Sexual behaviour, condom use, and disclosure of HIV status in HIV infected heterosexual individuals attending an inner London HIV clinic

HIV serostatus disclosure to sexual partner: a survey among women in Tehran, Iran

BACKGROUND

Disclosure of HIV-positive status in women is associated with many factors. Consequently, status disclosure remains a challenge for Iranian women living with HIV. This study aimed to assess the prevalence, related factors, and reflections of HIV-positive status disclosure to a sexual partner(s) among Iranian women living with HIV.

METHODS

A cross-sectional study was conducted on 170 HIV-seropositive women. Participants were selected from patients registered in the largest HIV clinic and HIV-positive club of Iran. The "HIV disclosure" questionnaire had 38-items and all the interviews were administered by the researcher. Data were analyzed using SPSS version 21.0 software. We used a logistic regression method to calculate the crude odds ratio (COR) and the adjusted odds ratio (AOR) for self-disclosure as the independent predictor variable and the dependent variable, respectively.

RESULTS

One hundred and seventy HIV-positive women were enrolled. Most of them had disclosed their HIV status to at least one person (94.1%) and their sexual partners (86.5%). In the univariate analysis, being married (COR = 18.66, 95% CI 5.63-61.87), living with a sexual partner (COR = 4.72, 95% CI 1.92-11.62), being aware of sexual partners' HIV status (COR = 6.20, 95% CI 1.79-21.49), and gaining the support of sexual partner (COR = 9.08, 95% CI 3.48-23.64) were associated with higher odds of HIV status disclosure. In the multivariate analysis, being aware of sexual partners' HIV status, and gaining the support of sexual partners remained associated with HIV status disclosure. Most women reported a positive reflection from their sexual partners after disclosure, however, negative reflections from society were more common compared to sexual partners and family members.

CONCLUSION

This study shows high overall HIV disclosure proportions. It should be noted that a large number of women were infected by their sexual partners, especially by their spouses. The high rate of transmission in married people indicates an urgent need for more emphasis on appropriate prevention behaviors by infected partners.

The Magnitude and Associated Factors of Consistent Condom Utilization Among ART Users in Hawassa City, Sidama, Ethiopia

BACKGROUND

Antiretroviral therapy (ART) introduction has sharply decreased mortality and morbidity rates among HIV-infected patients and resulted in longer and healthier lives among people living with HIV. Hence, the aim of this study is to determine the level of consistent condom use and associated factors among ART users in Hawassa City.

METHODS

Cross-sectional study design triangulated with qualitative phenomenology was used. One hospital and one health center were selected by simple random sampling and proportional to size allocation was used to assign participants to each health facility. Accordingly, 358 study subjects were selected. Adjusted odds ratio (AOR) with 95% confidence interval was used to implicate significant factors. Thematic content analysis was used and narrative report writing with a quote was used to present qualitative data.

RESULTS

The prevalence of consistent condom utilization in this study was 51.4%. Sex (AOR= 4.20, 95% CI: 2.386, 7.41), residence (AOR=3.55, 95% CI: 1.81, 6.99) educational status (AOR=0.4, 95% CI: 0.196, 0.946), perception on ART's does not reduction of HIV transmission (AOR=1.96, 95% CI: 1.12, 3.43), rate of counseling (AOR=0.37, 95% CI: 0.17, 0.84) and use condom to prevent pregnancy (AOR=4.53, 95% CI: 2.11, 9.73) were found to be independent predictors of consistent condom utilization among ART users. Refusal by husbands, decrement in satisfaction, gender difference with more women than men willing to use consistently and religious reasons were factors associated with inconsistent condom utilization in the qualitative study.

CONCLUSION AND RECOMMENDATION

Consistent condom utilization among ART users was low. Sex, residence, educational status, perception towards ART were significantly associated with consistent condom utilization. Moreover, husband refusal, religious reason, decrement in satisfaction on the qualitative study were associated with non-consistent use of a condom. The importance of consistent condom use should be well addressed in HIV/AIDS patients, to prevent transmission and multiple infections of HIV.

