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

Abstract

Background: Social concerns about unintentional HIV status disclosure and HIV-related stigma are barriers to pregnant women's access to prevention of mother-to-child transmission of HIV (PMTCT) care. There is limited quantitative evidence of women's social and emotional barriers to PMTCT care and HIV disclosure. We aimed to investigate how social concerns related to participation in PMTCT care are associated with HIV status disclosure to partners and relatives among pregnant women living with HIV in western Kenya. Methods: A cross-sectional study, including 437 pregnant women living with HIV, was carried out at enrolment in a multicentre mobile phone intervention trial (WelTel PMTCT) in western Kenya. Women diagnosed with HIV on the day of enrolment were excluded. To investigate social concerns and their association with HIV disclosure we used multivariableadjusted logistic regression, adjusted for sociodemographic and HIV-related characteristics, to estimate odds ratios (OR) and 95% confidence intervals (CI). Results: The majority (80%) had disclosed their HIV status to a current partner and 46% to a relative. Older women (35-44 years) had lower odds of disclosure to a partner (OR = 0.15; 95% CI: 0.05-0.44) compared to women 18-24 years. The most common social concern was involuntary HIV status disclosure (reported by 21%). Concern about isolation or lack of support from family or friends was reported by 9%, and was associated with lower odds of disclosure to partners (OR = 0.33; 95% CI: 0.12-0.85) and relatives (OR = 0.37; 95% CI: 0.16-0.85). Concern about separation (reported by 5%; OR = 0.17; 95% CI: 0.05-0.57), and concern about conflict with a partner (reported by 5%; OR = 0.18; 95% CI: 0.05-0.67), was associated with lower odds of disclosure to a partner.

The effect of weekly interactive text-messaging on early infant HIV testing in Kenya: a randomised controlled trial (WelTel PMTCT)

“…Other possible reasons are lower barriers to testing due improved partner disclosure of HIV status and diminished concerns of intimate partner violence 36 . We have previously observed that pregnant women in this study setting are more willing to disclose their HIV status to a current partner 37 compared to earlier studies 38 – 44 , which is consistent with other recently published studies from Kenya 45 – 47 , indicating a potential positive move forward towards more openness between partners. We have also reported on reduced concerns of intimate partner violence related to women’s participation in PMTCT care in the study area 37 .…”

“…We have previously observed that pregnant women in this study setting are more willing to disclose their HIV status to a current partner 37 compared to earlier studies 38 – 44 , which is consistent with other recently published studies from Kenya 45 – 47 , indicating a potential positive move forward towards more openness between partners. We have also reported on reduced concerns of intimate partner violence related to women’s participation in PMTCT care in the study area 37 . Moreover, the proportion of infants diagnosed with HIV by eight weeks of age in our trial was only 1.0%, which is much lower than the national EID HIV transmission rate (5%) by eight weeks of age among HIV-exposed infants in 2019 1 .…”

“…Moreover, the proportion of infants diagnosed with HIV by eight weeks of age in our trial was only 1.0%, which is much lower than the national EID HIV transmission rate (5%) by eight weeks of age among HIV-exposed infants in 2019 1 . This could also be an indication of reductions of barriers to testing with increasing disclosure and openness about HIV to partners 37 , reduction in stigma among women in PMTCT care 48 , and program improvements resulting in improved ART adherence among women enrolled in PMTCT care 1 , 6 . The different transmission rates (in Kenya vs. in our trial) are however not fully comparable since 6% of pregnant women living with HIV in Kenya did not receive ART in 2019 1 , a subpopulation that may have contributed disproportionally to the the MTCT of HIV.…”

HIV serostatus disclosure to sexual partner: a survey among women in Tehran, Iran

“…The analysis of this study shows that the prevalence of status disclosure to partners among HIV-positive women who were older than 18 years is 85.2%. The findings of this study are similar to disclosure rates in studies carried out in Uganda and Kenya reporting 85.4% and 80% HIV-status disclosure rates by women to their male partners, respectively [ 34 , 35 ]. Conversely, the prevalence observed in this study is higher compared to previous studies conducted in Uganda (57%) and Tanzania (66%) [ 34 , 36 ].…”

Male partner unknown HIV status as a risk factor for HIV incidence and clinical outcomes in prevention of mother-to-child transmission of HIV programmes in 21 WHO priority countries: a systematic review protocol

“…Results from a meta-analysis found that more than 67% of pregnant women in sub-Saharan Africa had disclosed their HIV status 17. Increased disclosure rates were also evident in subsequent studies conducted after 2015, with disclosure rates of 80%, 85%, 94.9% and 99% in Kenya, Nigeria, Malawi and Uganda, respectively6 18–21 and disclosure to male partners was more evident than disclosure to family members 6 17 19. According to Bucagu et al ,21 HIV status disclosure is more frequent in women than in men and disclosure is generally higher in steady partners than in casual partners.…”