Test and Tell: Correlates and Consequences of Testing and Disclosure of HIV Status in South Africa (HPTN 043 Project Accept)

Abstract

Background As the numbers of HIV-positive diagnoses rise in South Africa, it is important to understand the determinants and consequences of HIV disclosure. Methods Cross-sectional survey from random community samples of men and women in urban and rural South Africa (n = 217 HIV-positive individuals, 89% female). Results Two thirds of all known HIV-infected adults in these communities had disclosed their status to sexual partner(s). On average, individuals who disclosed were 2 years older, higher in socioeconomic assets, and had known their HIV status 7 months longer than those who had not told their sexual partner(s). The “need for privacy” was the most cited reason (45%) for nondisclosure among those who had never disclosed. People who eventually disclosed their HIV status to sexual partner(s) were significantly more likely to report always or more frequently using condoms, reducing their number of sexual partners, and/or becoming monogamous. Among individuals who disclosed their HIV status, 77% reported increases in social support, with families providing the most support. Conclusions Disclosure is associated with reports of consequent safer sexual behavior and greater social support. Interventions might be informed by the costs and benefits of disclosure and differences in disclosure to sexual partner vs. to one’s social network.

Disclosure in times of ART: A relational analysis of social practices

“…While quantitative studies on disclosure rates tell us something about practices among PLWHA (see, for instance: Akani & Erhabor 2006;Varga, Sherman & Jones 2006;Wong, Rooyen, Modiba, Richter, Gray, McIntyre, et al 2009), they face two main methodological challenges: (1) disclosure rates strongly depend on the duration of the recall/study period; (2) Alongside the rational motivations for disclosure emphasized by public health recommendations, the choice of disclosing -and to whom -often reflects power differentials within social relationships. Disclosing one's HIV status has been described as particularly risky for women, as (fear of) accusations of infidelity, rejection, abandonment, discrimination and violence may follow The situations presented and analyzed in this special issue add to our empirical knowledge of disclosure, helping to document the wide range of social contexts that influence practice and the ethical issues involved.…”

Sociocultural Factors Influencing HIV Disclosure Among Men in South Africa

“…Most HIV infections in sub-Saharan Africa occur in committed, heterosexual relationships where infected partners may not have disclosed their status (Ramirez-Ferrero & LustiNarasimhan, 2012). In recent years, a growing body of research has explored the disclosure experiences of people living with HIV and AIDS in South Africa (Vu et al, 2012;Wong et al, 2009). Results suggested that most people, particularly men living with HIV, do not disclose knowledge of their seropositive status to their partners (Olley, Seedat, & Stein, 2004;Simbayi et al, 2007).…”

Partager l'information sur son statut sérologique VIH dans un contexte de polygamie au Sénégal

“…Diverses études témoig-nent de la complexité du partage de l'information qu'elles abordent selon les approches des droits humains, de la santé publique, ou sous l'angle des contradictions entre obligations de santé publique et respect du secret médical (Reproductive Health Matters 2000). En Afrique subsaharienne la variété des niveaux de partage de l'information des personnes séropositives avec leur conjoint en fonction des contextes épidémiologiques, sanitaires et du vécu social de l'infection à VIH a été documentée (Smith, Rossetto & Peterson 2008;Wong, Rooyen, Modiba, Richter, Gray, McIntyre, et al 2009). Ces études rapportent des pratiques de « secret» autour de la séropositivité du fait des difficultés du partage de l'information.…”