The Association Between HIV Disclosure Status and Perceived Barriers to Care Faced by Women Living with HIV in Latin America, China, Central/Eastern Europe, and Western Europe/Canada

Abstract

Generally, women are less likely than men to disclose their HIV status. This analysis examined the relationship between HIV disclosure and (1) perceived barriers to care and (2) quality of life (QoL) for women with HIV. The ELLA (EpidemioLogical study to investigate the popuLation and disease characteristics, barriers to care, and quAlity of life for women living with HIV) study enrolled HIV-positive women aged ≥18 years. Women completed the 12-item Barriers to Care Scale (BACS) questionnaire. QoL was assessed using the Health Status Assessment. BACS and QoL were stratified by dichotomized HIV disclosure status (to anyone outside the healthcare system). Multilevel logistic regression analysis was used to identify factors associated with disclosure. Of 1945 patients enrolled from Latin America, China, Central/Eastern Europe, and Western Europe/Canada between July 2012 and September 2013, 1929 were included in the analysis (disclosed, n = 1724; nondisclosed, n = 205). Overall, 55% of patients lived with a husband/partner, 53% were employed, and 88% were receiving antiretroviral therapy. Patients who were with a serodiscordant partner were more likely to disclose (p = 0.0003). China had a disproportionately higher percentage of participants who did not disclose at all (nearly 30% vs. <15% for other regions). Mean BACS severity scores for medical/psychological service barriers and most personal resource barriers were significantly lower for the disclosed group compared with the nondisclosed group (p ≤ 0.02 for all). Compared with the disclosed group, the nondisclosed group reported statistically significantly higher (p ≤ 0.03) BACS item severity scores for 8 of the 12 potential barriers to care. The disclosed group reported better QoL. Overall, HIV nondisclosure was associated with more severe barriers to accessing healthcare by women with HIV.

Sex Trade and Health Care Utilization Among People Living with HIV/AIDS

“…Those trading sex were also more likely to use illicit drugs, but were not more likely to utilize substance use treatment, suggesting a greater need to address drug use in this population. Globally, such associations of sex trade and substance use have been seen among PLWH [3,4], but until now, this has not been well documented among persons living with HIV in the US. The results of this paper provide insights into the potential effects sex trade may have on engagement in HIV care and non-HIV related health services, particularly among racial and sexual minority PLWH in the US [44,45].…”

Comparing Outcomes of HIV-Infected Chinese Adults on Antiretroviral Therapy by CD4 Count at Treatment Initiation: A Nationwide Retrospective Observational Cohort Study, 2012–2014

“…38 Recent studies highlighted several major barriers of engagement in HIV care in China. 39,40 Two of these barriers are psychological burden of committing to HIV care and perceived discrimination from healthcare workers. 40 Thus, China had a high percentage of participants who did not disclose at all.…”

“…40 Thus, China had a high percentage of participants who did not disclose at all. 39 The importance of treatment adherence should be emphasized for patients newly initiated to ART therapy through education and counseling programs. 41 ART patients may benefit from patient support groups or other strategies aimed at promoting skills for coping with societal HIV-related stigma.…”

Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV

“…Quantifying people living with HIV who would benefit from an alternative to daily oral therapy: Perspectives from HIV physicians and people living with HIV oral) 12 . Daily intake can be a source of concern regarding unintentional disclosure of HIV status or serve as an unwanted reminder of HIV 13,14 . Drug-drug and drug-food interactions, as well as pill aversion, can also complicate daily oral ART 12,[15][16][17] .…”

“…Given the anticipated change in treatment paradigm because of the advent of long-acting regimens 18,19 , it is important to quantify problems related to daily oral dosing to determine who may benefit most from long-acting regimens. While some problems have been previously identified [12][13][14][15][16][17]20,21 , the populations in some of those studies were either PLHIV alone [22][23][24] or healthcare providers (HCPs) alone 25,26 . This may not provide a complete picture of problems associated with treatment as attitudes and perceived priorities of patients versus providers may not always converge perfectly.…”