Self-disclosure of HIV diagnosis to sexual partners by heterosexual and bisexual men: a challenge for HIV/AIDS care and prevention

Predictors of HIV Status Disclosure to Sexual Partners Among People Living with HIV in Brazil

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.

The effect of counseling, antiretroviral therapy and relationship on disclosing HIV positive status to sexual partner among adult HIV patients in Ethiopia: A systematic review and meta-analysis

BACKGROUND

Human Immunodeficiency Virus (HIV) is continued as a major public health problem, especially in developing countries. Therefore, this study aimed to estimate the effect of counseling, antiretroviral therapy (ART) and relationship on disclosing HIV positive status to sexual partner among adult HIV patients in Ethiopia.

METHODS

The Preferred Reporting Items for Systematic Review and Meta-analysis (PRISMA) was used during this review. The study included both published and unpublished studies which were conducted in Ethiopia until the end of 2019. Different electronic databases (PubMed, Cochrane library, CINAHL, Global Health, HINARI and Google scholar) were searched. Data were extracted in Microsoft Excel sheet and STATA/SE 14 was used to meta-analysis. I2 and Egger test statistics were used to test heterogeneity and publication bias respectively.

RESULTS

Twenty-two articles with 8,873 adult HIV infected peoples were included in this systematic review and meta-analysis. The pooled magnitude of disclosing HIV status to sexual partner was 74.63% [95% CI: (67.79, 81.47)]. Counseled [AOR = 4.96, 95% CI: (2.87, 8.55)], ART initiated [AOR = 4.78, 95% CI: (3.84, 5.94)] and who had a smooth relationship before HIV testing [AOR = 6.82, 95% CI: (3.49, 13.33)] were significantly associated with disclosing HIV status to sexual partner.

CONCLUSIONS

Disclosing HIV positive status to sexual partner in Ethiopia was low as the government invested in partner notification. Counseling, ART initiation and smooth relationship before HIV testing were significantly associated with disclosing HIV status to sexual partner. The government needs to strengthen pre and post HIV test counseling even after treatment started to increase disclosing status.

REGISTRATION

The protocol of this systematic review and meta-analysis was registered in the PROSPERO with a specific registration number: CRD42020161276; https://clinicaltrials.gov/.

The impact of serostatus disclosure on spousal relationships between wives and HIV-positive husbands who have sex with men in China

This study explored the impact of serostatus disclosure on the spousal relationship between wives and their HIV-positive husbands who have had sex with men. A qualitative study using semi-structured interviews was conducted in Sichuan, China in 2017 with wives (n = 31) who had known their husbands' HIV-positive status. Participants were identified by local governmental and non-governmental organizations that provide routine services for people living with HIV and their family members. Qualitative data underwent a detailed content analysis. Both positive and negative impacts on the spousal relationship were expressed by wives. Six themes were identified: (1) reduced sexual activities; (2) changes in intimacy; (3) limited communication on HIV-related issues but improved communication on other topics; (4) increased instrumental support but decreased emotional support; (5) improved resilience in the spousal relationship; and (6) shared privacy management rules regarding HIV-positive status. Moreover, the acknowledgment of the husband's homosexual behavior hurt the spousal relationship more seriously than the disclosure of the husband's HIV-positive status, and irremediable marriages were observed among wives who knew both. Disclosure of HIV-positive status had a great impact on the spousal relationship, though such impact varied across individuals.

Drivers of Sexual Inactivity Among Women Living with HIV and AIDS: Findings of the GENIH Study in São Paulo, Brazil