HIV Testing Behaviors among Black Rural Women: The Moderating Role of Conspiracy Beliefs and Partner Status Disclosure

Objective

This study investigated whether HIV testing attitudes, HIV conspiracy beliefs, and reported sexual partner disclosure of HIV/STI status related to one-month self-report HIV testing outcomes following a brief intervention among Black women aged 18-25 years residing in rural Mississippi.

Participants

Black women (N=119; M age=19.90, SD=1.81) recruited in rural Mississippi completed an online assessment before a brief HIV prevention intervention and a one month follow-up assessment during January to November 2016.

Main Outcome Measures

Self-reported HIV testing 30-days following the intervention, partner HIV/STI status disclosure, beliefs in HIV conspiracy theory, and HIV testing attitudes in pre- and post-intervention assessments. Bivariate and multivariate analyses tested associations with HIV testing behaviors following the intervention.

Results

Moderated moderation was used to examine whether HIV conspiracy beliefs and partner disclosure status both moderated the relationship between pre-intervention attitudes toward HIV testing and HIV testing at 1-month follow-up. It was found that both HIV conspiracy beliefs and partner disclosure moderated the relationship between attitudes and HIV testing at one-month follow-up. When partner disclosure was low, women with more negative attitudes toward testing and higher conspiracy beliefs were less likely to get tested than those with negative attitudes and lower conspiracy beliefs; conspiracy beliefs did not relate to testing outcomes when testing attitudes were positive.

Conclusion

Findings suggest that interventions may benefit from accounting for conspiracy beliefs and the dyadic status disclosure when encouraging young rural women to test for HIV.

Sero-positive HIV result disclosure to sexual partner in Ethiopia: a systematic review and meta-analysis

Background

The infection of HIV continues to be an important public health problem in Ethiopia. Disclosing own HIV positive result is crucial, and considered as a good indicator of behavior change towards HIV/AIDs. A systematic review and meta-analysis was conducted to pool the prevalence of positive HIV status disclosure to sexual partners and determine the influence of selected factors.

Methods

This systematic review and meta-analysis was conducted in Ethiopia among HIV positive people receiving health care at health facilities. In this review, primary studies were searched in Medline via PubMed, Google scholar and Google up to November, 2018. Data on disclosure of HIV positive result, knowledge of partner’s HIV status and prior discussion on HIV were extracted, and effect sizes like proportion and odds ratios were pooled. Heterogeneity and publication bias were assessed by chi-square and I2, and Egger test, respectively.

Results

A total of 12 studies with 4528 participants were included in to this review to estimate the prevalence of disclosure of HIV positive result to sexual partner, and 10 and 7 studies were included to determine the associations of the outcome variable with knowledge of sexual partner’s HIV status and with prior discussion on HIV, respectively. The pooled prevalence of HIV status disclosure to sexual partner was 73% (95% CI: 64, 82%). Having the knowledge of sexual partner’s HIV status [OR: 95%CI; 17.63 (7.88, 39.45)], and previous discussion on HIV [OR: 95% CI; 9.24 (5.56, 15.37)] increased the disclosure of own HIV positive result to sexual partner. The sub-group analysis indicated a prevalence of 74% in Oromia, 86% in Southern Nations Nationalities and Peoples (SNNPR), 87% in Amhara, 73% in Addis Ababa, and 54% in Tigray.

Conclusions

Disclosure of HIV status to sexual partner is lower than expected. Knowledge of partner’s HIV status and previous discussion on HIV were strong predictors of HIV positive status disclosure. Strategies helpful for encouraging open HIV discussion need to be strengthened to increase HIV positive result disclosure. Furthermore, since the heterogeneity of studies is high, large nationally representative study is suggested.

Underreported injection drug use and its potential contribution to reported increase in sexual transmission of HIV in Kazakhstan and Kyrgyzstan

Background

We conducted a cross-sectional integrated bio-behavioral survey among sex partners of persons who inject drugs (PWID) to explore reasons for reported increase in reporting of heterosexually transmitted HIV in Kazakhstan and Kyrgyzstan.

Methods

Sexual partners of PWID were recruited through PWID. Behavioral data were collected through semi-structured interviews. Dried blood spots were obtained and tested for HIV and hepatitis C virus antibodies (HCVAb). Descriptive univariate and bivariate analyses, and multivariate analyses using logistic regression modeling were performed to identify factors associated with HIV and HCV infections.

