1
|
Gutin SA, Ruark A, Darbes LA, Neilands TB, Mkandawire J, Conroy AA. Supportive couple relationships buffer against the harms of HIV stigma on HIV treatment adherence. BMC Public Health 2023; 23:1878. [PMID: 37770885 PMCID: PMC10540419 DOI: 10.1186/s12889-023-16762-w] [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: 05/18/2023] [Accepted: 09/14/2023] [Indexed: 09/30/2023] Open
Abstract
INTRODUCTION HIV stigma can impact couple relationships through stress or bring partners closer through shared experiences. Conversely, couple relationships may protect against the harms of stigma, including anticipated stigma on negative health outcomes. Yet few studies have assessed the potential link between HIV stigma, relationship dynamics, and antiretroviral therapy (ART) adherence. Using dyadic data from a cross-sectional study of Malawian couples living with HIV, we tested associations between anticipated stigma and: 1) relationship dynamics (e.g., trust, sexual satisfaction, communication) and partner support; and 2) self-reported ART adherence. METHODS Heterosexual couples (211 couples, 422 individuals) with at least one partner on ART were recruited from clinics in Zomba, Malawi. Partners completed separate surveys on anticipated stigma, relationship dynamics, and ART adherence. Linear mixed models evaluated associations between anticipated stigma and relationship dynamics, and whether associations varied by gender. Generalized estimating equation models tested for associations between anticipated stigma and high ART adherence (90-100% vs. < 90%) at the individual level, and whether they were moderated by relationship dynamics at the couple level. RESULTS Couples' relationship length averaged 12.5 years, 66.8% were HIV sero-concordant, and 95.6% reported high ART adherence. In multivariable models, sexual satisfaction (β = -0.22, 95%CI = -0.41;-0.03, p = 0.020) and partner social support (β = -0.02, 95%CI = -0.04;-0.01, p < 0.01) were negatively associated with anticipated stigma. Significant interaction effects showed that adherence is moderated in couples with higher partner support and sexual satisfaction such that adherence is lowest when anticipated stigma is high and social support is low, and that adherence is lowest when anticipated stigma is high and sexual satisfaction is low. CONCLUSIONS Increased anticipated stigma is most associated with lower ART non-adherence at lower levels of social support and sexual satisfaction. Conversely, supportive and fulfilling relationships may buffer the negative association between stigma and ART adherence. Couples' interventions that focus on improving communication and support systems within couples could reduce the negative impacts of anticipated stigma on couples living with HIV.
Collapse
Affiliation(s)
- Sarah A Gutin
- Department Of Community Health Systems, School of Nursing, University of California, San Francisco (UCSF), 2 Koret Way, San Francisco, CA, 94143, USA.
| | - Allison Ruark
- Wheaton College, 501 College Avenue, Wheaton, IL, USA
| | - Lynae A Darbes
- Department of Health Behavior and Biological Sciences, School of Nursing, University of Michigan, 400 North Ingalls Building, Ann Arbor, MI, USA
| | - Torsten B Neilands
- Division of Prevention Sciences, University of California, San Francisco (UCSF), 550 16Th. Street, #3311, San Francisco, CA, 94158, USA
| | - James Mkandawire
- Invest in Knowledge, Old Naisi Road, P.O. Box 506, Zomba, Malawi
| | - Amy A Conroy
- Division of Prevention Sciences, University of California, San Francisco (UCSF), 550 16Th. Street, #3311, San Francisco, CA, 94158, USA
| |
Collapse
|
2
|
Okorie CN, Gutin SA, Getahun M, Lebu SA, Okiring J, Neilands TB, Ssali S, Cohen CR, Maeri I, Eyul P, Bukusi EA, Charlebois ED, Camlin CS. Sex specific differences in HIV status disclosure and care engagement among people living with HIV in rural communities in Kenya and Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000556. [PMID: 37027350 PMCID: PMC10081749 DOI: 10.1371/journal.pgph.0000556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 02/28/2023] [Indexed: 04/08/2023]
Abstract
Non-disclosure of human immunodeficiency virus (HIV) status can hinder optimal health outcomes for people living with HIV (PLHIV). We sought to explore experiences with and correlates of disclosure among PLHIV participating in a study of population mobility. Survey data were collected from 1081 PLHIV from 2015-16 in 12 communities in Kenya and Uganda participating in a test-and-treat trial (SEARCH, NCT#01864603). Pooled and sex-stratified multiple logistic regression models examined associations of disclosure with risk behaviors controlling for covariates and community clustering. At baseline, 91.0% (n = 984) of PLHIV had disclosed their serostatus. Amongst those who had never disclosed, 31% feared abandonment (47.4% men vs. 15.0% women; p = 0.005). Non-disclosure was associated with no condom use in the past 6 months (aOR = 2.44; 95%CI, 1.40-4.25) and with lower odds of receiving care (aOR = 0.8; 95%CI, 0.04-0.17). Unmarried versus married men had higher odds of non- disclosure (aOR = 4.65, 95%CI, 1.32-16.35) and no condom use in the past 6 months (aOR = 4.80, 95%CI, 1.74-13.20), as well as lower odds of receiving HIV care (aOR = 0.15; 95%CI, 0.04-50 0.49). Unmarried versus married women had higher odds of non-disclosure (aOR = 3.14, 95%CI, 1.47-6.73) and lower odds of receiving HIV care if they had never disclosed (aOR = 0.05, 95%CI, 0.02-0.14). Findings highlight gender differences in barriers to HIV disclosure, use of condoms, and engagement in HIV care. Interventions focused on differing disclosure support needs for women and men are needed and may help facilitate better care engagement for men and women and improve condom use in men.