The advances on HIV/AIDS diagnosis and treatment have enabled people living with HIV/AIDS (PLHA) better quality of life. However, the persistence of HIV-related stigma and discrimination, and the risks triggered by HIV disclosure, may be a barrier to the sexual exercise of PLHA. We investigated the prevalence of sexual inactivity and the reasons given for it among a representative sample of women of reproductive age living with HIV/AIDS (WLWHA) in the municipality of São Paulo, Brazil. We surveyed 918 WLWHA with probability proportional to average number of visits in each of the 18 referral HIV/AIDS services. Sexual inactivity was defined as not having had vaginal sexual intercourse in the year prior to research. Statistical modeling of the factors associated with sexual inactivity was carried out by way of bivariate and multivariate analysis. In all, 22.2% (n = 200) of the women did not have sexual relations in the year prior to the interview. The majority reported a reduction in desire (64.5%) and sexual activity (68%). Among the women not in a relationship, the predictors of sexual inactivity were: being older (35-49) (ORa = 2.25); not being Catholic (ORa = 2.91); having kept the diagnosis secret from their partner (ORa = 2.45); having had up to five sexual partners throughout life (ORa = 3.81). The diagnosis of HIV seems to have more of an effect on the desire for and frequency of sexual activity than on its interruption. Sexual inactivity was influenced by the stigma of HIV/AIDS, by age, and by moral-religious values.

Adolescentes que vivem com HIV/aids: experiências de sexualidade

Resumo OBJETIVO Analisar as experiências de adolescentes que vivem com HIV/aids acerca da sexualidade. MÉTODO Pesquisa qualitativa realizada em um Serviço de Atendimento Especializado, de um município do Rio Grande do Sul, com 15 adolescentes que vivem com HIV/aids, no ano de 2014. Utilizou-se entrevista semiestruturada. Os dados foram analisados por meio da proposta operativa de Minayo. RESULTADOS As primeiras interações afetivas dos adolescentes foram experienciadas por meio do ficar e namorar, fortemente, influenciadas pela valência diferencial de gênero nas construções familiares. As experiências de relações sexuais foram decorrentes da dimensão afetiva do relacionamento e não se davam sem preocupação para os adolescentes. Administrar a condição de soropositividade em seus relacionamentos afetivos mobilizava o seu cotidiano. CONCLUSÃO O aprendizado da sexualidade extrapola o acesso às informações, decorrendo das experiências vivenciadas, do momento e dos distintos cenários em que elas se inserem.

Revisiting the use of condoms in Brazil

INTRODUCTION

It is known that a single prevention strategy is not enough to control multiple HIV epidemics around the world and in Brazil. However, it is not only necessary to recognize the importance of condoms as part of the policy of HIV/AIDS prevention but also discuss its limits. In this article, we aim to investigate the use of condoms in Brazil, draw critical reflections, and understand how they can once again be highlighted in Brazil's prevention strategy going forward.

METHODS

A narrative review of literature was conducted using keywords in PubMed. Reports from national surveys that guide the epidemiological and behavioral surveillance of the Brazilian Ministry of Health were also included.

RESULTS

A total of 40 articles and 3 reports were included in the review and 11 intervention studies to promote the condom use; the main findings were as follows: 1) Despite the increase in national studies on sexual behavior, little attention is given to the role of condom use; 2) There are few studies examining the factors associated with condom use among key populations such as men who have sex with men (MSM), female sex workers (FSW), drug users (DU), and transvestites and transexuals (TT), while substantial studies focus on adolescents and women; 3) Evidence suggests that a combination of interventions is more effective.

DISCUSSION

new prevention technologies must not lose sight of the critical importance of condoms, and efforts to reintroduce them should focus on the role of pleasure in addition to their potential to minimize the risk of HIV.

Sero-discovering versus sero-cognisant: initial challenges and needs of HIV-serodiscordant couples in Porto Alegre, Brazil

This paper focuses on challenges faced by heterosexual couples of mixed HIV status in Porto Alegre, Brazil, and argues for more conceptual nuance in our understanding of 'serodiscordance'. Couples' stories, collected over 11 months of qualitative research, demonstrate how profoundly serodiscordance involves both partners and suggest that the timing of relationship formation relative to HIV diagnosis influenced the particular challenges they confronted. In recognition of this variation, we propose the distinction of 'sero-discovering' from 'sero-cognisant' couples. Though Brazilian health policy strives to address the needs of individuals diagnosed with HIV, the needs of seronegative partners in this cohort received relatively little attention. In addition, the transformation of HIV from a death sentence to a chronic condition both facilitated the formation of serodiscordant unions and raised special challenges for such couples. Conceiving of any person receiving an HIV diagnosis as 'potentially partnered' may help address some of these lacunae while promoting primary prevention within mixed-status couples, and HIV testing more generally. More research with this population is needed.