Results

Among 1982 sex partners of PWID, overall HIV prevalence was 6.4%; 5.1% and 12.9% among those reported never and ever injecting drugs, respectively (p < 0.001). Overall, HCVAb prevalence was 21.3%; 15.0% and 53.9% among those reported never and ever injecting drugs, respectively (p < 0.001). Of HCV-positive participants, 58% and 34% (p < 0.001) reported prior history of injecting drug use among men and women, respectively. HIV prevalence was lower among HCV-negative (4.2%) compared to HCV-positive participants (14.4%) (p < 0.001). HIV prevalence was 3.5% (95%CI = 2.4–4.6) in a subset of female participants with no reported prior injecting drug use history and who were HCVAb-negative and did not report having an HIV-positive sex partner. Participant sex and number of sex partners as well as use of condoms in the past 12 months were not associated with HIV seropositivity.

Conclusions

High prevalence of HCV among sex partners of PWID who denied ever injecting drugs suggests underreporting of injecting practices. The increased attribution of HIV infection to sexual transmission based on self-report may be partly explained by underreporting of injection drug use due to stigmatization of this behavior.

Using communication privacy management theory to examine HIV disclosure to sexual partners/spouses among PLHIV in Guangxi

The current study employed Communication Privacy Management (CPM) theory to examine the factors associated with disclosure of HIV infection to sexual partners or spouses as well as gender differences in these associations among a sample of people living with HIV (PLHIV) in China. A total of 1254 PLHIV who had 5–16 years old children were invited to answer the questions related to disclosure of HIV infection to sexual partners/spouses. Prevalence of HIV disclosure was reported. Key variables related to CPM theory (such as motivations for disclosure and nondisclosure, HIV-related stigma, and relational factors) were compared between females and males. Logistic regression was employed to determine the factors of influencing whether or not the participants disclosed their HIV status to spouses/partners for the male, the female and the combined samples. Fear of rejection was a significant predictor of HIV nondisclosure for the male, the female and the combined samples. Concern about privacy was a significant factor in not disclosing to sexual partners/spouses only in the male sample. The endorsement of duty to inform/educate was the only motivation factor that was significantly related to HIV disclosure for the three samples. The motivation to establish a close/supportive relationship with intimate partners/spouses was found to be associated with HIV disclosure for the combined and male samples. The current study confirmed the utilities of CPM in studying HIV disclosure to sexual partners/spouse. The findings have theoretical and practical implications for HIV disclosure interventions among PLHIV in Guangxi.

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.

Factors Responsible for Disclosure of HIV Seropositivity among Residents of Cross River State, Nigeria

Context:

Disclosure of HIV-positive status to sex partners is viewed as a preventive measure and as a social and legal responsibility for HIV-infected individuals.

Aims:

The aim of this study is to determine the proportions and factors responsible for disclosure of HIV seropositivity among residents of Cross River State, Nigeria.

Settings and Design:

This was a cross-sectional comparative study.

Subjects and Methods:

It involved 320 HIV-positive individuals equally selected from the urban and rural settings of Cross River State and use questionnaires.

Statistical Analysis Used:

Data analysis used SPSS version 20.0. Chi-square test and logistic regression were used to identify determinants of HIV status disclosure.

Results:

Among urban respondents, 93.8% had disclosed compared with 79.4% among rural respondents, the difference was statistically significant (P < 0.001). There was a statistically significant association between HIV status disclosure and age (P = 0.008), marital status (P = 0.027), number of nonspousal sexual partner (P = 0.006), and area of residence (P < 0.001). There was no statistically significant association between HIV status disclosure and gender (P = 0.622), between occupation (P = 0.495) or income (P = 0.351 and head of household (P = 0.241). There was statistically significant association between HIV status disclosure and level of education (P = 0.015), house ownership (P = 0.008), time from diagnosis (P = 0.003), and duration of treatment (P = 0.002).

Conclusions:

This study has shown that HIV seropositive status disclosure was higher when compared with other local studies, and age, marital status, and area of residence were factors associated with HIV seropositive status disclosure.

