HIV serostatus disclosure and associated factors among HIV positive pregnant and lactating women at Nekemte public health facilities, western Ethiopia

A qualitative inquiry of experiences of HIV-related stigma and its effects among people living with HIV on treatment in rural Kilifi, Kenya

Background

The pervasiveness of HIV-related stigma and discrimination, and its consequences on HIV prevention and treatment, have been well documented. However, little is known about the lived experiences of HIV-related stigma and its effects among the general adult population living with HIV in rural African settings. This study set out to explore this knowledge gap.

Methods

From April to June 2018, we conducted in-depth interviews with a convenience sample of 40 adults living with HIV aged 18-58 years in Kilifi, Kenya. A semi-structured interview guide was used to explore experiences of HIV-related stigma and its impact on these adults. A framework approach was used to analyze the data using NVIVO 11 software.

Results

Participants reported experiences of HIV-related stigma in its various forms (anticipated, perceived, internalised, and enacted), as well as its effects on HIV treatment and social and personal spheres. The internalisation of stigma caused by enacted stigma impacted care-seeking behavior resulting in worse overall health. Anxiety and depression characterized by suicidal ideation were the results of internalised stigma. Anticipated stigma prompted HIV medication concealment, care-seeking in remote healthcare facilities, and care avoidance. Fewer social interactions and marital conflicts resulted from perceived stigma. Overall, HIV-related stigma resulted in partial and non-disclosure of HIV seropositivity and medication non-adherence. At a personal level, mental health issues and diminished sexual or marital prospects (for the unmarried) were reported.

Conclusion

Despite high awareness of HIV and AIDS among the general population in Kenya, adults living with HIV in rural Kilifi still experience different forms of HIV-related stigma (including self-stigma) that result in a raft of social, personal, and HIV-treatment-related consequences. Our findings underscore the urgent need to reevaluate and adopt more effective strategies for implementing HIV-related anti-stigma programs at the community level. Addressing individual-level stigma will require the design of targeted interventions. To improve the lives of adults living with HIV in Kilifi, the effects of HIV-related stigma, particularly on HIV treatment, must be addressed.

Disclosure of HIV status to sexual partner and its associated factors among pregnant women living with HIV attending prenatal care in Amhara Regional state Referral Hospitals, Ethiopia

BACKGROUND

Disclosure of Human Immunodeficiency Virus (HIV) status to sexual partners plays a significant role in the successful prevention and care of HIV infection. Pregnant women who did not reveal their HIV status to their sexual partners make the prevention and control efforts challenging. Therefore, this study was aimed to assess HIV status disclosure to sexual partners and associated factors among pregnant women living with HIV attending prenatal care in Amhara Regional state referral Hospitals, Ethiopia in 2021.

METHODS

An institution-based cross-sectional study was conducted from October 17th, 2020 to March 1st, 2021. A total of 423 pregnant women living with HIV were participated in this study. A systematic random sampling technique was used to select all eligible women. Data was collected using a semi-structured, pretested, and interviewer-administered questionnaire. EPI INFO version 7 and SPSS version 21 were used for data entry and analysis, respectively. Both univariable and multivariable logistic regression analyses were performed to find factors associated with women's disclosure status to a sexual partner. Statistical association was decided based on the adjusted odds ratio (AOR) with its 95% Confidence Interval (CI) and p-value of ≤ 0.05.

RESULTS

The prevalence of disclosure of their HIV status to their sexual partners was 73% (95% CI: 68.9%, 77.3%). Being an urban resident (AOR = 5.04, 95% CI: 2.14, 11.81), diagnosed HIV before pregnancy (AOR = 7.77, 95% CI: 3.09, 19.52), disclosing their HIV status to others (AOR = 7.01, 95% CI: 3.78, 13.25), planned pregnancy (AOR = 2.46, 95% CI: 1.32, 4.57), and having good knowledge on HIV/AIDS prevention (AOR = 2.19, 95% CI:1.22, 3.94) were found to be statistically significant with women's disclosure of their HIV status to their sexual partner.

CONCLUSION

In this study, nearly three-fourth of pregnant women disclosed their HIV status to their sexual partner. Thus, setting strategies in preventing unplanned pregnancy, HIV diagnosed before pregnancy, and increasing knowledge of HIV prevention will have significant role in escalating women's disclosure status.

