Patterns and Predictors of HIV-Status Disclosure Among Pregnant Women in South Africa: Dimensions of Disclosure and Influence of Social and Economic Circumstances

Brittain, Kirsty; Mellins, Claude A.; Remien, Robert H.; Phillips, Tamsin K; Zerbe, Allison; Abrams, Elaine J.; Myer, Landon

doi:10.1007/s10461-018-2263-6

Cited by 22 publications

(26 citation statements)

References 35 publications

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“…Similar disclosure rates were reported in the literature among pregnant and postpartum women [20,25,26]. Given that HIV status disclosure is a dynamic process that evolves [2,27], the seven-point increase in the disclosure rate observed after 24 months post-delivery is not surprising. This further demonstrates that individuals living with HIV become more open and comfortable with their partners, thus, facilitating discussion about their status [25,28].…”

Section: Discussionsupporting

confidence: 84%

“…Evidence shows that disclosure of HIV status promotes voluntary testing, safer sexual practices and improves adherence to antiretroviral therapy (ART) [1]. Also, HIV status disclosure has been linked to positive mental health outcomes given that social support from family and social networks has been shown to improve psychological well-being and may play a signi cant role in the facilitation of the development of effective coping strategies, in addition to obtaining nancial support from family members [2].…”

Section: Introductionmentioning

confidence: 99%

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

Adeniyi

Nwogwugwu

Ajayi

et al. 2020

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Background: Disclosure of HIV serostatus to sexual partner does not only facilitate partner's support and testing, but it also correlates with better treatment outcomes. We drew from a cross-sectional survey conducted among postpartum women with HIV to examine the rate of serostatus disclosure to sexual partners, the influence of relationship status, and knowing one's partner's status on disclosure and reasons for non-disclosure. Methods: We conducted telephonic interviews with a final sample of 485 postpartum women with HIV drawn from the East London Prospective Cohort study database between January and May 2018. Disclosure of HIV status to partner was based on self-reporting. We fitted adjusted and unadjusted logistic regression models and also conducted descriptive statistical analyses. Results: Overall, 82.5% of the respondents had disclosed their status to their partners. After adjusting for important covariates (age, education level, employment status, number of years since HIV diagnosis, alcohol use and smoking behaviour), being married [adjusted odds ratio (AOR): 2.66; 95% confidence interval (CI):1.17-6.05] and knowing one's partner's status [AOR: 46.91; 95% CI:19.50-112.81] were significantly associated with a higher odds of having disclosed HIV status to sexual partners. Fear of rejection, stigma or being judged, new or casual relationships, and having a violent partner were the main reasons for not disclosing HIV status to sexual partners. Conclusion: We found a relatively high rate of HIV status disclosure in the cohort. Being married and having open communication with a partner about HIV status are important factors facilitating disclosure to sexual partners.

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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

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

Adeniyi

Nwogwugwu

Ajayi

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…Similar disclosure rates were reported in the literature among pregnant and postpartum women [17,22,23]. Given that HIV status disclosure is a dynamic process that evolves [2,24], the seven-point increase in the disclosure rate observed after 24 months post-delivery is not surprising. This further demonstrates that individuals living with HIV become more open and comfortable with their partners, thus, facilitating discussion about their status [22,25].…”

Section: Discussionsupporting

confidence: 84%

“…Evidence shows that disclosure of HIV status promotes voluntary testing, safer sexual practices and improves adherence to antiretroviral therapy (ART) [1]. Also, HIV status disclosure has been linked to positive mental health outcomes given that social support from family and social networks has been shown to improve psychological well-being and may play a significant role in the facilitation of the development of effective coping strategies, in addition to obtaining financial support from family members [2].…”