Consistent condom use in HIV/AIDS patients receiving antiretroviral therapy in northwestern Ethiopia: implication to reduce transmission and multiple infections

Background

Human immunodeficiency virus (HIV)/acquired immune deficiency syndrome (AIDS) is one of the greatest public health problems of sub-Saharan African countries. Consistent condom use, among others, remains the most effective barrier method against HIV transmission. However, existing reports on frequency of consistent condom use have targeted the general public, rather than HIV/AIDS patients due, to the assumption that condom use is not important in HIV-infected persons. Since consistent condom use among HIV/AIDS patients is vital, to prevent the virus transmission from the infected to noninfected as well as to prevent multiple infections among already infected persons, its frequency and determining factors need to be investigated.

Methods

A cross-sectional study was conducted from April 2013 to May 2013 among 317 randomly selected patients who were currently taking antiretroviral therapy (ART). Logistic regressions were performed to examine predictors of consistent condom use.

Results

A total of 317 HIV/AIDS patients who were currently receiving ART participated in the study, and the mean age of the study population was 31.4 (standard deviation [SD] 10.5) years. Overall, 250 (78.9%) participants reported consistent condom use in the past 6 months. Of these, 140 (88.6%) were males and 110 (69.1%) females. Multivariate analysis indicated that respondents with an advanced level of education were more likely to report regular use of condoms (odds ratio [OR] 8.98; 95% confidence interval [CI] 5.06–14.45) compared with illiterate participants. Being male (OR 6.87; 95% CI 3.84–11.22), living in or around a town (OR 4.65; 95% CI 3.09–9.11), and taking ART for longer time (OR 3.91; 95% CI 2.07–6.25) were also positively associated with consistent condom use.

Conclusion

Females, patients living in rural areas, uneducated groups, and new ART users were less likely to use condoms consistently. The importance of consistent condom use should be well-addressed in HIV/AIDS patients, to prevent transmission and multiple infections of HIV.

A scoping review and thematic analysis of social and behavioural research among HIV-serodiscordant couples in high-income settings

BACKGROUND

While HIV incidence has stabilized in many settings, increases in health and wellbeing among many people living with HIV/AIDS suggest that the number of HIV-serodiscordant relationships is growing. Given the deficit of reviews addressing social and behavioural characteristics of HIV-serodiscordant couples within high-income settings, our objective was to understand the scope of the published literature, identify evidence gaps, and suggest future research needs.

METHODS

Ten electronic databases were searched. Studies were included if they were reported in English, used primary data, were from the combination antiretroviral (cART) era (>1996), reported on social or behavioural aspects, included any fraction of primary (i.e., stable) relationships, and were conducted in high-income settings. Studies that identified their unit of analysis as either the dyad or individual member of the couple were included. Studies were coded according to a thematic framework.

RESULTS

Included studies (n = 154) clustered into eight themes: risk behaviours (29%), risk management (26%), reproductive issues (12%), relationship quality (9%), serostatus disclosure (7%), adherence to antiretroviral therapy (7%), vulnerability (5%), and social support (3%). The proportion of studies conducted among heterosexual couples, same-sex male couples, and mixed cohorts were 42%, 34%, and 24%, respectively. Most studies (70%) were conducted in the United States, 70% of all studies were quantitative (including interventions), but only one-third were focused on couples (dyads) where both partners are recruited to a study. Over 25% of studies focused on sexual risk among same-sex male couples.

CONCLUSIONS

Future research efforts should focus on the interrelationship of risk management strategies and relationship quality, social determinants of health and wellbeing, HIV testing, vulnerable populations, reproductive issues among same-sex couples, disclosure of serodiscordant status to social networks, dyadic studies, population-based studies, and interventions to support risk management within couples. Additional population-based studies and studies among marginalized groups would be helpful for targeting research and interventions to couples that are most in need. As HIV-positive partners are typically the link to services and research, innovative ways are needed for reaching out to HIV-negative partners. Our review suggests that significantly more research is needed to understand the social and behavioural contexts of HIV-serodiscordant relationships.

