Predictors of HIV serostatus disclosure to partners among HIV-positive pregnant women in Morogoro, Tanzania

Abstract

BackgroundPrevention of mother to child transmission of HIV (PMTCT) has been scaled, to more than 90% of health facilities in Tanzania. Disclosure of HIV results to partners and their participation is encouraged in the program. This study aimed to determine the prevalence, patterns and predictors of HIV sero-status disclosure to partners among HIV positive pregnant women in Morogoro municipality, Tanzania.MethodsA cross sectional study was conducted in March to May 2010 among HIV-positive pregnant women who were attending for routine antenatal care in primary health care facilities of the municipality and had been tested for HIV at least one month prior to the study. Questionnaires were used to collect information on possible predictors of HIV disclosure to partners.ResultsA total of 250 HIV-positive pregnant women were enrolled. Forty one percent (102) had disclosed their HIV sero-status to their partners. HIV-disclosure to partners was more likely among pregnant women who were < 25 years old [Adjusted odds ratio (AOR) = 2.2; 95% CI: 1.2–4.1], who knew their HIV status before the current pregnancy [AOR = 3.7; 95% CI: 1.7–8.3], and discussed with their partner before testing [AOR = 6.9; 95% CI: 2.4–20.1]. Dependency on the partner for food/rent/school fees, led to lower odds of disclosure to partners [AOR = 0.4; 95% CI: 0.1–0.7]. Nine out of ten women reported to have been counseled on importance of disclosure and partner participation.ConclusionsSix in ten HIV positive pregnant women in this setting had not disclosed their results of the HIV test to their partners. Empowering pregnant women to have an individualized HIV-disclosure plan, strengthening of the HIV provider initiated counseling and testing and addressing economic development, may be some of the strategies in improving HIV disclosure and partner involvement in this setting.

Gender-Specific Risk Factors for Virologic Failure in KwaZulu-Natal: Automobile Ownership and Financial Insecurity

“…Existing literature has demonstrated that financial insecurity is a barrier to care and is associated with poor adherence and VF, yet no studies have assessed differences in this association between genders (25, 26, 56–58). The association between financial dependency indicators and VF among women but not men in this cohort may indicate that personal financial insecurity is a risk factor for VF more specific to women in this context, as has been suggested by some findings in countries where women are often dependent upon men (16, 59, 60). …”

Sexual Behaviour, Sero-Status Disclosure and Willingness to Disclose Status among HIV Positive Male Patients Receiving Care in Hospitals in Imo State, Nigeria

“…These determinants were; being in an older age group [32,40,41], married [5,16,27,35,38,41], not religious [42] having a higher level of education [32,38,41,43] and residing in an urban or semi-urban place [43]. Notwithstanding, some of these socio-demographic determinants for disclosure were on the contrary, not also observed in other studies such as; being in an older age group [5,35], being married [33,40], not religious [32], level of education [5,35,40], occupation [40,41], lower level of income [41] and residing in an urban or semi-urban place [35]. Therefore, it can be further observed that these relationships with disclosure appear to vary within and across studies which is probably due to the influence of a number of peculiar factors and circumstances that motivate disclosure such as the target of disclosure, HIV care and also, the enabling social and environmental conditions that exists.…”

Untitled

“…Thus, gender must be considered when analyzing power structure and access to resources in the United States (US), where historically and socioculturally women have had lower social standing than men [19]. The challenges of power inequalities and group subordination within the social construction of gender have become increasingly important in the context of HIV transmission and engagement in HIV care, and treatment [20,21]. For women, HIV-related stigma is frequently layered on top of the stigma and discrimination that sexism generates.…”

“…HIV-infected women are often hesitant to disclose their status for fear of being labeled promiscuous, a drug user, or simply dirty [20,28]. They know that disclosing their medical condition to others may jeopardize their personal relationships and economic status [21]. Lower rates of disclosure of positive serostatus among women have been associated with increased reports of mental health challenges [25].…”

“…For example, internalized stigma was specifically associated with ART non-adherence while enacted and anticipated stigma were linked to the presence of co-morbid conditions and lower CD4 counts [57]. Anticipated stigma has also been linked with patterns of HIV disclosure [21].…”