Section: Introductionmentioning

confidence: 99%

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

Adeniyi

Nwogwugwu

Ajayi

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Disclosure of HIV serostatus to sexual partner does not only facilitate partner's support and testing, but it also correlates with better treatment outcomes. We drew from a cross-sectional survey data conducted among postpartum women with HIV to examine the rate of serostatus disclosure to sexual partners, the influence of relationship status, and knowing one's partner's status on disclosure and reasons for non-disclosure.Methods We conducted telephonic interviews with a final sample of 485 postpartum women with HIV drawn from the East London Prospective Cohort study database between January and May 2018. Disclosure of HIV status to partner was based on self-reporting. We fitted adjusted and unadjusted logistic regression models and also conducted descriptive statistical analyses.Results Overall, 82.5% of the respondents had disclosed their status to their partners. After adjusting for important covariates (age, education level, employment status, number of years since HIV diagnosis, alcohol use and smoking behaviour), being married [adjusted odd ratio (AOR): 2.66; 95% confidence interval (CI):1.17–6.05] and knowing one's partner's status [AOR: 46.91; 95% CI:19.50-112.81] were significantly associated with a higher odds of having disclosed HIV status to sexual partners. Fear of rejection, stigma or being judged, new or casual relationships, and having a violent partner were the main reasons for not disclosing HIV status to sexual partners.Conclusion We found a relatively high rate of HIV status disclosure in the cohort. Being married and having open communication with a partner about HIV status are important factors facilitating disclosure to sexual partners.

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“…Nonetheless, our finding in that disclosure of HIV status to anyone might negatively affect viral suppression in breastfeeding women warrants further investigations. Emerging data from South Africa suggest that disclosure is not always universally positive and may depend on the person to whom the status is disclosed to .…”

Section: Discussionmentioning

confidence: 99%

HIV viral suppression among pregnant and breastfeeding women in routine care in the Kinshasa province: a baseline evaluation of participants in CQI‐PMTCT study

et al. 2019

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Introduction Published data on viral suppression among pregnant and breastfeeding women in routine care settings are scarce. Here, we report provincial estimates of undetectable and suppressed viral load among pregnant or breastfeeding women in HIV care in Kinshasa, Democratic Republic of Congo (DRC) and associated risk factors. Methods This cross‐sectional study was conducted as part of a baseline assessment for the CQI‐PMTCT study: an ongoing cluster randomized trial to evaluate the effect of continuous quality interventions (CQI) on long‐term ART outcomes among pregnant and breastfeeding women (NCT03048669). From November 2016 to June 2018, in each of the 35 Kinshasa provincial health zones (HZ), study teams visited the three busiest maternal and child health clinics, enrolled all HIV‐positive pregnant or breastfeeding women (≤1 year post‐delivery) receiving ART, and performed viral load testing. Log binomial models with generalized estimating equations to account for clustering at the HZ level, were used to estimate prevalence ratios comparing participants with undetected (<40 copies/mL) or suppressed (<1000 copies/mL) viral load across levels of individual and site characteristics. Results Of the 1752 eligible women, 1623 had viral load results available, including 38% who had been on ART for <6 months and 74% were on tenofovir‐lamivudine‐efavirenz. Viral load was undetectable in 53% of women and suppressed in 62%. Among women who were on ART for ≥12 months, only 60% and 67% respectively, had undetectable or suppressed viral load. Viral load was undetectable in 53%, 48% and 58% of women testing during pregnancy, at delivery, and in postpartum respectively. In multivariable log binomial models, duration of ART >12 months, older age, being married, disclosure of HIV status, receiving care in an urban health zone or one supported by PEPFAR were all positively associated with viral suppression. Conclusions The observed high level of detectable viral load suggests that high ART coverage alone without substantial efforts to improve the quality of care for pregnant and breastfeeding women, will not be enough to achieve the goal of virtual elimination of vertical HIV transmission in high‐burden and limited resources settings like DRC.

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Patterns and Predictors of HIV-Status Disclosure Among Pregnant Women in South Africa: Dimensions of Disclosure and Influence of Social and Economic Circumstances

Cited by 22 publications

References 35 publications

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

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

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

HIV viral suppression among pregnant and breastfeeding women in routine care in the Kinshasa province: a baseline evaluation of participants in CQI‐PMTCT study

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