The impact of HIV treatment-related stigma on uptake of antiretroviral therapy

HIV-related stigma has been linked to avoidance of health care services and suboptimal adherence to antiretroviral therapy (ART). However, less is known about concerns of stigma related specifically to the taking of ART in uptake of treatment. This study examines experiences of HIV treatment-related stigma and assesses if these experiences are associated with ART uptake, independent of general HIV-related stigma. People living with HIV (PLHIV; n = 697) were targeted to complete an online questionnaire measuring perceived HIV- and treatment-related stigma, social support, self-esteem, resilience, psychological distress, health satisfaction and quality of life. Findings suggest that experiences of general and treatment-related stigma were common, and that participants appear to experience greater stigma related to taking HIV treatment than general stigma associated with HIV. Neither general nor treatment-related stigma uniquely impacted HIV treatment uptake. Instead, treatment uptake was associated with being older (adjusted OR 1.05; 95% CIs: 1.03, 1.08), greater duration of HIV infection (adjusted OR 1.07; 95% CIs: 1.03-1.11) and having greater health satisfaction (adjusted OR 1.28; 95% CIs: 1.03, 1.59). Findings highlight that concerns around taking HIV treatment can be an added source of stigma for PLHIV, however other factors may be greater contributors to the likelihood of taking HIV treatment.

HIV disclosure to sexual partner and associated factors among women attending ART clinic at Mekelle hospital, Northern Ethiopia

Background

Disclosure of HIV positive status has two sets of contrary effects. It may motivate partner for Voluntary Counseling and Testing; on the other hand, it may cause blame, discrimination, depression and loss of economic support. Consequently, HIV positive status disclosure among women has become one of the major concerns that should be addressed in HIV prevention and control activities. This study aimed at assessing the magnitude and factors related to HIV positive status disclosure to sexual partners among HIV positive women.

Methods

A cross sectional study was conducted in Mekelle hospital from July 10–26, 2013 to collect data from 315 HIV positive women using a systematic random sampling. Descriptive and multiple logistic regression analyses were performed using SPSS 20 for windows to estimate indicators and effect sizes of the predictors on HIV disclosure status to partners.

Results

The proportion of HIV disclosure status to their partner was 63.8%. Women who knew the HIV status of their sexual partner and those who got pretest counseling had a positive association with HIV disclosure with AOR of 16.9 (95% CI: 8.11, 35.21) and AOR of 2.8 (95% CI: 1.83, 4.28). Mothers with two years or beyond, since they knew their HIV status had more odds (AOR = 3. 2, 95% CI: 1.7, 6.29) to disclose their HIV status to their partner. Mothers who had seen people with HIV positive who disclose their HIV status to the community (AOR = 2.1, 95% CI: 1.08, 4.01) and those who had a discussion prior to HIV testing (AOR = 4.87, 95% CI: 2.45, 9.71) were more likely to disclose their HIV status than their counterparts.

Conclusions

The rate of HIV disclosure to their partner was low. Knowledge of HIV status of partner, receiving pretest counseling, longer time since the HIV testing, know people who disclose their status to the community and having discussion prior to HIV testing could influence disclosure of HIV status of mothers to their partners.

Determinants of HIV serostatus disclosure to sexual partner among HIV-positive alcohol users in Haiti

This study examined the relationship between antiretroviral therapy use, participants' knowledge of partner's HIV serostatus, number of sex partners, perceived infectivity and HIV disclosure to a main sexual partner among 258 HIV-positive Haitian alcohol users. Only 38.6 % had disclosed their HIV serostatus to sexual partners. Logistic regression analyses revealed that participants who self-reported having an HIV-negative partner (OR = 0.36, 95 % CI 0.13-0.97) or a partner of unknown HIV status (OR = 0.09, 95 % CI 0.04-0.22) were less likely to disclose their HIV serostatus than participants who self-reported having an HIV-positive partner. Participants who had more than one sexual partner in the past 3 months (OR = 0.41, 95 % CI 0.19-0.90) were also less likely to disclose than participants who had one partner. These findings suggest the need for couples-based programs to assist people living with HIV (PLWH) with the disclosure process, especially among PLWH who have more than one sexual partner and/or are in serodiscordant relationships.

Gender perspective of risk factors associated with disclosure of HIV status, a cross-sectional study in Soweto, South Africa

Background

Human Immunodeficiency Virus (HIV) status disclosure has been shown to provide several benefits, both at the individual and societal levels.

Aim

To determine risk factors associated with disclosing HIV status among antiretroviral therapy (ART) recipients in South Africa.

