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

Abstract

BackgroundHIV 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.MethodsHIV-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.ResultsWe 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.ConclusionIn 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 registrationClinicaltrials.gov registration number NCT 01936753, September 3, 2013 (retrospectively registered).

Social concerns related to HIV status disclosure and participation in the prevention of mother-to-child transmission of HIV care among pregnant women in Kenya

“…We found that concern about isolation or lack of support from family or friends appear to be barriers to HIV disclosure, which is in line with a recently published mixed-methods study from Tanzania where stigma in family and community was the most frequently cited reason for non-disclosure of HIV status among 24 women in PMTCT care [23]. Our finding that concerns about conflict or separation appear to be a barrier for disclosure is also in line with one quantitative and five qualitative studies from SSA, suggesting that these concerns are important to address when developing strategies to promote HIV disclosure [19][20][21][22][23]25].…”

“…However, qualitative evidence from sub-Saharan Africa (SSA) and Asia has shown that concerns about unintentional HIV status disclosure and HIV related stigma are barriers to participate in PMTCT care among pregnant women [13][14][15][16][17][18]. Qualitative studies have also identified other important barriers to HIV status disclosure including concerns about separation or divorce [19][20][21][22][23], conflicts with a partner [19,21], intimate partner violence (IPV) [19][20][21]23] and stigma in the family or community [20,23]. However, only a few quantitative studies have been conducted to further identify social concerns related to HIV disclosure and participation in PMTCT care.…”

Male involvement in prevention of mother to child transmission of human immunodeficiency virus and associated factors in Enebsiesarmider District, north West Ethiopia, 2018: a cross-sectional study

“…The aforementioned mode of transmissions is collectively known as mother-to-child transmission of HIV or vertical transmission of HIV [1][2][3]. Preventing HIV transmission in pregnant women and their children often referred to as the prevention of mother-to-child transmission [4,5]. Mother-to-child transmission of HIV remains a significant problem in the low and middleincome countries, despite the development and growing availability of effective prevention methods for resourcelimited settings [6,7].…”

HIV positive status disclosure to a sexual partner: the influence of marital status and partner communication

“…Control variables: Socio-demographic, lifestyle behaviours and clinical charateristics were the covariates included in this study. The selection of these covariates were based on the existing knowledge of HIV disclosure in the literature (8)(9)(10)(11).…”

“…Sociocultural factors impacting gender and inequality are key factors in uencing the low rates of serostatus disclosure among women living with HIV [8]. Varying rationale for the lack of disclosure includes, but is not limited to, fear of abandonment, especially where nancial resources are involved, safety, and intimate partner violence [9][10][11].…”