Partner notification for sexually transmitted infections and perception of notified partners

OBJECTIVE

Learn the perceptions of patients with sexually transmitted infections and sexual partners who are notified of the infection.

METHOD

A descriptive and qualitative study, based on the collective subject discourse technique, was conducted in four healthcare centers of reference in Fortaleza, Ceará, from March to July 2014. The sample comprised 21 subjects (11 index patients and 10 notified partners).

RESULTS

The index patients reported complicity, concern about the partner's health and revelation of diagnosis aiming to preserve the relationship. The partners showed antagonistic perceptions: tranquility-betrayal, fear of death, of incurability and the diagnosis, especially of HIV. The reasons for coming to a healthcare center were: fear of being sick, attenuation of guilt of infection transmission, need for diagnosis, early start of treatment.

CONCLUSION

Fear of losing trust, insecurities when dealing with a sexual infection and being responsible or co-responsible for the transmission were the predominant feelings. Various types of partner notification were reported (verbal, telephone, notification card), according to individual convenience. This study suggests the use of alternative methods of notification and an integrated system of notification.

OBJETIVO

Conhecer as percepções dos pacientes com infecções sexualmente transmissíveis e parceiros sexuais sobre a notificação da infecção.

MÉTODO

Estudo descritivo e qualitativo, baseado na técnica do discurso do sujeito coletivo, realizado em quatro Unidades de Saúde de referência em Fortaleza/CE, de março a julho de 2014. Amostra composta por 21 sujeitos (11 pacientes-índice e 10 parceiros notificados).

RESULTADOS

Pacientes-índice relataram cumplicidade, preocupação com a saúde do parceiro e revelação do diagnóstico como forma de preservação do relacionamento. Para os parceiros, as percepções foram antagônicas: tranquilidade-traição, medo da morte, da incurabilidade e do diagnóstico, especialmente do HIV. Os motivos para o comparecimento foram: medo de estar doente, atenuação da culpa relativa à transmissão, necessidade do diagnóstico, início precoce do tratamento.

CONCLUSÃO

Predominou o medo da quebra da confiança, inseguranças em lidar com uma infecção sexual e ser responsável ou corresponsável pela transmissão. As formas de comunicação às parcerias sexuais foram diversificadas (verbal, telefone, cartão de comunicação), atendendo a uma conveniência individual. Sugere-se a união de métodos alternativos de notificação e um sistema de notificação integrado.

Costs and benefits of secrecy: the dilemma experienced by adolescents seropositive for HIV

This study explored the experiences of the first generation of adolescents who acquired HIV through vertical transmission when disclosing their diagnosis to friends and romantic partners. The study sample was selected by convenience, with 20 patients (13-20 years old) participating in a qualitative investigation using individual interviews (language: Portuguese; duration: 45 minutes). The participants were followed in specialized clinics for the treatment of pediatric AIDS in São Paulo, Brazil. The results suggest that families who live with HIV tend to keep it a secret, and such behavior is learned and accepted unquestioningly as natural. Respect for privacy and the fear of rejection, coupled with the belief that information about their disease will be spread, are the main beliefs with which participants justify their secrecy. In terms of romantic relationships, adolescents were aware that their HIV status should at some point be shared with current or future sexual partners. However, the decision to reveal an HIV diagnosis in romantic relationships is permeated by anxieties, uncertainties about the right time, and fear of abandonment. In any case, telling the truth requires trust, guarantees of the other's love, and, in some cases, probing romantic partners beforehand to learn their perceptions about the disease. Participants who had experiences disclosing their HIV status shared positive and negative results, including emotional support, acceptance, and understanding, along with ostracism, discrimination, and abandonment by family members. The findings of this paper reinforce the challenges of revealing an HIV diagnosis to third parties. It requires understanding the meaning and importance of the secret for each patient, along with the conflict between the right to confidentiality and the responsibility of treating others exposed to the disease. All these aspects should be discussed extensively with this population and incorporated into clinical practice.