Setting

A cross-sectional study on risk factors for viremia and drug resistance took place at two outpatient HIV clinics in 2008, at a large hospital located in Soweto, South Africa.

Methods

We conducted a secondary data analysis on socio-economic characteristics and HIV status disclosure to anyone, focusing on gender differences. Descriptive and multivariable logistic regression analyses were performed to model the associations between risk factors and HIV status disclosure. Additionally, descriptive analysis was conducted to describe gender differences of HIV status disclosure to partner, parents, parents in law, partner, child, family, employer, and other.

Patients

A total of 883 patients were interviewed. The majority were women (73%) with median age of 39 years.

Results

Employed patients were less likely to disclose than unemployed (odds ratio (OR) 0.36; 95% confidence interval (CI) 0.1–1.0; p = 0.05)). Women with higher income were more likely to disclose (OR 3.25; 95% CI 0.90–11.7; p = 0.07) than women with lower income, while men with higher income were less likely (OR 0.20; 95% CI 0.02–1.99; p = 0.17) than men with lower income. Men were more likely than women to disclose to their partner (p<0.01), and to partner and family (p<0.01), women were more likely than men to disclose to child and family (p<0.01), to child, family and others (p = 0.01).

Conclusion

Being employed imposed a risk factor for HIV status disclosure, additionally we found an interaction effect of gender and income on disclosure. Interventions designed to reduce workplace discrimination and gender-sensitive interventions promoting disclosure are strongly recommended.

The 'Antiretrovirals, Sexual Transmission Risk and Attitudes' (ASTRA) study. Design, methods and participant characteristics

Life expectancy for people diagnosed with HIV has improved dramatically however the number of new infections in the UK remains high. Understanding patterns of sexual behaviour among people living with diagnosed HIV, and the factors associated with having condom-less sex, is important for informing HIV prevention strategies and clinical care. In addition, in view of the current interest in a policy of early antiretroviral treatment (ART) for all people diagnosed with HIV in the UK, it is of particular importance to assess whether ART use is associated with increased levels of condom-less sex. In this context the ASTRA study was designed to investigate current sexual activity, and attitudes to HIV transmission risk, in a large unselected sample of HIV-infected patients under care in the UK. The study also gathered background information on demographic, socio-economic, lifestyle and disease-related characteristics, and physical and psychological symptoms, in order to identify other key factors impacting on HIV patients and the behaviours which underpin transmission. In this paper we describe the study rationale, design, methods, response rate and the demographic characteristics of the participants. People diagnosed with HIV infection attending 8 UK HIV out-patient clinics in 2011-2012 were invited to participate in the study. Those who agreed to participate completed a confidential, self-administered pen-and-paper questionnaire, and their latest CD4 count and viral load test results were recorded. During the study period, 5112 eligible patients were invited to take part in the study and 3258 completed questionnaires were obtained, representing a response rate of 64% of eligible patients. The study includes 2248 men who have sex with men (MSM), 373 heterosexual men and 637 women. Future results from ASTRA will be a key resource for understanding HIV transmission within the UK, targeting prevention efforts, and informing clinical care of individuals living with HIV.

Notes on the concepts of 'serodiscordance' and 'risk' in couples with mixed HIV status

Serodiscordant primary relationships, in which one partner is HIV-positive and the other is HIV-negative, are increasingly recognised as a key context for the transmission of HIV globally. Yet insights into the dynamics of serodiscordance remain relatively limited. I argue that to understand what makes serodiscordant couples engage in sexual practices that increase the chance of transmission, we need to examine what HIV 'risk' actually means in different cultures and contexts. A 'socially situated' approach to HIV risk moves beyond its scientific conceptualisation as an objective 'fact', revealing a diversity of perceptions and competing risks. It also reveals that couples do not necessarily perceive their mixed HIV status in terms of 'difference', a common assumption that predetermines serodiscordance and thereby obscures its many and complex enactments. I draw on examples from the social research literature to illustrate how serodiscordance is shaped in different ways by local practices, priorities, and meanings. I argue that it is within these lived contexts that perceptions and negotiations of 'risk' arise and, thus, where couples' sexual practices need to be situated and understood. Such insights are timely as HIV research and prevention grapple with emerging scientific data that challenge traditional understandings about HIV transmission risk.

