba, South Africa
- London School of Hygiene and Tropical Medicine, London, United Kingdom
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
| | - Maryam Shahmanesh
- Africa Health Research Institute, Mtubatuba, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
| | - Christina Psaros
- Department of Psychiatry, Harvard Medical School, Massachusetts General Hospital, Boston, USA
| | | | - Nothando Ngwenya
- Africa Health Research Institute, Mtubatuba, South Africa
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
- Institute for Global Health, University College London, London, United Kingdom
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Dlamini BP, Mtshali NG. "We will tell when we are ready": perinatally HIV-infected adolescents and self-disclosure of their status in Eswatini. AFRICAN JOURNAL OF AIDS RESEARCH : AJAR 2023; 22:201-209. [PMID: 37915268 DOI: 10.2989/16085906.2023.2266406] [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: 04/01/2023] [Accepted: 09/01/2023] [Indexed: 11/03/2023]
Abstract
Access to antiretroviral therapy (ART) has promoted a significant decrease in mortality of vertically HIV-infected children. As a result, there has been an increasing growth of this population that reaches adolescence. These adolescents face problems such as self-disclosure and the stigma of the disease. This study aimed to determine the process followed by perinatally HIV-infected adolescents in self-disclosing their HIV status to significant others and the barriers and promoters of perinatally HIV-infected adolescents' disclosure of their HIV status to others. Data were collected from 15-19-year-old adolescents through 23 in-depth individual interviews and three focus groups. For adolescents, a clear barrier to disclosure was being told when they were younger by a parent to keep their status secret from other people. Lack of trust and fear of breaches of confidentiality which would lead to stigma and discrimination also hindered disclosure. For those adolescents who disclosed, they did so face to face and through short text messages. Adolescents expressed the need to be capacitated to self-disclose and also called for HIV and AIDS education to the general public as a way of fighting stigma and discrimination in their communities and in society. For adolescents to be able to disclose, they have to work through issues of acceptance of their own HIV status first. This study is the first-ever study to document difficulties faced by adolescents in the self-disclosure of their status in Eswatini.
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Affiliation(s)
- Baliwe P Dlamini
- School of Nursing and Public Health, University of KwaZulu-Natal, Durban, South Africa
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Antinori A, Vergori A, Ripamonti D, Valenti D, Esposito V, Carleo MA, Rusconi S, Cascio A, Manzillo E, Andreoni M, Orofino G, Cappuccio A, Reale L, Marini MG, Mancusi D, Termini R, Uglietti A, Portaro M. Investigating coping and stigma in people living with HIV through narrative medicine in the Italian multicentre non-interventional study DIAMANTE. Sci Rep 2023; 13:17624. [PMID: 37848464 PMCID: PMC10582167 DOI: 10.1038/s41598-023-44768-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Accepted: 10/12/2023] [Indexed: 10/19/2023] Open
Abstract
Antiretroviral therapy (ART) significantly reduced Human Immunodeficiency Virus (HIV) morbidity and mortality; nevertheless, stigma still characterises the living with this condition. This study explored patients' coping experience by integrating narrative medicine (NM) in a non-interventional clinical trial. From June 2018 to September 2020 the study involved 18 centres across Italy; enrolled patients were both D/C/F/TAF naïve and previously ART-treated. Narratives were collected at enrolment (V1) and last visit (V4) and then independently analysed by three NM specialist researchers through content analysis. One-hundred and fourteen patients completed both V1 and V4 narratives. Supportive relationships with clinicians and undetectable viral load facilitated coping. Conversely, lack of disclosure of HIV-positive status, HIV metaphors, and unwillingness to narrate the life before the diagnosis indicated internalised stigma. This is the first non-interventional study to include narratives as patient reported outcomes (PROs). Improving HIV awareness and reducing the sense of guilt experienced by patients helps to overcome stigma and foster coping.
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Affiliation(s)
- A Antinori
- HIV/AIDS Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - A Vergori
- HIV/AIDS Unit, National Institute for Infectious Diseases "Lazzaro Spallanzani" IRCCS, Rome, Italy
| | - D Ripamonti
- Infectious Diseases Clinic, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - D Valenti
- Infectious Diseases Clinic, Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - V Esposito
- General Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, Cotugno Hospital, Naples, Italy
| | - M A Carleo
- General Infectious Diseases Unit, Department of Infectious Disease and Infectious Emergencies, Cotugno Hospital, Naples, Italy
| | - S Rusconi
- DIBIC Luigi Sacco, University of Milan, Milan, Italy
- Infectious Diseases Unit, Legnano Hospital ASST Ovest Milanese, Legnano, Italy
| | - A Cascio
- Infectious Diseases Clinic, AOU Policlinico "P.Giaccone", Palermo, Italy
| | - E Manzillo
- Infectious Disease and Infectious Emergencies, Azienda Ospedaliera dei Colli, Naples, Italy
| | - M Andreoni
- Infectious Diseases Clinic, Foundation Policlinico Tor Vergata University Hospital, Rome, Italy
| | - G Orofino
- Amedeo di Savoia Hospital Unit of Infectious Diseases Torino, Turin, Italy
| | | | - L Reale
- Healthcare Area, ISTUD Srl, Milan, Italy
| | - M G Marini
- Healthcare Area, ISTUD Srl, Milan, Italy
| | - D Mancusi
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy
| | - R Termini
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy
| | - A Uglietti
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy
| | - M Portaro
- Medical Affairs Department, Infectious Diseases and Vaccines, Janssen-Cilag SpA, Via Michelangelo Buonarroti, 23, 20093, Cologno Monzese, MI, Italy.