Collapse
Affiliation(s)
- Chinomnso N. Okorie
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Sarah A. Gutin
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
| | - Monica Getahun
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Sarah A. Lebu
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Jaffer Okiring
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Torsten B. Neilands
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
| | - Sarah Ssali
- School of Women and Gender Studies, Makerere University, Kampala, Uganda
| | - Craig R. Cohen
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
| | - Irene Maeri
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Patrick Eyul
- Infectious Diseases Research Collaboration, Kampala, Uganda
| | - Elizabeth A. Bukusi
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
- Kenya Medical Research Institute, Centre for Microbiology Research, Nairobi, Kenya
| | - Edwin D. Charlebois
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
| | - Carol S. Camlin
- Department of Obstetrics, Gynecology & Reproductive Sciences, University of California, San Francisco, California, United States of America
- Department of Medicine, Division of Prevention Science, University of California, San Francisco, California, United States of America
| |
Collapse
|
3
|
HIV status disclosure by Nigerian men who have sex with men and transgender women living with HIV: a cross-sectional analysis at enrollment into an observational cohort. BMC Public Health 2020; 20:1282. [PMID: 32842997 PMCID: PMC7448976 DOI: 10.1186/s12889-020-09315-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 07/29/2020] [Indexed: 11/10/2022] Open
Abstract
Background Men who have sex with men (MSM) and transgender women (TGW) are disproportionately impacted by HIV and may face barriers to HIV status disclosure with negative ramifications for HIV prevention and care. We evaluated HIV status disclosure to sexual partners, HIV treatment outcomes, and stigma patterns of MSM and TGW in Abuja and Lagos, Nigeria. Methods Previously-diagnosed MSM and TGW living with HIV who enrolled in the TRUST/RV368 cohort from March 2013 to August 2018 were asked, “Have you told your (male/female) sexual partners (MSP/FSP) that you are living with HIV?” In separate analyses, robust Poisson regression models were used to estimate risk ratios (RRs) and 95% confidence intervals (95% CIs) for characteristics associated with HIV status disclosure to MSP and FSP. Self-reported stigma indicators were compared between groups. Results Of 493 participants living with HIV, 153 (31.0%) had disclosed their HIV status to some or all MSP since being diagnosed. Among 222 with FSP, 34 (15.3%) had disclosed to some or all FSP. Factors independently associated with disclosure to MSP included living in Lagos (RR 1.58 [95% CI 1.14–2.20]) and having viral load < 50 copies/mL (RR 1.67 [95% CI 1.24–2.25]). Disclosure to FSP was more common among participants who were working in entertainment industries (RR 6.25 [95% CI 1.06–36.84]) or as drivers/laborers (RR 6.66 [95% CI 1.10–40.36], as compared to unemployed) and also among those married/cohabiting (RR 3.95 [95% CI 1.97–7.91], as compared to single) and prescribed ART (RR 2.27 [95% CI 1.07–4.83]). No differences in self-reported stigma indicators were observed by disclosure status to MSP but disclosure to FSP was associated with a lower likelihood of ever having been assaulted (26.5% versus 45.2%, p = 0.042). Conclusions HIV status disclosure to sexual partners was uncommon among Nigerian MSM and TGW living with HIV but was associated with improved HIV care outcomes. Disclosure was not associated with substantially increased experiences of stigma. Strategies to encourage HIV status disclosure may improve HIV management outcomes in these highly-marginalized populations with a high burden of HIV infection.