Behavioral surveillance study: sexual risk taking behaviour in UK HIV outpatient attendees

This study aimed to determine demographic, behavioural and self-report disease/treatment variables among HIV-infected individuals (n = 666) that predict unprotected intercourse with a partner of unknown/discordant status. Sexual risk behaviour was reported by 12.8%. In multivariable analysis, risk was more likely to be reported by gay men compared to women or heterosexual men, and for those with higher psychological symptom burden. Psychological symptoms should be assessed and managed in the HIV outpatient setting to ensure integrated care that enhances prevention.

HIV disclosure, condom use, and awareness of HIV infection among HIV-positive, heterosexual drug injectors in St. Petersburg, Russian Federation

We examined the prevalence of HIV disclosure to sexual partners by HIV-positive drug injectors (IDUs) in St. Petersburg, Russia and compared the magnitude and direction of associations of condom use with awareness of one's HIV infection and disclosure to partners. Among 157 HIV-infected participants, awareness of infection at time of last intercourse was associated with condom use with partners perceived to be HIV-negative (aOR 6.68, 95% CI 1.60-27.88). Among the 70 participants aware of their infection prior to enrolment, disclosure to potentially uninfected sexual partners was independently and negatively associated with condom use (aOR 0.13, 95% CI 0.02-0.66). Disclosure was independently associated with having injected ≥ 9 years (aOR 6.04, 95% CI 1.53-23.77) and partnership with another IDU (aOR 3.61, 95% CI 1.44-9.06) or HIV-seropositive (aOR 45.12, 95% CI 2.79-730.46). Scaling up HIV testing services and interventions that increase the likelihood of individuals receiving their test results is recommended.

Disclosure of HIV-positive serostatus to sexual partners and associated factors in southern China

In light of an increased push for disclosure of HIV-positive serostatus to sexual partners (partner disclosure, PD) in China as reflected by national and local policies, the objective of this study was to determine the proportion and evaluate associated factors of PD among people living with HIV/AIDS (PLWHA) in HIV/AIDS high-risk areas in southern China. Of the 946 HIV-positive individuals, the proportion of those who disclosed positive serostatus results to their sexual partners was 90.2% (625/693). Variables independently associated with non-disclosure included testing in Guangxi province (adjusted relative ratio [ARR] = 0.33), becoming infected with HIV via injecting drug use (IDU) transmission (ARR = 0.32), having not reported discussing disclosure with health department staff during post-test counselling (ARR = 0.41) and having a sexual relationship of ≤2 years' duration (ARR = 0.31). This study also identified a relatively larger differential between the proportion of disclosure to regular partners and the proportion of disclosure to casual partners (94.8% versus 13.0%) in comparison with other studies. Findings from this study may aid policies for future consideration.

Secondary prevention of HIV infection: the current state of prevention for positives

PURPOSE OF REVIEW

To provide a state-of-the-science review of the literature on secondary prevention of HIV infection or 'prevention for positives' (PfP) interventions.

RECENT FINDINGS

Early work on PfP focused on understanding the dynamics of risky behavior among People Living with HIV/AIDS (PLWH) and on designing, implementing, and evaluating a limited number of interventions to promote safer sexual and drug use behavior in this population (i.e., PfP interventions). Previous meta-analyses demonstrated that PfP interventions can effectively promote safer behavior. However, the understanding of risk dynamics among PLWH and the extant number and breadth of effective PfP interventions were scant. Recent work has addressed some of these problems, yielding greater understanding of risk dynamics and providing additional, effective interventions. Still, only a modest number of recent, rigorously evaluated, effective interventions have been identified. New ideas for creating stronger, more integrated, and effective PfP interventions have emerged that will guide future intervention research and practice.

SUMMARY

There remains much to be done to understand why, when, and under what conditions PLWH practice risk. Substantial work also needs to be performed to design, implement, rigorously evaluate, and when effective, to disseminate widely, additional, evidence-based PfP interventions targeting diverse populations. Directing such interventions to populations of PLWH at greatest risk for transmission of HIV has the potential to yield significant impact on the pandemic.