Depression, anxiety and stress among HIV-positive pregnant women in Ethiopia during the COVID-19 pandemic

BACKGROUND

Assessing the maternal mental health status during the coronavirus disease 2019 (COVID-19) pandemic is necessary to prevent the occurrence of severe mental disorders. Prenatal depression, anxiety and stress disorders are prominent in pregnant women living with human immunodeficiency virus (HIV) and highly associated with poor maternal and neonatal outcomes. Therefore this study aimed to assess the level of depression, anxiety, and stress among HIV-positive pregnant women in Ethiopia during the COVID-19 pandemic.

METHODS

An institution-based cross-sectional study was conducted in Amhara region referral hospitals from 17 October 2020 to 1 March 2021. A systematic random sampling technique was used to select 423 eligible women. A structured, pretested and interviewer-administered questionnaire was employed to collect the data. A multivariable logistic regression analysis was implemented to identify factors associated with women's depression, anxiety and stress. Statistical association was certain based on the adjusted odds ratio (AOR) with its 95% confidence interval (CI) and p-values ≤0.05.

RESULTS

Prenatal depression, anxiety and stress among HIV-positive pregnant women were 37.6% (95% CI 33 to 42.3), 42.1 (95% CI 37.7 to 46.7) and 34.8% (95% CI 30.3 to 39.2), respectively. Having an HIV-negative sexual partner (AOR 1.91 [95% CI 1.16 to 3.15]) and being on antiretroviral therapy >1 year (AOR 2.18 [95% CI 1.41 to 3.36]) were found to be statistically significant with women's antenatal depression, while unplanned pregnancy (AOR 1.09 [95% CI 1.02 to 2.33]) and did not discuss with the sexual partner about HIV (AOR 3.21 [95% CI 2.12 to 7.07]) were the factors associated with prenatal anxiety.

CONCLUSIONS

In this study, more than one in three HIV-positive pregnant women had depression and anxiety. Thus, implementing strategies to prevent unplanned pregnancy and advocating open discussion with sexual partners about HIV will play a large role in reducing pregnancy-related depression and anxiety.

HIV sero-status disclosure and associated factors among HIV positive women in East Africa: Systematic review and meta-analysis. Implications for prevention of mother-to-child HIV transmission

Background

Women's HIV-positive disclosure plays a pivotal role to achieve the goal of preventing mother-to-child transmission (PMTCT) among pregnant women in particular. Although several primary studies were conducted in the different countries of East Africa, no study concluded the prevalence of women's HIV status disclosure and associated factors in East Africa. Therefore, the current study aimed to assess the pooled prevalence of disclosure status and associated factors among women in East Africa.

Objectives

To assess the pooled prevalence of HIV sero-status disclosure and associated factors among women in East Africa.

Methods

HINARI, PubMed, and Cochrane Library databases were searched. The data were extracted using a Microsoft Excel spreadsheet and STATA v 14.1 was used for the analysis. The Funnel plots and Egger's statistical test was used to check publication bias. Heterogeneity was assessed by conducting sensitivity and subgroup analyses.

Result

The pooled prevalence of sero-status disclosure among women in East Africa was 73.77% (95%CI 67.76, 79.77). Knowing partner's sero-status (OR = 10.04(95%CI 3.36, 31.84), married (OR = 2.46 (95%CI 1.23, 4.89), smooth relationship (OR = 3.30 (95%CI 1.39, 7.84), and discussion on HIV before the test (OR = 6.96 (95%CI 3.21, 15.05) were identified determinants of HIV sero-status disclosure.

Conclusion

The current systematic and meta-analysis revealed that nearly one-fourth of women had not disclosed HIV sero-status to at least one individual. Knowing the partner's HIV sero-status, being married, having a smooth relationship, and discussing on HIV before the test were determinants of disclosure status. Therefore, disclosure of HIV-positive sero-status among women living with HIV needs to be strengthened.