Collapse
|
4
|
Modi RA, McGwin GL, Willig JH, Westfall AO, Griffin RL, Amico R, Martin KD, Raper JL, Keruly JC, Golin CE, Zinski A, Napravnik S, Crane HM, Mugavero MJ. Factors Associated with HIV Disclosure Status Among iENGAGE Cohort of New to HIV Care Patients. AIDS Patient Care STDS 2020; 34:213-227. [PMID: 32396474 DOI: 10.1089/apc.2019.0271] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
HIV disclosure is an important behavior with implications for HIV treatment and prevention but understudied among new to HIV care patients who face unique challenges adjusting to a new diagnosis. This study evaluated the factors associated with HIV disclosure status and patterns of HIV disclosure among new to HIV care patients. A cross-sectional study was conducted evaluating the iENGAGE (integrating ENGagement and Adherence Goals upon Entry) cohort. Participants were enrolled in this randomized behavioral trial between December 2013 and June 2016. The primary and secondary outcomes included HIV disclosure status (Yes/No) and patterns of disclosure (Broad, Selective and Nondisclosure), respectively. Logistic and Multinomial Logistic Regression were used to evaluate the association of participant factors with HIV disclosure and patterns of HIV disclosure, respectively. Of 371 participants, the average age was 37 ± 12 years, 79.3% were males, and 62.3% were African Americans. A majority of participants (78.4%) disclosed their HIV status at baseline, 63.1% were broad disclosers and 15.2% were selective disclosers. In multivariable regression, black race, emotional support, and unmet needs predicted any HIV and broad disclosure, whereas males, emotional support, active coping, and acceptance were associated with selective disclosure. Interventions to promote early disclosure should focus on coping strategies and unmet needs, particularly among black and male people living with HIV initiating care.
Collapse
Affiliation(s)
- Riddhi A. Modi
- Department of Pathology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Gerald L. McGwin
- Department of Epidemiology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - James H. Willig
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Andrew O. Westfall
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Russell L. Griffin
- Department of Epidemiology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - Rivet Amico
- Department of Health Behavior and Education, University of Connecticut, Storrs, Connecticut
| | - Kimberly D. Martin
- Department of Epidemiology, and University of Alabama at Birmingham, Birmingham, Alabama
| | - James L. Raper
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeanne C. Keruly
- Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland
| | - Carol E. Golin
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Anne Zinski
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Sonia Napravnik
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Heidi M. Crane
- Department of Medicine, University of Washington, Seattle, Washington
| | - Michael J. Mugavero
- Department of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| |
Collapse
|
5
|
Greene H, Jolly PE, Johnson T, Galarza R, Jaoko W, Padilla LA. Characteristics Associated with Disclosure Status to Sexual Partners among Kenyan Women. ACTA ACUST UNITED AC 2019; 5. [PMID: 32766452 PMCID: PMC7405985 DOI: 10.16966/2380-5536.166] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background: Kenya has the fourth-largest HIV epidemic across the globe. Disclosure of HIV-positive status plays a critical role in the prevention of HIV transmission. Disclosure, specifically to sexual partners, has been shown to foster safer sexual behaviors in addition to emotional, social, or monetary support from partners. Objective: This study was conducted to identify factors associated with HIV-positive status disclosure to sexual partners compared to disclosure to other than sexual partners. Methods: A cross-sectional study was conducted from May to August 2012 among 497 HIV-positive women 19–49 years of age who had sex in the past six months. Participants were recruited from the Kenyatta National Hospital and Mbagathi Direct Hospital in Nairobi, Kenya. A questionnaire was administered to obtain data on HIV disclosure. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with disclosure of HIV-positive status to sexual partners. Results: Of the 497 women, 349 reported to whom they had disclosed their HIV status. Approximately 34% had disclosed their HIV-positive status to a sexual partner. Women who disclosed to their sexual partners were 11 times more likely to be married or in a common-law relationship and 4 times more likely for their sexual partner or spouse to be the heads of the households. Frequency of condom use, belief that HIV disclosure is important for HIV prevention and control, knowledge of partner’s HIV status, and number of sex partners were also significantly associated with disclosing to a sexual partner. Conclusion: This study found a low rate of disclosure of HIV-positive status by women to sexual partners and identified a number of factors associated with disclosure to sexual partners. These findings can be used in designing interventions that focus on individuals who have not disclosed their HIV-positive status to their sexual partners by demonstrating the importance of disclosure and safe sex practices.
