To disclose or not: experiences of HIV infected pregnant women in disclosing their HIV status to their male sexual partners in Blantyre, Malawi

Abstract

Background HIV status disclosure is one of the pillars of success of the elimination of Mother to Child Transmission of HIV (eMTCT) program. However, there are challenges associated with it that limit full disclosure. Literature shows that for pregnant women in developing countries, who have been diagnosed with HIV, 16% to 86% disclose their status to their sexual partners. This study explored the experiences of newly diagnosed HIV-infected antenatal women in disclosing their HIV status to their male sexual partners in Blantyre, Malawi. Methods This was a qualitative explanatory multiple case study that was conducted from 2018 to 2019 using in-depth interviews and diaries as data collection tools. We recruited seven newly diagnosed HIV pregnant women who had not disclosed their status to their male sexual partners and were initiated on Option B + strategy of the eMTCT of HIV at Limbe Health Centre. The investigator had 3 contacts with each participant from which data was gathered except for one participant who got lost to follow-up. This study employed content analysis and used a within-case and across-case analysis. Results Women either use facilitated mutual disclosure process or disclosed directly to their male sexual partners. Women were motivated to disclose because they wanted an HIV-free baby, to know the partners' status, and to resolve the gap on how they got infected with HIV. The disclosure process faced challenges such as uncertainty about a partner’s reaction after disclosure, fear of relationship dissolution, and the soberness of the partner. Privacy was an important consideration during the process of disclosure. Following disclosure, male sexual partners either accepted the status immediately after disclosure or initially denied but later accepted. Conclusion This study has shown that newly diagnosed HIV pregnant women accessing eMTCT services have a plan of either to disclose or conceal their HIV status from their male sexual partner and this decision is affected by the nature of relationship that exist between them and their partner. Factors relating to the unborn baby, the relationship as well as to know partners status motivate women to either disclose or conceal.

Prevention of Mother-to-Child Transmission (PMTCT) Adherence Barriers of Pregnant Women and New Mothers Living with HIV in Greater Gaborone, Botswana

“…This nding on HIV status disclosure was lower than most studies from Sub-Saharan Africa, with disclosing HIV status with a partner ranging from 70% and 86.5% ( [50,6,[51][52][53][54] . Other African studies have found that HIV-infected women who had not disclosed their status did not do so due to the fear of abandonment by a male partner [55] and these women were less likely to use PMTCT services [56,57]. In a qualitative study in urban Kenya, HIV positive women who did not disclose their status [56] were found to be relatively new in their relationships and their employment status was also associated with non-disclosure of HIV-positive status.…”

Understanding the Intersections of IPV and HIV and Their Impact on Infant Feeding Practices: A Narrative Literature Review

“…HIV-related stigma and discrimination can prevent women from seeking testing, treatment, and support services. Fear of disclosure, judgment, or rejection may lead to delayed diagnosis and reduced adherence to treatment, impacting overall health outcomes [60,61].…”

Support, not blame: safe partner disclosure among women diagnosed with HIV late in pregnancy in South Africa and Uganda

“…Partner disclosure – the process of enlightening HIV status to a partner – is associated with improved antiretroviral therapy (ART) initiation, adherence, and retention in care among pregnant and postpartum women [ 2 ] and safe infant feeding practices [ 3 , 4 ]. Further, women’s partner disclosure can boost partner relationships, through male partner’s involvement in pregnancy [ 5 , 6 ], social support [ 7 ], HIV testing among male partners, and condom use among HIV sero-different partners [ 6 , 8 , 9 ] but evidence is inconsistent across settings [ 10 , 11 ]. Non-disclosure, on the other hand, can cause worry and stress among pregnant women [ 12 ] leading to sub-optimal engagement in antenatal care (ANC) [ 13 ] and ART services [ 12 , 14 , 15 ], virologic non-suppression [ 16 , 17 ] and infant feeding challenges [ 3 ].…”

“…Partner disclosure is difficult, more so during pregnancy [ 9 , 12 ]. Rates of partner disclosure among pregnant women living with HIV range from 30 to 93% (pooled estimate: 64%) across Africa [ 18 ], also being lower for HIV-seropositive status compared to HIV-negative status [ 10 , 19 ].…”

“…Rates of partner disclosure among pregnant women living with HIV range from 30 to 93% (pooled estimate: 64%) across Africa [ 18 ], also being lower for HIV-seropositive status compared to HIV-negative status [ 10 , 19 ]. A smooth relationship, caring partner, and supportive health workers can facilitate partner disclosure [ 9 , 20 , 21 ], whereas fear of blame, anger, violence, abandonment, and/or loss of partner’s financial or emotional support deters partner disclosure [ 12 , 21 – 23 ]. Although many partners react calmly and are supportive, partner disclosure can trigger negative outcomes, including anger and emotional, physical, or sexual intimate partner violence (IPV) [ 19 , 24 , 25 ].…”