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Moraa H, Njuguna I, Mugo C, Mbwayo A, Nyapara F, Aballa C, Wagner AD, Wamalwa D, John-Stewart G, Inwani I, O'Malley G. "We can tell a good teacher who cares, understands, and can be confidential about it": youth and caregiver experiences with HIV disclosure to schools in Kenya. Front Public Health 2023; 11:1172431. [PMID: 37559743 PMCID: PMC10407401 DOI: 10.3389/fpubh.2023.1172431] [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: 02/23/2023] [Accepted: 07/04/2023] [Indexed: 08/11/2023] Open
Abstract
Introduction Disclosure of one's HIV status to others is often difficult due to the fear of stigma. However, disclosure may facilitate receiving social support. Many youth living with HIV (YLH) are enrolled in school as better treatments have improved the health and survival of children with HIV. There is no structured process for disclosure at school for YLH and their caregivers. We sought to understand school disclosure experiences among YLH and their caregivers and assess the need for the development of a structured disclosure intervention tailored to school settings. Methods We conducted in-depth qualitative interviews with 28 school-going YLH aged 14-19 years and 24 caregivers of YLH. Interviews were conducted in English and Swahili, transcribed, and translated. The transcripts were uploaded to Atlas.ti 9 for thematic analysis. Results YLH and caregivers clearly articulated the benefits of disclosing to school staff. Disclosure to school staff was seen as the first step to receiving support for medication storage, adherence, and clinic attendance. However, disclosure was also perceived to be a very complicated and stressful process. Fear of stigma drove caregivers and YLH toward careful planning of when and to whom to disclose. Distrust of school staff was a significant barrier to disclosure, even among those who clearly articulated the benefits of disclosure. Disclosure to school staff largely resulted in positive experiences; the immediate reactions were positive or somewhat neutral and confidentiality was upheld. The anticipated benefits of practical and emotional support were demonstrated by the school staff to whom the HIV information was disclosed. Conclusion Disclosure of HIV status to someone at school is necessary to receive support for medication adherence. Stigma and the lack of structured support for the disclosure process at school often hinder YLH and their caregivers from disclosing. YLH would benefit from better support at schools, including policies to facilitate disclosure that address the caregiver and YLH's fear of stigma and loss of confidentiality. School policies could also provide guidance on whom to disclose to and available post-disclosure support.
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Affiliation(s)
- Hellen Moraa
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya
| | - Irene Njuguna
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya
- Departments of Global Health, University of Washington, Seattle, WA, United States
| | - Cyrus Mugo
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya
| | - Anne Mbwayo
- Department of Psychiatry, University of Nairobi, Nairobi, Kenya
| | - Florence Nyapara
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya
| | - Calvins Aballa
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya
| | - Anjuli Dawn Wagner
- Departments of Global Health, University of Washington, Seattle, WA, United States
| | - Dalton Wamalwa
- Department of Pediatrics and Child Health University of Nairobi, Nairobi, Kenya
| | - Grace John-Stewart
- Departments of Global Health, University of Washington, Seattle, WA, United States
- Department of Epidemiology, University of Washington, Seattle, WA, United States
- Department of Medicine, University of Washington, Seattle, WA, United States
- Department of Pediatrics, University of Washington, Seattle, WA, United States
| | - Irene Inwani
- Kenyatta National Hospital, Research and Programs, Nairobi, Kenya
| | - Gabrielle O'Malley
- Departments of Global Health, University of Washington, Seattle, WA, United States
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Kavuma D, Kirwana VB, Taani M. Factors Associated with HIV Positive Serostatus Disclosure to Sexual Partners Among Sexually Active Young People on Anti-Retroviral Therapy in Central Uganda. HIV AIDS (Auckl) 2023; 15:293-311. [PMID: 37312814 PMCID: PMC10259591 DOI: 10.2147/hiv.s407535] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 05/28/2023] [Indexed: 06/15/2023] Open
Abstract
Introduction HIV serostatus disclosure is a fundamental HIV prevention and care strategy yet with a paucity of literature. This study comprehended the factors associated with HIV serostatus disclosure to sexual partners among young people aged 15-24 years on anti-retroviral therapy (ART). Methods This explanatory sequential study utilized quantitative data from 238 young people who had been on ART for over 12 months and were sexually active for at least 6 months in seven districts of Central Uganda. Pearson's Chi-square and multinomial logistic regression analysis at α=0.05 was used to determine the factors associated with serostatus disclosure among study participants. Qualitative data from 18 young people were collected using an in-depth interview guide and analyzed thematically. Results Non-disclosure was at 26.9%, one-way disclosure was at 24.4%, and two-way disclosure was at 48.7%. Participants who contracted HIV from their partners were three times more likely (RRR=2.752; 95% CI: 1.100-6.888) to have one-way disclosure than non-disclosure, compared to those who had a perinatal infection. Those who contracted HIV from their partners were twice more likely (RRR=2.357; 95% CI: 1.065-5.214) to have two-way disclosure than non-disclosure, compared to those who had a perinatal infection. Participants who stayed with their partners were four times more likely (RRR=3.869; 95% CI: 1.146-13.060) to have two-way disclosure than non-disclosure, compared to those who stayed with their parents. Young people disclosed because they were tired of secrecy and desired treatment adherence and did not disclose due to fear of stigma and losing their partners' support. Conclusion Many sexually active young people on ART did not disclose their HIV-positive status to sexual partners mainly due to poverty, having multiple-sexual partners, and stigma. Interventions fighting stigma, multiple-sexual relationships, and poverty among sexually active young people on ART should be strengthened.
