The dimensionality of disclosure of HIV status amongst post-partum women in Cape Town, South Africa

Abstract

Disclosure of HIV status to sexual partners and others has been presented as positive health behaviour and is widely encouraged by antiretroviral treatment (ART) programmes, providers and policies. However, disclosure is also highly contextual and its positive effects are not universal. We explore the dimensions of disclosure amongst post-partum women who initiated ART during pregnancy in Cape Town, South Africa. Forty-seven semi-structured interviews with post-partum women were conducted as part of the Maternal Child Health-Antiretroviral Therapy (MCH-ART) study. Primary elements of disclosure were coded and interpreted according to dominant themes and subthemes. Disclosure was commonplace in the sample, ranging from widely disclosing status (rare); to disclosing to some family, friends and partners; to tacit disclosure, where participants took medication in front of others without explicitly discussing their status. Women described reasons for non-disclosure in terms of not being ready, fear of negative reactions (including violence and loss of financial support), and fear of their status being widely known. Self-reported adherence was uniformly high throughout the range of disclosure. Even those who made special efforts to avoid disclosure, such as attending clinics distant from their homes, reported good adherence. Those who disclosed experienced a range of responses to their disclosure, from support to shunning. Despite access to ART, stigma remained a persistent feature in descriptions of disclosure, particularly in relation to partner disclosure. Our findings suggest that disclosure is not always positive and adherence can be maintained within a wide range of disclosure behaviours. It is important that clinic settings allow women to retain control over their disclosure process.

HIV viral suppression among pregnant and breastfeeding women in routine care in the Kinshasa province: a baseline evaluation of participants in CQI‐PMTCT study

“…Nonetheless, our finding in that disclosure of HIV status to anyone might negatively affect viral suppression in breastfeeding women warrants further investigations. Emerging data from South Africa suggest that disclosure is not always universally positive and may depend on the person to whom the status is disclosed to .…”

How Much Do They Know? An Analysis of the Accuracy of HIV Knowledge among Youth Affected by HIV in South Africa

“…25 Also, HIV disclosure is becoming less stigmatized in the country with research showing that among HIV-positive females in the Western Cape province, disclosure of status to some family, friends, and partners was common practice, and tacit exposure, seen through taking medication in front of others, was not uncommon. 26 This makes it more likely that youth in the country would be aware of someone living with or who has died from the disease in their households and communities. A small percentage of youth affected by HIV/AIDS have, by this conceptualization, accurate knowledge of the disease.…”

Social support, disclosure and stigma and the association with non-adherence in the six months after antiretroviral therapy initiation among a cohort of HIV-positive adults in rural KwaZulu-Natal, South Africa

“…However, we found no association between disclosure to a partner and non-adherence. Secondly, past studies indicate that depression and lack of belief in own self-efficacy are associated with both low social support and increased non-adherence in HIV-positive adults in SSA (Conroy et al., 2017; Hunter-Adams et al., 2017; Kekwaletswe, Jordaan, Nkosi, & Morojele, 2016; Ncama et al., 2008). Our study did not measure these factors, so it is possible that residual confounding by these factors contributed to the difference between our results and previous research Finally, the majority of research in this area has collected qualitative data, which may better reflect relationship dynamics and individualised support networks provided by friends and family than the quantitative measures used in our analyses (Conroy et al., 2017; Hunter-Adams et al., 2017).…”

“…Chronic disease literature based in sub-Saharan Africa (SSA) has documented poor adherence and the importance of social support in conditions which require life-long treatment (Adegbola, Marincowitz, Govender, & Ogunbanjo, 2016; Loeliger, Niccolai, Mtungwa, Moll, & Shenoi, 2016; Mendenhall & Norris, 2015; Ncama et al., 2008; Oni et al., 2014; Osamor, 2015). However, high levels of HIV-related perceived stigma can inhibit HIV disclosure and thus prevent patients from accessing social support (Bhengu et al., 2011; Hunter-Adams et al., 2017; Ncama et al., 2008; Osamor, 2015; Treffry-Goatley et al., 2016). The closely interwoven and likely dynamic nature of disclosure, stigma and social support make this a challenging research area (Treffry-Goatley et al., 2016).…”