Vulnerability, gender and "proxy negativity": women in relationships with HIV-positive men in Australia

In contemporary international HIV discourse, women are positioned as especially vulnerable to HIV. This vulnerability is ascribed to gender inequality and its many structural, social and sexual manifestations. It is an important discourse in that it foregrounds how the realities of women worldwide constrain their ability to control their lives and bodies and, consequently, their ability to protect themselves against HIV infection. At the same time, its analysis rarely exceeds a generalised description of gender and power and, as such, fails to usefully engage with the specificity of serodiscordant gender relationships. Drawing on qualitative interviews with HIV-negative women and their HIV-positive male partners, who participated in a larger study on HIV and heterosexuality in Australia, we argue that without a considered analysis of the gendered interplay of differing HIV statuses, the vulnerability discourse remains limited in its capacity to capture the diverse, complex ways in which these HIV-negative women negotiate HIV in their sexual lives, how they are positioned in their relationships, and how vulnerability can figure in less obvious ways. We discuss how gendered meanings invested in the women's HIV-negative status constituted a powerful conduit to heteronormality for their male partners. The mixing of serostatuses made it possible for the men to assume a kind of proxy negativity, a desired state of redeemed masculinity. We explore two ways in which this proxy negativity operated among the couples and shaped their sexual practices. As a result, this paper makes an important contribution by showing how vulnerability to HIV infection can hinge on the different ways serodiscordant couples manage gendered meanings around serostatus emotionally and sexually.

HIV disclosure among adults living with HIV

Research on disclosure among heterosexual adult person(s) living with HIV (PLH) was reviewed, omitting disclosure of parental HIV to children. Disclosure has been studied within five additional relational contexts: with partners, family members, friends, healthcare professionals and in work settings. Disclosure is higher among women than men, among Latino and white compared to African-American families, and among younger compared to older HIV-positive adults. Most PLH disclose to their sexual partners and family members, yet there is a significant minority who do not disclose. Similarly, rates of disclosure to employers range from 27-68%, suggesting broad variability in perceived consequences of employment disclosures. Of concern, 40% of PLH do not consistently disclose to their healthcare professionals. Rather than examine HIV disclosures in the context of relationships, it is possible to understand disclosures around personal identity. Disclosure decisions are often made to tell everyone (making HIV status a central attribute of one's identity), no one (requiring strategies for securing social support while remaining anonymous) or some people (requiring strategic decisions based on context). Given that disclosure decisions are central to personal identity, future data on disclosure and interventions designed to increase disclosure or comfort with disclosure must focus on communication strategies adopted by PLH to present a coherent identity.

Disclosure experience and associated factors among HIV positive men and women clinical service users in Southwest Ethiopia

BACKGROUND

Disclosing HIV test results to one's sexual partner allows the partner to engage in preventive behaviors as well as the access of necessary support for coping with serostatus or illness. It may motivate partners to seek testing or change behavior, and ultimately decrease the transmission of HIV. The present study was undertaken to determine the rate, outcomes and factors associated with HIV positive status disclosure in Southwest Ethiopia among HIV positive service users.

METHODS

A cross-sectional study was carried out from January 15, 2007 to March 15, 2007 in Jimma University Specialized Hospital. Data were collected using a pre-tested interviewer-administered structured questionnaire.

RESULTS

A total of 705 people (353 women and 352 men), participated in the study of which 71.6% were taking ART. The vast majority (94.5%) disclosed their result to at least one person and 90.8% disclosed to their current main partner. However, 14.2% of disclosure was delayed and 20.6% did not know their partner's HIV status. Among those who did not disclose, 54% stated their reason as fear of negative reaction from their partner. Among those disclosures however, only 5% reported any negative reaction from the partner. Most (80.3%) reported that their partners reacted supportively to disclosure of HIV status. Disclosure of HIV results to a sexual partner was associated with knowing the partner's HIV status, advanced disease stage, low negative self-image, residing in the same house with partner, and discussion about HIV testing prior to seeking services.

CONCLUSION

Although the majority of participants disclosed their test results, lack of disclosure by a minority resulted in a limited ability to engage in preventive behaviors and to access support. In addition, a considerable proportion of the participants did not know their partner's HIV status. Programmatic and counseling efforts should focus on mutual disclosure of HIV test results, by encouraging individuals to ask their partner's HIV status in addition to disclosing their own.