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Affiliation(s)
- David Kavuma
- Mildmay Institute of Health Sciences, Kampala, Uganda
- School of Graduate Studies, Uganda Martyrs University-Nkozi, Kampala, Uganda
- Makerere University School of Public Health, Kampala, Uganda
| | - Venantius Bbaale Kirwana
- Monitoring, Evaluation and Learning, Sexual Reproductive Health and Rights Alliance, Kampala, Uganda
- Makerere University School of Statistics and Applied Economics, Kampala, Uganda
| | - Mary Taani
- Community Systems Strengthening, Mubende Region, Mildmay Uganda, Kampala, Uganda
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Mugo C, Firdawsi O, Wang J, Njuguna IN, Wamalwa DC, Slyker JA, John-Stewart GC, O'Malley G, Wagner AD. "When they are all grown, I will tell them": Experience and perceptions of parental self-disclosure of HIV status to children in Nairobi, Kenya. BMC Public Health 2023; 23:519. [PMID: 36932351 PMCID: PMC10024367 DOI: 10.1186/s12889-023-15387-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023] Open
Abstract
BACKGROUND There is mixed evidence on the influence of self-disclosure of one's HIV status on mental health, health behaviours and clinical outcomes. We studied the patterns of self-disclosure among parents living with HIV, and factors that influence parental disclosure. METHODS This mixed-methods study was among adults in HIV care participating in a study assessing the uptake of pediatric index-case testing. They completed a survey to provide demographic and HIV-related health information, and assess self-disclosure to partners, children and others. We ran generalized linear models to determine factors associated with disclosure and reported prevalence ratios (PR). Eighteen participants also participated in in-depth interviews to explore perceived barriers and facilitators of self-disclosure to one's child. A content analysis approach was used to analyze interview transcripts. RESULTS Of 493 caregivers, 238 (48%) had a child ≥ 6 years old who could potentially be disclosed to about their parent's HIV status. Of 238 participants, 205 (86%) were female, median age was 35 years, and 132 (55%) were in a stable relationship. Among those in a stable relationship, 96 (73%) knew their partner's HIV status, with 79 (60%) reporting that their partner was living with HIV. Caregivers had known their HIV status for a median 2 years, and the median age of their oldest child was 11 years old. Older caregiver age and older first born child's age were each associated with 10% higher likelihood of having disclosed to a child (PR: 1.10 [1.06-1.13] and PR: 1.10 [1.06-1.15], per year of age, respectively). The child's age or perceived maturity and fear of causing anxiety to the child inhibited disclosure. Child's sexual activity was a motivator for disclosure, as well as the belief that disclosing was the "right thing to do". Caregivers advocated for peer and counseling support to gain insight on appropriate ways to disclose their status. CONCLUSIONS Child's age is a key consideration for parents to disclose their own HIV status to their children. While parents were open to disclosing their HIV status to their children, there is a need to address barriers including anticipated stigma, and fear that disclosure will cause distress to their children.
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Affiliation(s)
- Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, 00202, Kenya.
- Department of Epidemiology, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA.
| | - Olivia Firdawsi
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Jiayu Wang
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Irene N Njuguna
- Department of Research and Programs, Kenyatta National Hospital, Nairobi, 00202, Kenya
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Dalton C Wamalwa
- Department of Medicine, University of Washington, Box 359909, WA, 98104, Seattle, USA
| | - Jennifer A Slyker
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Grace C John-Stewart
- Department of Epidemiology, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
- Department of Medicine, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
- Department of Pediatrics, University of Nairobi, Nairobi, KE, 00202, USA
| | - Gabrielle O'Malley
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Box 359909, 3980 15th Ave. NE, Seattle, WA, 98195, USA
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12
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Beichler H, Kutalek R, Dorner TE. People Living with HIV and AIDS: Experiences towards Antiretroviral Therapy, Paradigm Changes, Coping, Stigma, and Discrimination-A Grounded Theory Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3000. [PMID: 36833695 PMCID: PMC9962544 DOI: 10.3390/ijerph20043000] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/06/2023] [Accepted: 02/06/2023] [Indexed: 06/18/2023]
Abstract
BACKGROUND The experiences in coping with HIV/AIDS from people living with HIV (PLWH) in Austria, Munich, and Berlin regarding adherence, antiretroviral therapy (ART), stigmatization, and discrimination were the main focus of this study. Therapy adherence is the cornerstone for PLWH to reduce disease progression and increase life expectancy combined with a high quality of life. The experience of stigmatization and discrimination in different life situations and settings is still experienced today. AIMS We aimed to examine the subjective perspective of PLWH concerning living with, coping with, and managing HIV/AIDS in daily life. METHODS Grounded Theory Methodology (GTM) was used. Data collection was conducted with semi-structured face-to-face interviews with 25 participants. Data analysis was performed in three steps, open, axial, and selective coding. RESULTS Five categories emerged, which included the following: (1) fast coping with diagnosis, (2) psychosocial burden due to HIV, (3) ART as a necessity, (4) building trust in HIV disclosure, (5) stigmatization and discrimination are still existing. CONCLUSION In conclusion, it can be said that it is not the disease itself that causes the greatest stress, but the process of coping with the diagnosis. Therapy, as well as lifelong adherence, is hardly worth mentioning today. Much more significant is currently still the burden of discrimination and stigmatization.