HIV status disclosure and sexual activity among pregnant women in Ghana

Human Human immunodeficiency virus (HIV) status disclosure to sexual partners is associated with prevention, care, treatment, and support for pregnant women with HIV. We aimed to assess HIV status disclosure and sexual activity among pregnant women with HIV. We conducted a cross-sectional hospital-based survey using quantitative methods. Data were collected from 118 pregnant women with HIV enrolled in the prevention of mother-to-child transmission (PMTCT) program from January to November 2019. Sixty-seven percent (67%) of these pregnant women did not know they had HIV until they were tested in the routine antenatal HIV testing program. HIV status nondisclosure rate was 62.7%, and the most common reason for nondisclosure was fear of loss of financial support (41.9%). Higher parity was associated with lower odds of disclosing HIV status (aOR = 0.36; p < 0.01). Sexual activity with partners and condom use were associated with HIV disclosure (ps < 0.01). Pregnant women who disclosed their HIV status to their partners were sexually active with them (37.3%), and all those who did not but were sexually active with their partners did not use condoms (36.2%) during the pregnancy. Our findings emphasize the need for interventions that encourage HIV status disclosure and affirm the importance of routine HIV testing for pregnant women.

To disclose or not: experiences of HIV infected pregnant women in disclosing their HIV status to their male sexual partners in Blantyre, Malawi

Background

HIV status disclosure is one of the pillars of success of the elimination of Mother to Child Transmission of HIV (eMTCT) program. However, there are challenges associated with it that limit full disclosure. Literature shows that for pregnant women in developing countries, who have been diagnosed with HIV, 16% to 86% disclose their status to their sexual partners. This study explored the experiences of newly diagnosed HIV-infected antenatal women in disclosing their HIV status to their male sexual partners in Blantyre, Malawi.

Methods

This was a qualitative explanatory multiple case study that was conducted from 2018 to 2019 using in-depth interviews and diaries as data collection tools. We recruited seven newly diagnosed HIV pregnant women who had not disclosed their status to their male sexual partners and were initiated on Option B + strategy of the eMTCT of HIV at Limbe Health Centre. The investigator had 3 contacts with each participant from which data was gathered except for one participant who got lost to follow-up. This study employed content analysis and used a within-case and across-case analysis.

Results

Women either use facilitated mutual disclosure process or disclosed directly to their male sexual partners. Women were motivated to disclose because they wanted an HIV-free baby, to know the partners' status, and to resolve the gap on how they got infected with HIV. The disclosure process faced challenges such as uncertainty about a partner’s reaction after disclosure, fear of relationship dissolution, and the soberness of the partner. Privacy was an important consideration during the process of disclosure. Following disclosure, male sexual partners either accepted the status immediately after disclosure or initially denied but later accepted.

Conclusion

This study has shown that newly diagnosed HIV pregnant women accessing eMTCT services have a plan of either to disclose or conceal their HIV status from their male sexual partner and this decision is affected by the nature of relationship that exist between them and their partner. Factors relating to the unborn baby, the relationship as well as to know partners status motivate women to either disclose or conceal.

The Burden of HIV Infection among Pregnant Women Attending Antenatal Care in Jimma University Specialized Hospital in Ethiopia: A Retrospective Observational Study

Background

The HIV (human immunodeficiency virus) epidemic enters its fifth decade amid a global pandemic. Nearly 61% of the people newly infected with HIV live in sub-Saharan Africa (SSA). The virus is transmitted from mother to child during pregnancy, labour, delivery, and breastfeeding, warranting routine counselling at antenatal care (ANC). Hence, this study aimed to determine the prevalence and trend of HIV infection among pregnant women on ANC follow-up at Jimma University Specialized Hospital (JUSH) in Ethiopia from November 2018 to 2021.

Methods

A retrospective cross-sectional study was conducted from June 25, 2021, to November 30, 2021. A total of 634 mothers were sampled by systematic random sampling, and the data were analyzed by descriptive statistics package of SPSS software. A chi-square test was employed to assess an association between variables. Analyses outputs were summarized and presented in tables and figures.

Results

Among the sampled women (634), 96.1% received counselling services on the prevention of maternal-to-child transmission of HIV/AIDS. Around 83.1% of the mothers refused to consult their partners and were unable to persuade their surrogate or afraid to discuss HIV serostatus tests. The overall prevalence of HIV infection among pregnant mothers was 7.1% and no significant decrease in the trends of HIV prevalence over the three years study period (p value >0.05). The seroprevalence is high in urban residents (4.4%) and age group of 25–29 years (38.9%) (p value <0.05). Residence, level of education attained, and marital status of women were significantly associated (p value <0.05) with seropositivity.

Conclusion

HIV burden among ANC attendees in JUSH is high as compared to the national figure and its trend over three years is steady. Accordingly, mandatory early screening tests and community-based education are mandatory for all women and adolescent girls in the reproductive age group.