Predictors of couple HIV counseling and testing among adult residents of Bukomero sub-county, Kiboga district, rural Uganda

Background

Studies have shown that couple HIV counseling and testing (CHCT) increased rates of sero-status disclosure and adoption of safer sexual behaviors with better linkage to treatment and care. However, current evidence suggests that new HIV infections are occurring among heterosexual couples in stable relationships where the majority of the individuals are not aware of their partner’s serostatus. This study examined the predictors of CHCT uptake among married or cohabiting couples of Bukomero sub-county Kiboga district in Uganda.

Methods

This cross-sectional correlational study was conducted among 323 individuals who were either married or cohabiting, aged 18–49 years. Participants were enrolled from randomly selected households in Bukomero sub-county. Data were collected using an interviewer-administered questionnaire on socio-demographics, self-rating on awareness of CHCT benefits, couple discussion about HIV testing and CHCT practices. Couples were compared between those who had reported to have tested as a couple and those who had not. Binary logistic regression was performed to determine the adjusted odds ratio [aOR] and 95 % confidence intervals [CI] for CHCT uptake and the other independent variables.

Results

Of the participants 288 (89.2 %) reported to have ever taken an HIV test only 99 (34.4 %) did so as a couple. The predictors of testing for HIV as a couple were discussing CHCT with the partner (adjusted odds ratio 4.95[aOR], 95 % confidence interval [CI]:1.99–12.98; p < 0.001), awareness of CHCT benefits (aOR 3.23; 95 % CI 1.78–5.87; p < 0.001) and having time to test as a couple (aOR 2.61; 95 % CI 1.22–5.61; p <0.05).

Conclusion

Uptake of HIV counseling and testing among couples was low. Discussing CHCT with partner, awareness of CHCT benefits, and availability of time to test as a couple were predictive of CHCT uptake. Thus CHCT campaigns should emphasize communication and discussion of HIV counseling and testing among partners.

[Experiences of adolescents seropositive for HIV/AIDS: a qualitative study]

Objective:

Explore the meanings attributed by young individuals about "living as an adolescent with HIV" in a group of patients that acquired the infection at birth and the elements involved with the adherence to antiretroviral treatment.

Methods:

Qualitative study, involving 20 subjects (aged 13-20 years), followed at services specialized in the treatment of pediatric AIDS in São Paulo, Brazil. Semi-structured interviews were carried out of which script consisted of questions about their personal histories, experiences and difficulties they must face while living with HIV/AIDS.

Results:

Being "normal" and "different" were central issues voiced by the participants. However, a normal life situation is guaranteed by being responsible with one's health, the condition that the diagnosis be kept secret and concerns about HIV transmission and dissemination to a sexual partner. The answers about treatment show that adherence is a dynamic process and involves moments of greater or lesser interest in relation to care for one's health. The adolescents have plans and projects and although HIV is considered a stressor, positive perspectives for the future prevailed.

Conclusions:

To live as an adolescent with HIV involves subtle dimensions that need to be recognized and legitimized by professionals who follow the trajectory of these young individuals. It is necessary to allow a space in which the adolescents can reflect and find support regarding issues related to the construction of their sexuality and care of one's own body.

[Experiences of adolescents seropositive for HIV/AIDS: a qualitative study]

OBJECTIVE

Explore the meanings attributed by young individuals about "living as an adolescent with HIV" in a group of patients that acquired the infection at birth and the elements involved with the adherence to antiretroviral treatment.

METHODS

Qualitative study, involving 20 subjects (aged 13-20 years), followed at services specialized in the treatment of pediatric Aids in São Paulo, Brazil. Semi-structured interviews were carried out of which script consisted of questions about their personal histories, experiences and difficulties they must face while living with HIV/Aids.

RESULTS

Being "normal" and "different" were central issues voiced by the participants. However, a normal life situation is guaranteed by being responsible with one's health, the condition that the diagnosis be kept secret and concerns about HIV transmission and dissemination to a sexual partner. The answers about treatment show that adherence is a dynamic process and involves moments of greater or lesser interest in relation to care for one's health. The adolescents have plans and projects and although HIV is considered a stressor, positive perspectives for the future prevailed.