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Affiliation(s)
- Helmut Beichler
- Nursing School, General Hospital, Medical University Vienna, 1090 Vienna, Austria
| | - Ruth Kutalek
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, 1090 Vienna, Austria
| | - Thomas E. Dorner
- Academy for Ageing Research, Haus der Barmherzigkeit, 1160 Vienna, Austria
- Department of Social and Preventive Medicine, Centre for Public Health, Medical University of Vienna, Kinderspitalgasse 15/1, 1090 Vienna, Austria
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13
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HIV Disclosure Among Sexually Infected People Living with HIV and AIDS in China: Prevalence, Influencing Factors, and Negative Outcomes. AIDS Behav 2022; 27:2411-2429. [PMID: 36580165 DOI: 10.1007/s10461-022-03968-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/16/2022] [Indexed: 12/30/2022]
Abstract
HIV disclosure is crucial for HIV prevention and control, but may also lead to discrimination, insult, and even violence against people living with HIV and AIDS (PLWHAs). In this study, we examined HIV disclosure, its influencing factors, and its association with intimate partner violence (IPV) among 1153 PLWHAs through the sexual route in Jinan, Shandong Province, China. Our results showed that 76.4% (881/1153) PLWHAs had disclosed someone about their HIV infection, the HIV disclosure rates among family members, friends, spouses, and current fixed partners of PLWHAs were 43.5% (501/1153), 47.9% (552/1153), 56.8% (129/227), and 43.2% (336/777), respectively. HIV disclosure was affected by socio-demographics, disease characteristics, and psycho-social factors and varied among family members, close friends, spouses, and current fixed sexual partners. Age ≤ 33 years (aOR 1.79, 95% CI 1.27-2.53), heterosexual infection route (aOR 1.52, 95% CI 1.06-2.17), HIV diagnosis time > 36 months (aOR 1.84, 95% CI 1.30-2.59), with other chronic diseases (aOR 1.87, 95% CI 1.34-2.61), lower self-stigma (aOR 4.03-4.36, 95% CI 1.98-8.74), higher social support (aOR 1.71-1.73, 95% CI 1.03-2.83), no depression (aOR 1.54, 95% CI 1.12-2.11), and no suicidal ideation (aOR 1.79, 95% CI 1.28-2.50) were all independently associated with increased likelihood of HIV disclosure. HIV disclosure was associated with an increased risk of IPV among current fixed sexual partners (aOR 1.87, 95% CI 1.38-2.54) and spouses (aOR 2.54, 95% CI 1.41-4.56). Our findings suggest that the HIV disclosure rate of PLWHAs is still low and is affected by multiple factors. There is an urgent need to design targeted and comprehensive interventions to improve HIV disclosure. IPV prevention should also be incorporated into the intervention system of HIV disclosure to ensure adequate and continuous support for PLWHAs.
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Jia W, Jiao K, Ma J, Liao M, Wang C, Kang D, Lin Y, Yan Y, Li Y, Cheng C, Meng J, Wang L, Yang X, Cao Y, Zhao Z, Wang X, Ma W. HIV infection disclosure, treatment self-efficacy and quality of life in HIV-infected MSM receiving antiretroviral therapy. BMC Infect Dis 2022; 22:937. [PMID: 36514071 PMCID: PMC9749163 DOI: 10.1186/s12879-022-07932-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Accepted: 12/07/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Research on the relationship between disclosure of HIV status to male sexual partners (HIV disclosure) and quality of life (QOL) revealed complex and even contradictory results. The impact of HIV disclosure on various domains of QOL and the mediation effect between them are unclear. The purposes of this study were to explore the impact of HIV disclosure on QOL among men who have sex with men (MSM), and whether HIV treatment self-efficacy mediated these relationships. METHODS The data came from a baseline survey on the design of a randomized control trial conducted in Shandong, China. A total of 579 MSM patients were included. SPSS 24.0 was used to conduct independent samples t test, one-way analysis of variance and nonparametric tests and the PROCESS macro was used to conduct mediation analysis. RESULTS Among 579 participants, 16.06% disclosed their HIV infection status to their male sexual partners. The effect of HIV disclosure on QOL was mediated by treatment self-efficacy. Self-efficacy played partial mediating role in social relationships, meaning that HIV disclosure had both direct and indirect effects on this factor. In the overall QOL and domains of physical, psychological, independence, and environment, HIV disclosure had an indirect effect only through self-efficacy and no significant effect on the spirituality domain. CONCLUSIONS The results emphasize the importance of HIV disclosure and self-efficacy on the QOL of MSM patients and suggest that health care providers should assist MSM patients in deciding whether to disclose their HIV status during daily medical services.