Collapse
Affiliation(s)
- Haley Greene
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Pauline E Jolly
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Tierra Johnson
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Ruby Galarza
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| | - Walter Jaoko
- Department of Medical Microbiology, University of Nairobi, Nairobi, Kenya
| | - Luz A Padilla
- Department of Epidemiology, Ryals School of Public Health, University of Alabama at Birmingham, Alabama, USA
| |
Collapse
|
6
|
Odiachi A, Erekaha S, Cornelius LJ, Isah C, Ramadhani HO, Rapoport L, Sam-Agudu NA. HIV status disclosure to male partners among rural Nigerian women along the prevention of mother-to-child transmission of HIV cascade: a mixed methods study. Reprod Health 2018; 15:36. [PMID: 29499704 PMCID: PMC5833030 DOI: 10.1186/s12978-018-0474-y] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2017] [Accepted: 02/08/2018] [Indexed: 01/22/2023] Open
Abstract
Background HIV status disclosure to male partners is important for optimal outcomes in the prevention of mother-to-child transmission of HIV (PMTCT). Depending on timing of HIV diagnosis or pregnancy status, readiness to disclose and disclosure rates may differ among HIV-positive women. We sought to determine rates, patterns, and experiences of disclosure among Nigerian women along the PMTCT cascade. Methods HIV-positive women in rural North-Central Nigeria were purposively recruited according to their PMTCT cascade status: pregnant-newly HIV-diagnosed, pregnant-in care, postpartum, and lost-to-follow-up (LTFU). Participants were surveyed to determine rates of disclosure to male partners and others; in-depth interviews evaluated disclosure patterns and experiences. Tests of association were applied to quantitative data. Qualitative data were manually analysed by theme and content using the constant comparative method in a Grounded Theory approach. Results We interviewed 100 women; 69% were 21–30 years old, and 86% were married. There were 25, 26, 28 and 21 women in the newly-diagnosed, in-care, postpartum, and LTFU groups, respectively. Approximately 81% of all participants reported disclosing to anyone; however, family members were typically disclosed to first. Ultimately, more women had disclosed to male partners (85%) than to family members (55%). Rates of disclosure to anyone varied between groups: newly-diagnosed and LTFU women had the lowest (56%) and highest (100%) rates, respectively (p = 0.001). However, family (p = 0.402) and male partner (p = 0.218) disclosure rates were similar between cascade groups. Across all cascade groups, fear of divorce and intimate partner violence deterred women from disclosing to male partners. However, participants reported that with assistance from healthcare workers, disclosure and post-disclosure experiences were mostly positive. Conclusion In our study cohort, although disclosure to male partners was overall higher, family members appeared more approachable for initial disclosure. Across cascade groups, male partners were ultimately disclosed to at rates > 75%, with no significant inter-group differences. Fear appears to be a major reason for non-disclosure or delayed disclosure by women to male partners. Augmentation of healthcare workers’ skills and involvement can mediate gender power differentials, minimize fear and shorten time to male partner disclosure among women living with HIV, regardless of their PMTCT cascade status. Trial registration Clinicaltrials.gov registration number NCT 01936753, September 3, 2013 (retrospectively registered).
Collapse
Affiliation(s)
| | - Salome Erekaha
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Llewellyn J Cornelius
- School of Social Work and College of Public Health, University of Georgia Athens, Athens, USA
| | - Christopher Isah
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria
| | - Habib O Ramadhani
- Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA
| | | | - Nadia A Sam-Agudu
- International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria. .,Institute of Human Virology, University of Maryland School of Medicine, Baltimore, USA.