CONCLUSIONS

To live as an adolescent with HIV involves subtle dimensions that need to be recognized and legitimized by professionals who follow the trajectory of these young individuals. It is necessary to allow a space in which the adolescents can reflect and find support regarding issues related to the construction of their sexuality and care of one's own body.

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

Disclosure of HIV serostatus to sexual partners is mandated within certain states in the United States and other countries. Despite these laws implemented and public health efforts to increase disclosure, rates of disclosure to sexual partners among people living with HIV (PLWH) remain low, suggesting the need for interventions to assist PLWH with the disclosure process. We conducted a systematic review of studies testing whether HIV serostatus disclosure interventions increase disclosure to sexual partners. We searched six electronic databases and screened 484 records. Five studies published between 2005 and 2012 met inclusion criteria and were included in this review. Results showed that three of the HIV serostatus disclosure-related intervention studies were efficacious in promoting disclosure to sexual partners. Although all three studies were conducted in the United States the intervention content and measurements of disclosure across the studies varied, so broad conclusions are not possible. The findings suggest that more rigorous HIV serostatus disclosure-related intervention trials targeting different populations in the United States and abroad are needed to facilitate disclosure to sexual partners.

Factors associated with HIV voluntary disclosure of people living with HIV to their steady sexual partner in the Democratic Republic of the Congo: results from a community-based participatory research

Introduction

HIV disclosure to a steady sexual partner (SSP) is important both in preventing HIV transmission and improving the quality of life of people living with HIV (PLHIV). Its determinants have been poorly investigated in the Democratic Republic of the Congo. The study objective was to determine factors independently associated with voluntary disclosure to one's SSP in PLHIV receiving services from a Congolese community-based organization (CBO).

Methods

A community-based participatory research was performed and 300 PLHIV were interviewed by members of the CBO, using a standardized questionnaire. A multivariate logistic regression was used to determine the variables independently associated with disclosure.

Results

In this sample, 79 of the 127 participants (62%) included in the analysis declared having voluntarily disclosed their serostatus to their SSP. Declaring to be in a relationship (Odds Ratio (95% Confidence Interval): 4.2 (1.4-12.6)), having tested for HIV because of symptoms (2.5 (1.0-6.4)), having taken the test on one's own initiative (3.2 (1.3-8.0)), having felt sympathy and indifference from people when disclosing (6.0 (1.4-26.9) and 5.0 (1.1-22.8), respectively) as well as having a higher score of the “regular discussion about daily life with HIV” index (1.7 (1.1-2.5)) were significantly associated with disclosure to one's SSP.

Conclusion

Several individual and contextual factors were associated with voluntary disclosure to SSP in this study, highlighting the complex nature of the disclosure process. Interventions encouraging disclosure should be designed so as to adapt to one's personal life with HIV as well as psychosocial environment.

The role of HIV serostatus disclosure on sexual risk behaviours among people living with HIV in steady partnerships in Rio de Janeiro, Brazil

Understanding partnership dynamics is a crucial step in the process of HIV serostatus disclosure to partners. This study examines the relational characteristics associated with HIV serostatus disclosure and the role of disclosure on sexual behaviours within steady partnerships among people living with HIV (PLHIV) in Rio de Janeiro, Brazil. The overall study surveyed 900 participants from six large public health facilities to investigate psychosocial and structural factors associated with sexual health and well-being. This analysis focuses on 489 individuals reporting being in steady partnerships, 86% of whom reported HIV serostatus disclosure to steady partners. After adjusting for demographic variables, attitudes towards disclosure, having an HIV-positive partner, living with partner and longer relationships were significantly associated with reported disclosure in multivariable logistic regression. Living with partner was negatively associated with partner concurrency. However, having an HIV-positive partner, sex under the influence of drugs or alcohol and experiencing physical aggression by a steady partner were negatively associated with consistent condom use. Interventions supporting PLHIV to safely and voluntarily disclose to partners may be an effective prevention approach between steady partners; however, partner violence and substance use should be addressed in future work.