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Affiliation(s)
- Wenwen Jia
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Kedi Jiao
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Jing Ma
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Meizhen Liao
- grid.512751.50000 0004 1791 5397Institution for AIDS/STD Control and Prevention, Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014 Shandong People’s Republic of China
| | - Chunmei Wang
- Shandong Public Health Clinical Center, 12 East Martyrs Mountain Road, Jinan, 250132 Shandong People’s Republic of China
| | - Dianmin Kang
- grid.512751.50000 0004 1791 5397Institution for AIDS/STD Control and Prevention, Shandong Center for Disease Control and Prevention, 16992 Jingshi Road, Jinan, 250014 Shandong People’s Republic of China
| | - Yuxi Lin
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Yu Yan
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Yijun Li
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Chunxiao Cheng
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Jing Meng
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Lina Wang
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Xuan Yang
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Yanwen Cao
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Zhonghui Zhao
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Xinting Wang
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
| | - Wei Ma
- grid.27255.370000 0004 1761 1174Department of Epidemiology, School of Public Health, Cheeloo College of Medicine, Shandong University, 44 West Wenhua Road, Jinan, 250012 Shandong People’s Republic of China
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15
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Peng W, Song X, Zhang C, Chen Y, Zhou Q, Välimäki MA, Li X. The proportion of HIV disclosure to sexual partners among people diagnosed with HIV in China: A systematic review and meta-analysis. Front Public Health 2022; 10:1004869. [PMID: 36324439 PMCID: PMC9620859 DOI: 10.3389/fpubh.2022.1004869] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/30/2022] [Indexed: 01/27/2023] Open
Abstract
Background Sexual behavior is one of the main routes of HIV/AIDS spread. HIV disclosure to sexual partners has been confirmed to be an important strategy for HIV/AIDS prevention and control. We conducted a systematic review and meta-analysis to pool proportions and characteristics of HIV disclosure to sexual partners among people diagnosed with HIV in China. Methods We searched eight databases and extracted the data on HIV disclosure to partners. Heterogeneity of the data was tested with I 2. Published bias subjectively and objectively analyzed through the funnel plot and Egger's regression test. Subgroup analyses were performed to explore the variation in the proportion by sexual partnership types (unclassified, regular, casual sexual partners), whether being men who have sex with men (MSM), and when to diagnose. The sources of heterogeneity were analyzed. Sensitivity analysis was carried out to evaluate the stability of the results. Results Out of 3,698 studies, 44 were included in the review; 11 targeted on MSM. The pooled proportion of HIV disclosure to sexual partners was 65% (95% CI: 56%-75%; 34 studies). Sub-group analyses indicated the proportions of HIV disclosure to regular, casual and unclassified sexual partners were 63% (95% CI: 45%-81%; 31 studies), 20% (95% CI: 8%-33%; nine studies), and 66% (95% CI: 59%-73%; 14 studies), respectively. Fifty-seven percent (95% CI: 45%-69%; three studies) disclosed on the day of diagnosis, 62% (95% CI: 42%-82%; four studies) disclosed within 1 month, and 39% (95% CI: 2%-77%; four studies) disclosed 1 month later. Among MSM, the disclosure to regular male partners, regular female sexual partners, spouses, and casual partner were 47% (95% CI: 29%-65%; six studies), 49% (95% CI: 33%-65%; three studies), 48% (95% CI: 18%-78%; seven studies), and 34% (95% CI: 19%-49%; four studies), respectively. Conclusions The disclosure prevalence of people diagnosed with HIV to sexual partners still need improving in China, and it varies among partner types, key populations, and time being diagnosed. HIV disclosure strategies and procedures need to be developed more detailed and tailored based on the pain points of disclosure status, so as to ultimately prevent HIV transmission through sexual contact. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022291631, identifier: CRD42022291631.
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Affiliation(s)
- Wenwen Peng
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China,Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation (A JBI Affiliated Group), Changsha, Hunan Province, China
| | - Xiaohan Song
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China,Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation (A JBI Affiliated Group), Changsha, Hunan Province, China
| | - Ci Zhang
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China,Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation (A JBI Affiliated Group), Changsha, Hunan Province, China
| | - Yuqing Chen
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China,Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation (A JBI Affiliated Group), Changsha, Hunan Province, China
| | - Qidi Zhou
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China,Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation (A JBI Affiliated Group), Changsha, Hunan Province, China
| | - Maritta Anneli Välimäki
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China,Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation (A JBI Affiliated Group), Changsha, Hunan Province, China,Department of Nursing Science, University of Turku, Turku, Finland,*Correspondence: Xianhong Li
| | - Xianhong Li
- Xiangya School of Nursing, Central South University, Changsha, Hunan Province, China,Xiangya Center for Evidence-Based Nursing Practice & Healthcare Innovation (A JBI Affiliated Group), Changsha, Hunan Province, China,Maritta Anneli Välimäki
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Hightow-Weidman LB, Muessig K, Soberano Z, Rosso MT, Currie A, Adams Larsen M, Knudtson K, Vecchio A. Tough Talks Virtual Simulation HIV Disclosure Intervention for Young Men Who Have Sex With Men: Development and Usability Testing. JMIR Form Res 2022; 6:e38354. [PMID: 36074551 PMCID: PMC9501675 DOI: 10.2196/38354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 07/25/2022] [Accepted: 07/25/2022] [Indexed: 11/13/2022] Open
Abstract
Background
HIV status disclosure is an important decision with barriers specific to young men who have sex with men (YMSM), who have the highest rates of new HIV infections in the United States. Behavioral and social determinants of the difficulty to disclose can include fear of rejection, stigma, loss of financial stability, and lack of communication skills. Once able to disclose, a person may have increased access to social support and improved informed risk reduction conversations and medication adherence. Despite the known challenges and advantages of disclosure, there are few effective tools supporting this behavior.
Objective
To address this gap in disclosure interventions, the Tough Talks (TT) app, an mHealth intervention using artificial intelligence (AI)–facilitated role-playing scenarios, was developed for YMSM. This paper reports stages of development of the integrated app and results of the usability testing.
Methods
Building on the successful development and testing of a stand-alone interactive dialogue feature in phases 1-3, we conducted additional formative research to further refine and enhance the disclosure scenarios and develop and situate them within the context of a comprehensive intervention app to support disclosure. We assessed the new iteration for acceptability and relevance in a usability study with 8 YMSM with HIV. Participants completed a presurvey, app modules, and a semistructured qualitative interview.