| |
Collapse
|
7
|
Sarko KA, Blevins M, Ahonkhai AA, Audet CM, Moon TD, Gebi UI, Gana AM, Wester CW, Vermund SH, Aliyu MH. HIV status disclosure, facility-based delivery and postpartum retention of mothers in a prevention clinical trial in rural Nigeria. Int Health 2017; 9:243-251. [PMID: 28810669 DOI: 10.1093/inthealth/ihx023] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2017] [Accepted: 06/20/2017] [Indexed: 11/14/2022] Open
Abstract
Background Within the context of a cluster randomized prevention of mother-to-child HIV transmission (PMTCT) trial, we evaluated the impact of disclosure on selected PMTCT continuum of care measures. Methods In 12 rural matched-pair clinics randomly assigned to an intervention package versus standard-of-care, we enrolled 372 HIV-infected pregnant women from April 2013 to March 2014. This secondary analysis included 327 (87.9%) women with unknown HIV status or who were treatment naïve at presentation to antenatal care. We employed mixed effects logistic regression to estimate impact of disclosure on facility delivery and postpartum retention in HIV care at 6 and 12 weeks. Results Fully 86.5% (283/327) of women disclosed their HIV status to their partner, more in the trial intervention arm (OR 3.17, 95% CI 1.39-7.23). Adjusting for intervention arm, maternal age, education and employment, women who disclosed were more likely to deliver at a health facility (OR 2.73, 95%CI 1.11-6.72). Participants who disclosed also had a trend towards being retained in care at 6 and 12 weeks' postpartum (OR 2.72, 95% CI 0.79-9.41 and 2.46, 95% CI 0.70-8.63, respectively). Conclusions HIV status disclosure at 6 weeks' postpartum was positively associated with facility-based delivery, but not with early postpartum retention. Facilitating HIV status disclosure to partners can increase utilization of facility obstetric services.
Collapse
Affiliation(s)
- Kidane A Sarko
- Vanderbilt Institute for Global Health, Nashville, TN, USA
- Health Policy
| | | | - Aimalohi A Ahonkhai
- Vanderbilt Institute for Global Health, Nashville, TN, USA
- Medicine, Vanderbilt University Medical Center, TN, USA
| | - Carolyn M Audet
- Vanderbilt Institute for Global Health, Nashville, TN, USA
- Health Policy
| | - Troy D Moon
- Vanderbilt Institute for Global Health, Nashville, TN, USA
- Pediatrics
| | - Usman I Gebi
- Health Policy
- Friends for Global Health Initiative in Nigeria, Abuja, Nigeria
| | | | - C William Wester
- Vanderbilt Institute for Global Health, Nashville, TN, USA
- Medicine, Vanderbilt University Medical Center, TN, USA
| | | | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Nashville, TN, USA
- Health Policy
- Medicine, Vanderbilt University Medical Center, TN, USA
| |
Collapse
|
8
|
Maeri I, El Ayadi A, Getahun M, Charlebois E, Akatukwasa C, Tumwebaze D, Itiakorit H, Owino L, Kwarisiima D, Ssemmondo E, Sang N, Kabami J, Clark TD, Petersen M, Cohen CR, Bukusi EA, Kamya M, Havlir D, Camlin CS. "How can I tell?" Consequences of HIV status disclosure among couples in eastern African communities in the context of an ongoing HIV "test-and-treat" trial. AIDS Care 2017; 28 Suppl 3:59-66. [PMID: 27421052 PMCID: PMC5751752 DOI: 10.1080/09540121.2016.1168917] [Citation(s) in RCA: 50] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
People living with HIV/AIDS anticipate HIV-related stigma and fear disclosure to intimate partners. Yet, disclosure is critical to reducing HIV transmission and improving care engagement. This qualitative study characterized HIV disclosure experiences and normative beliefs among couples in communities participating in an HIV test-and-treat trial in Kenya and Uganda (Sustainable East Africa Research in Community Health, NCT#01864603). In-depth interviews were conducted with care providers (n = 50), leaders (n = 32) and members (n = 112) of eight communities. Data were analyzed using grounded theoretical approaches and Atlas.ti software. Findings confirmed gender differences in barriers to disclosure: while both men and women feared blame and accusation, women also feared violence and abandonment (“I did not tell my husband because [what if] I tell him and he abandons me at the last moment when I am in labor?”). Positive consequences included partner support for increased care-seeking and adherence (“My husband keeps on reminding me ‘have you taken those drugs?’”) Yet negative consequences included partnership dissolution, blame, and reports of violence (“some men beat their wives just because of that [bringing HIV medications home]”). Among HIV-infected individuals in discordant relationships, men more often reported supportive spouses (“we normally share [HIV-risk-reduction strategies] since I have been infected and she is HIV negative”), than did women (“my husband refused to use condoms and even threatened to marry another wife”). Care providers lent support for HIV-positive women who wanted to engage partners in testing but feared negative consequences: “They engaged the two of us in a session and asked him if we could all test.” Findings demonstrate differing experiences and support needs of women and men living with HIV in eastern Africa, with HIV-positive women in discordant couples particularly vulnerable to negative consequences of disclosure. Efforts to strengthen capacity in health systems for gender-sensitive clinician- or counselor-assisted disclosure should be accelerated within test-and-treat efforts.
