Safer disclosure of HIV serostatus for women living with HIV who experience or fear violence: a systematic review

Abstract

IntroductionSupporting individuals as they disclose their HIV serostatus may lead to a variety of individual and public health benefits. However, many women living with HIV are hesitant to disclose their HIV status due to fear of negative outcomes such as violence, abandonment, relationship dissolution and stigma.MethodsWe conducted a systematic review of studies evaluating interventions to facilitate safer disclosure of HIV status for women living with HIV who experience or fear violence. Articles, conference abstracts and programme reports were included if they reported post-intervention evaluation results and were published before 1 April 2015. Searching was conducted through electronic databases for peer-reviewed articles and conference abstracts, reviewing websites of relevant organizations for grey literature, hand searching reference lists of included studies and contacting experts. Systematic methods were used for screening and data abstraction, which was conducted in duplicate. Study quality (rigor) was assessed with the Cochrane risk of bias tool.ResultsTwo interventions met the inclusion criteria: the Safe Homes and Respect for Everyone cluster-randomized trial of combination HIV and intimate partner violence (IPV) services in Rakai, Uganda, and the South Africa HIV/AIDS Antenatal Post-Test Support study individual randomized trial of an enhanced counselling intervention for pregnant women undergoing HIV testing and counselling. Both programmes integrated screening for IPV into HIV testing services and trained counsellors to facilitate discussions about disclosure based on a woman's risk of violence. However, both were implemented as part of multiple-component interventions, making it impossible to isolate the impact of the safer disclosure components.ConclusionsThe existing evidence base for interventions to facilitate safe HIV serostatus disclosure for women who experience or fear violence is limited. Development and implementation of new approaches and rigorous evaluation of safe disclosure outcomes is needed to guide programme planners and policy makers.

Violencia de pareja en la mujer que vive con VIH

“…A pesar del consenso internacional sobre la necesidad de facilitar una revelación más segura del estado serológico del VIH por parte de las mujeres a sus parejas, en aquellas que experimentan o temen la violencia, la revisión de Kennedy y colegas solo identificó dos estudios que evaluaron estas intervenciones (63). Ambos eran de África subsahariana, y no proporcionaron evidencia clara de la efectividad de una intervención de revelación del estado de diagnóstico de infección por el VIH, pero en general se observa que hay mayor riesgo de muerte por suicidio u homicidio que en las mujeres que no experimentan este tipo de violencia (64,65).…”

Estigmatização de pessoas que vivem com HIV/aids e sua relação com suporte social e qualidade de vida

“…Uma outra relação também muito ligada à busca pelo sigilo é o medo da violência doméstica referida por muitas mulheres, as quais, temendo a reação agressiva de seus companheiros, da separação, da perda da casa e de outros bens, e até pelo medo de perder a guarda dos filhos, omitem a situação diagnóstica (KENNEDY et al, 2015).…”

“…Assim, lidar com as comorbidades e com os efeitos adversos não é fácil para PVHA, pois viver omitindo qualquer manifestação corporal, torna-se necessário para manter o papel social do indivíduo, o respeito e a dignidade por apresentarem uma imagem de cidadão "saudável" (KENNEDY et al, 2015;SILVA, J. B. et al, 2015;SOUZA et al, 2013).…”

Mitigating intimate partner violence to promote safe linkage to care for South African women who test HIV positive during mobile counseling and testing.

“…5). Consequently, strategies to facilitate non-violence upon partner notification are vitally needed for women affected by both HIV and IPV (Kennedy et al, 2015;Maman, Mbwambo, Hogan, Kilonzo & Sweat, 2001). In the process of planning safe disclosure strategies, individuals should be empowered to make their own decision as to whether or not they will disclose to 41 their partners, given that each situation is unique and each person must determine if it is safe for her to disclose (A le Roux-Kemp, 2013).…”

“…Test the effectiveness of HIV-IPV interventions (WHO, 2001) using rigorous methodology and prioritizing effectiveness in resource-limited countries in sub-Saharan Africa (Jewkes et al, 2006); and 5. Explore strategies for effective safety planning for women with HIV who are also IPV victims (Mkandawire-Vahlmu et al, 2013), with a particular need for developing safe partner notification strategies (Kennedy, Haberlen, Amin, Baggaley & Narasimhan, 2015).…”