Results
TT content and activities were based on social cognitive theory and disclosure process model framework and expanded to a 4-module curriculum. The AI-facilitated scenarios used dialogue from an utterance database developed using language crowdsourced through a comic book contest. In usability testing, YMSM reported high satisfaction with TT, with 98% (31/33) of activities receiving positive ratings. Participants found the AI-facilitated scenarios and activities to be representative and relevant to their lived experiences, although they noted difficulty having nuanced disclosure conversations with the AI.
Conclusions
TT was an engaging and practical intervention for self-disclosure among YMSM with HIV. Facilitating informed disclosure decisions has the potential to impact engagement in sexual risk behaviors and HIV care. More information is needed about the ideal environment, technical assistance, and clinical support for an mHealth disclosure intervention. TT is being tested as a scalable intervention in a multisite randomized controlled trial to address outstanding questions on accessibility and effect on viral suppression.
Trial Registration
ClinicalTrials.gov NCT03414372; https://clinicaltrials.gov/ct2/show/NCT03414372
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Affiliation(s)
- Lisa B Hightow-Weidman
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Kathryn Muessig
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Zach Soberano
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | - Matthew T Rosso
- Institute for Global Health and Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| | | | | | - Kelly Knudtson
- School of Medicine, University of Washington, Seattle, WA, United States
| | - Alyssa Vecchio
- Department of Family & Community Medicine, University of New Mexico, Albuquerque, NM, United States
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17
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Tran NK, Vu BN, Susa J, DeSilva M. Stigma, coping strategies, and their impact on treatment and health outcomes among young men living with HIV in Vietnam: A qualitative study. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0000669. [PMID: 36962527 PMCID: PMC10021752 DOI: 10.1371/journal.pgph.0000669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Accepted: 08/12/2022] [Indexed: 11/19/2022]
Abstract
BACKGROUND Stigma affects persons living with HIV in myriad ways, including mental health, adherence to antiretroviral therapy, and retention in care, and may manifest at inter- and intra-personal levels. Youth are particularly vulnerable; those in vulnerable groups may experience multiple stigmas. In Vietnam, new HIV infections are rising among men in young age groups. To better understand the facets of stigma experienced by young men living with HIV in Vietnam, we conducted a qualitative study with youth and clinicians. METHODS We conducted in-depth interviews with ten youth and two clinicians in Hanoi, querying experiences of inter- and intra-personal stigma, coping strategies, and disclosure. As a framework for further research, we developed a conceptual model based on our findings and the published evidence base which portrays interactions among HIV-related stigma, coping strategies, and ART adherence, care engagement, and health outcomes. RESULTS Common themes that emerged from interviews with youth included extensive internalized/self-stigma and perceived stigma, yet limited experienced interpersonal stigma due to non-disclosure and avoidant coping strategies. Within different types of relationships or contexts, youth used different strategies. Non-disclosure with family, friends, and workplaces/school, and avoidance of romantic relationships and health care were common. Mental health and social support appeared to be mediating factors between coping strategies and health outcomes. CONCLUSIONS Validation of this model of mechanisms of the impact of stigma for youth will require further research with larger samples. In the meantime, public campaigns to increase public awareness related to HIV should be implemented in Vietnam. Critical support for youth and their mental health should involve approaches tailored to the individual, taking into account context and personal capacity, including adequate time to prepare psychologically for disclosure. Some strategies for safe and effective disclosure are suggested.
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Affiliation(s)
- Nhu Kieu Tran
- Institute for Social Development Studies, Hanoi, Vietnam
| | - Bach Ngoc Vu
- Institute for Social Development Studies, Hanoi, Vietnam
| | - Jordan Susa
- Center for Excellence in Public Health, University of New England, Portland, Maine, United States of America
| | - Mary DeSilva
- Center for Excellence in Public Health, University of New England, Portland, Maine, United States of America
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18
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Disclosure processes as predictors of relationship outcomes among people in recovery from opioid use disorder: A longitudinal analysis. Drug Alcohol Depend 2021; 228:109093. [PMID: 34601276 DOI: 10.1016/j.drugalcdep.2021.109093] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/15/2021] [Accepted: 09/15/2021] [Indexed: 11/20/2022]
Abstract
BACKGROUND Personal disclosure of opioid use disorder (OUD) recovery can lead to relationship outcomes such as social support, which is associated with greater treatment retention, or stigma, which is associated with risk of treatment dropout. Although disclosure may have important impacts on the relationships and ensuing recovery trajectories of people with OUD, disclosure processes remain understudied in the context of OUD. METHODS Guided by the Disclosure Process Model, this longitudinal study explored the disclosure goals of people in treatment for OUD and examined associations between disclosure goals and relationship outcomes. Data were collected at baseline (N = 146) and three months later (n = 124) from participants who were in treatment for OUD and planning to disclose their OUD history and/or treatment to someone new. RESULTS Qualitative baseline data were analyzed to identify disclosure goals. Approach goals (i.e., reasons for disclosure) included support, honesty, amends, set an example, and logistics; avoidance goals (i.e., reasons against disclosure) included judgment, worry, and privacy. Quantitative data suggested that approach goals at baseline were associated with greater likelihood of disclosure within three months (OR=2.16, 95% CI=1.04-4.49) as well as with greater social support [B(SE)= 0.35(0.16), p = 0.03] and relationship closeness [B(SE)= 0.29(0.17), p = 0.01] following disclosures. In contrast, avoidance goals at baseline were associated with greater enacted stigma following disclosures [B(SE)= 0.30(0.14), p = 0.04]. CONCLUSIONS Findings draw attention to the potentially important role of disclosures in relationship outcomes among people in recovery from OUD. Disclosure may represent a promising intervention target to improve relationship outcomes and recovery trajectories of people in recovery from OUD.