Collapse
Affiliation(s)
- Irene Maeri
- a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya
| | - Alison El Ayadi
- b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA
| | - Monica Getahun
- b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA
| | - Edwin Charlebois
- c Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA
| | | | | | | | - Lawrence Owino
- a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya
| | | | | | - Norton Sang
- a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya
| | - Jane Kabami
- d Infectious Diseases Research Collaboration , Kampala , Uganda
| | - Tamara D Clark
- f Department of HIV, Infectious Disease and Global Medicine , University of California , San Francisco , CA , USA
| | - Maya Petersen
- g Divisions of Biostatistics and Epidemiology, School of Public Health , University of California , Berkeley , CA , USA
| | - Craig R Cohen
- b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA
| | - Elizabeth A Bukusi
- a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya
| | - Moses Kamya
- d Infectious Diseases Research Collaboration , Kampala , Uganda.,h School of Medicine, Makerere University College of Health Sciences , Kampala , Uganda
| | - Diane Havlir
- f Department of HIV, Infectious Disease and Global Medicine , University of California , San Francisco , CA , USA
| | - Carol S Camlin
- b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA.,c Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA
| | | |
Collapse
|
9
|
Adeoye-Agboola DI, Evans H, Hewson D, Pappas Y. Factors influencing HIV disclosure among people living with HIV/AIDS in Nigeria: a systematic review using narrative synthesis and meta-analysis. Public Health 2016; 136:13-28. [PMID: 27059370 DOI: 10.1016/j.puhe.2016.02.021] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 02/20/2016] [Accepted: 02/24/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVES To critically review, appraise and evaluate quality of evidence on HIV disclosure among people living with HIV/AIDS (PLWHA) in Nigeria, and to identify a possible gap in knowledge on HIV/AIDS and disclosure. STUDY DESIGN A systematic review using narrative synthesis and meta-analysis. METHODS MedLine, PsycINFO, PubMed Central, Scopus and CINAHL were searched. Data were extracted with the use of spread sheet. An analysis of heterogeneity was performed for the disclosure rate and the presence of a supportive reaction from partners. A meta-analysis was performed for the disclosure rates to sexual partners, with data available for all ten studies. RESULTS Ten studies met the inclusion criteria. The outcomes show that HIV disclosure of sero-positive status is most common between spouses or sexual partners than disclosure to relatives/family members, friends, pastor/Imam or work colleagues/employers. The participants in most of these studies are women, and amongst the most influential factors on disclosure are gender, anticipated outcome, marital status and knowledge of partners' status. Some studies reported non-disclosure as a way of limiting stigma. Almost all of the studies highlighted that there is fear of stigma and social exclusion associated with disclosure. CONCLUSION This review discusses the overall experience of HIV disclosure on the management of the disease and barriers to disclosure. We found that PLWHA in Nigeria disclosed to at least one person within their social networks. Stigma is still a major consideration for PLWHA who experience a range of misconceptions around HIV transmission. The findings of this study may inform local policies and plans for improving the PLWHA quality of life. Targeted policies to increase disclosure of sero-positive status and reduce stigma may facilitate disease prevention. The methodological rigour of the included studies was appraised low.
Collapse
Affiliation(s)
- D I Adeoye-Agboola
- Institute for Health Research, University of Bedfordshire, United Kingdom.
| | - H Evans
- Institute for Health Research, University of Bedfordshire, United Kingdom
| | - D Hewson
- Institute for Health Research, University of Bedfordshire, United Kingdom
| | - Y Pappas
- Institute for Health Research, University of Bedfordshire, United Kingdom
| |
Collapse
|
10
|
Tumwine JK. From Ebola in the slums of East and West Africa to NCDs, mental, child and reproductive health. Afr Health Sci 2015; 15:i-iii. [PMID: 25834569 PMCID: PMC4370150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023] Open
|