HIV status disclosure during acute HIV infection in Malawi

Abstract

Diagnosis of acute HIV infection (AHI) presents an opportunity to prevent HIV transmission during a highly infectious period. Disclosure is important during AHI as a means to facilitate safer sex practices and notify partners, particularly as those with AHI may be better able to identify the source of their infection because of the recency of HIV acquisition. However, little is known about disclosure during AHI. We conducted 40 semi-structured interviews with Malawians diagnosed with AHI (24 men; 21 married). Most participants reported disclosing to a sexual partner within a month of diagnosis, and knew or had a strong suspicion about the source of their infection. Participants often assumed their source had knowingly infected them, contributing to anger and feeling that disclosure is futile if the source already knew their HIV status. Assisted partner notification, individual and couples counseling, and couples HIV testing may facilitate disclosure during AHI.Clinical trial registration number: NCT01450189.

It Cannot Happen, Never: A Qualitative Study Exploring Youth Views on Disclosure of HIV Diagnosis to Their Sexual Partners in Southern Malawi

“…Malawi is one of several developing countries with reports of early sexual debut (below 15 years of age) and high engagement in risky sexual behaviors in youth, including by those living with HIV (Malawi National AIDS Commission, 2015; Pindani et al, 2014). Studies in this country have examined HIV status disclosure among people living with HIV in Malawi; however, these studies focused on patterns of HIV status disclosure to children of their HIV diagnosis by caregivers or health workers and between adult sexual partners (Hino et al, 2018; Kalembo et al, 2018; Mandalazi et al, 2014). No published study has yet investigated HIV status disclosure by youth living with HIV to sexual partners, despite current evidence of high engagement in risky sexual behaviors in this group.…”

Ethical considerations for HIV remission clinical research involving participants diagnosed during acute HIV infection

“…This potentially tumultuous process may involve the formation of new HIV-positive identities [ 77 ] and negotiating what infection means to patients, their partners, and families. For those diagnosed during AHI, evidence suggests that this time is “often a marker of chaotic events in patients’ lives” [ 10 ] and, similar to HIV diagnoses generally, AHI diagnoses have been linked to distress, anxiety, depression [ 10 ], anger, confusion [ 78 ], and guilt [ 74 ]. Previous research on AHI has considered its social, emotional, and sexual hallmarks [ 56 , 66 – 71 , 78 – 80 ].…”

“…For those diagnosed during AHI, evidence suggests that this time is “often a marker of chaotic events in patients’ lives” [ 10 ] and, similar to HIV diagnoses generally, AHI diagnoses have been linked to distress, anxiety, depression [ 10 ], anger, confusion [ 78 ], and guilt [ 74 ]. Previous research on AHI has considered its social, emotional, and sexual hallmarks [ 56 , 66 – 71 , 78 – 80 ]. The National Institute of Mental Health Multisite Acute HIV Infection study [ 81 , 82 ] found that AHI people reduced their numbers of sexual partners and serosorted, but continued to practice condomless sex [ 66 ].…”

“…Second, due to the shorter duration between infection and diagnosis, AHI people may have a much better understanding of the risk behaviors or sex partners that led to their infections [ 8 , 9 , 74 , 78 ] compared to CHI counterparts. Therefore, AHI people may have more guilt and/or clearly directed resentment toward their partners [ 74 , 78 ], depending on the circumstances of the suspected route of transmission.…”

“…Second, due to the shorter duration between infection and diagnosis, AHI people may have a much better understanding of the risk behaviors or sex partners that led to their infections [ 8 , 9 , 74 , 78 ] compared to CHI counterparts. Therefore, AHI people may have more guilt and/or clearly directed resentment toward their partners [ 74 , 78 ], depending on the circumstances of the suspected route of transmission. Conversely, in the age of cART and its widely understood benefits, AHI people who perceive themselves as at higher risk for infection may feel grateful to have prompt detection of HIV infection and the opportunity to begin cART early [ 87 ].…”