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Reis RK, Sousa LRM, Melo ES, Fernandes NM, Sorensen W, Gir E. Predictors of HIV Status Disclosure to Sexual Partners Among People Living with HIV in Brazil. AIDS Behav 2021; 25:3538-3546. [PMID: 34173896 DOI: 10.1007/s10461-021-03362-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2021] [Indexed: 11/26/2022]
Abstract
The objective of this study was to identify the factors associated with the non-disclosure of HIV seropositivity among people living with HIV/AIDS undergoing antiretroviral treatment. A cross-sectional study was carried out in five HIV clinics in the interior of the state of São Paulo, Brazil. Logistic regression analysis was used to determine independent predictors of HIV status disclosure. It was found that 68.5% revealed their HIV seropositivity to their most recent sexual partner. The variables "casual partner" [OR 19.08, 95% CI (4.08, 20.23), p = 0.001], "sexual partners with negative HIV or unknown HIV" [OR 4.54, 95% CI (1.58, 1.01), p = 0.005], "multiple sexual partners" [OR = 3.17, 95% CI (1.34, 7.35), p = 0.009], and "lack of communication with the partner on HIV prevention"[OR = 8.3, 95% CI (3.88, 16.61), p = 0.001] were independently associated with non-disclosure of the diagnosis. Future HIV prevention interventions should encourage open communication between sexual partners.
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Affiliation(s)
- Renata Karina Reis
- Department of General and Specialized Nursing, WHO Collaborating Centre for Nursing Research Development, University of São Paulo At Ribeirão Preto College of Nursing, Avenida: Bandeirantes, 3900 Campus Universitário - Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil.
| | - Laelson Rochelle Milanês Sousa
- Department of General and Specialized Nursing, WHO Collaborating Centre for Nursing Research Development, University of São Paulo At Ribeirão Preto College of Nursing, Avenida: Bandeirantes, 3900 Campus Universitário - Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | - Elizabete Santos Melo
- Department of General and Specialized Nursing, WHO Collaborating Centre for Nursing Research Development, University of São Paulo At Ribeirão Preto College of Nursing, Avenida: Bandeirantes, 3900 Campus Universitário - Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil
| | | | - William Sorensen
- Department of Health and Kinesiology, University of Texas, Tyler, TX, USA
| | - Elucir Gir
- Department of General and Specialized Nursing, WHO Collaborating Centre for Nursing Research Development, University of São Paulo At Ribeirão Preto College of Nursing, Avenida: Bandeirantes, 3900 Campus Universitário - Bairro Monte Alegre, Ribeirão Preto, São Paulo, Brazil
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20
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Kang E, Mellins CA, Kim W, Dolezal C, Kindler C, Leu CS, Abrams EJ. Navigating Stigma Trajectory and Mental Health Among Young Adults Living with Perinatal HIV in New York City. AIDS Behav 2021; 25:3712-3720. [PMID: 33523346 DOI: 10.1007/s10461-021-03166-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/16/2021] [Indexed: 12/26/2022]
Abstract
Perceived HIV stigma and mental health are fluid across the lifespan for people living with perinatally-acquired HIV (PHIV). The process of navigating discredited identities over time in the context of other life demands potentially exerts a toll on the mental health of adolescents and young adults living with PHIV (AYAPHIV). Based on data from a longitudinal study in New York City examining mental health and health risk behaviors among 182 AYAPHIV, we examined if increased perceived HIV stigma predicted mental health, future orientation, HIV-disclosure, and healthcare transition over time (2003-2018). Findings from linear mixed-effects modeling indicated that older age predicted poorer mental health, less future orientation, more HIV-serostatus disclosure, and adult medical services utilization. Perceived stigma was the only significant predictor of mental health and mediated the association between age and mental health-highlighting the importance of addressing stigma across development for AYAPHIV while addressing systems that perpetuate them.
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Affiliation(s)
- Ezer Kang
- Department of Psychology, Howard University, 2041 Georgia Ave, Northwest, Washington, DC, 20059, USA.
| | - Claude A Mellins
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Woojae Kim
- Department of Psychology, Howard University, 2041 Georgia Ave, Northwest, Washington, DC, 20059, USA
| | - Curtis Dolezal
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Christine Kindler
- Department of Psychology, Howard University, 2041 Georgia Ave, Northwest, Washington, DC, 20059, USA
| | - Cheng-Shiun Leu
- HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, USA
| | - Elaine J Abrams
- ICAP at Columbia, Mailman School of Public Health, Columbia University, New York, USA
- College of Physicians & Surgeon, Columbia University, New York, USA
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21
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Mugo C, Seeh D, Guthrie B, Moreno M, Kumar M, John-Stewart G, Inwani I, Ronen K. Association of experienced and internalized stigma with self-disclosure of HIV status by youth living with HIV. AIDS Behav 2021; 25:2084-2093. [PMID: 33389374 PMCID: PMC8768004 DOI: 10.1007/s10461-020-03137-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/12/2020] [Indexed: 01/07/2023]
Abstract
We examined patterns of disclosure among youth living with HIV (YLHIV) in Kenya, and the association between self-disclosure and antiretroviral therapy adherence, stigma, depression, resilience, and social support. Of 96 YLHIV, 78% were female, 33% were ages 14-18, and 40% acquired HIV perinatally. Sixty-three (66%) YLHIV had self-disclosed their HIV status; 67% to family and 43% to non-family members. Older YLHIV were 75% more likely to have self-disclosed than those 14-18 years. Of the 68 either married or ever sexually active, 45 (66%) did not disclose to their partners. Those who had self-disclosed were more likely to report internalized stigma (50% vs. 21%, prevalence ratio [PR] 2.3, 1.1-4.6), experienced stigma (26% vs. 3%, PR 11.0, 1.4-86), and elevated depressive symptoms (57% vs. 30%, PR 1.8, 1.0-3.1). The association with stigma was stronger with self-disclosure to family than non-family. Support should be provided to YLHIV during self-disclosure to mitigate psychosocial harms.
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Affiliation(s)
- Cyrus Mugo
- Department of Research and Programs, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya.
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA.
| | - David Seeh
- Department of Research and Programs, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
| | - Brandon Guthrie
- Department of Global Health, University of Washington, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA
| | - Megan Moreno
- School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA
| | - Manasi Kumar
- Department of Psychiatry, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya
| | - Grace John-Stewart
- Department of Global Health, University of Washington, Seattle, WA, 98104, USA
- Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA
- Department of Pediatrics, University of Washington, Seattle, WA, 98104, USA
- Department of Medicine, University of Washington, Seattle, WA, 98104, USA
| | - Irene Inwani
- Department of Pediatrics, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya
| | - Keshet Ronen
- Department of Global Health, University of Washington, Seattle, WA, 98104, USA
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22
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Schatz E, David I, Angotti N, Gómez-Olivé FX, Mojola SA. From "Secret" to "Sensitive Issue": Shifting Ideas About HIV Disclosure Among Middle-Aged and Older Rural South Africans in the Era of Antiretroviral Treatment. J Aging Health 2021; 34:14-24. [PMID: 34027688 DOI: 10.1177/08982643211020202] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE As HIV shifts from "death sentence" to "chronic condition," disclosure of HIV status to intimate partners and family is a significant component of both prevention and treatment adherence. While disclosure is closely considered in many studies, few examine middle-aged and older persons' (age 40+) perspectives or practices. We trace older rural South Africans' views on HIV disclosure to their partners and family members in a high prevalence community over a period of extensive antiretroviral treatment (ART) rollout. METHODS Community focus group discussions (FGD) conducted in 2013 and 2018 show shifts in older persons' thinking about HIV disclosure. FINDINGS Our FGD participants saw fewer negative consequences of disclosure in 2018 than in 2013, and highlighted positive outcomes including building trust (partners) as well as greater support for medication collection and adherence (family). DISCUSSION Particularly as the epidemic ages in South Africa and globally, tracing changes in older persons' views on disclosure is an important step in developing messaging that could enhance treatment as prevention and ART adherence.
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Affiliation(s)
- Enid Schatz
- University of Missouri14716, Columbia, MO, USA.,37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Nicole Angotti
- 37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,8363American University, Washington, DC, USA
| | - F Xavier Gómez-Olivé
- 37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sanyu A Mojola
- 37708MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.,6740Princeton University, Princeton, NJ, USA
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23
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Simmons JV, Carcioppolo N, Peng W, Huang Q, Seelig M, Katz R, Potter J. 90 DAYS: An investigation of a short entertainment-education film to improve HIV status disclosure among black women living with HIV in Miami-Dade County. Soc Sci Med 2021; 270:113683. [PMID: 33465596 DOI: 10.1016/j.socscimed.2021.113683] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Revised: 12/08/2020] [Accepted: 01/03/2021] [Indexed: 11/28/2022]
Abstract
Within Miami-Dade County, Black women experience disproportionate rates of HIV incidence and prevalence. Status disclosure to sexual partners is central to mitigating the HIV epidemic and ensuring a healthier lifestyle for those living with the virus. The disclosure processes model (DPM) posits that barriers such as stigma and negative outcome expectations often facilitate disclosure avoidance. Therefore, this study investigated the utility and acceptability of an entertainment-education (EE) short film, 90 DAYS, for disclosure among Black women living with HIV in Miami-Dade County. Employing photo-elicitation (Harper, 2002), focus groups were conducted with 48 participants. After screening the 90 DAYS film about stigma and disclosure, participants were asked semi-structured questions based upon extant EE and DPM literature. Via inductive and deductive processes, five themes were derived from the data. Participants found the 90 DAYS film to be an empowering counter-narrative that could be used to overcome multiple disclosure-related factors. They felt it provided a social script for how to disclose to their sexual partners. A novel finding of this investigation was that respondents asserted the film could facilitate safer disclosure events. Additional themes included the film being a resource of hope for young and newly diagnosed women; and an educational tool for the community. Altogether, findings lend promise to the use of EE for addressing disclosure avoidance among Black women living with HIV.
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Affiliation(s)
- Jazmyne V Simmons
- Division of Health Science, Florida A&M University, Tallahassee, FL, USA.
| | - Nick Carcioppolo
- Dept of Communication Studies, University of Miami, Coral Gables, FL, USA
| | - Wei Peng
- Murrow College of Communication, Washington State University, Pullman, WA, USA
| | - Qian Huang
- Dept of Communication Studies, University of Miami, Coral Gables, FL, USA
| | - Michelle Seelig
- Dept of Cinema and Interactive Media, University of Miami, Coral Gables, FL, USA
| | - Rachel Katz
- Dept of Communication Studies, University of Miami, Coral Gables, FL, USA
| | - JoNell Potter
- Dept of Obstetrics and Gynecology, University of Miami, Miami, FL, USA
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24
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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: 6] [Impact Index Per Article: 1.5] [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.
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