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Pagano-Therrien J, Griswold MK, Amoah RK. "Go With the Flow": A Qualitative Description of Infant Feeding Experiences Among Women With HIV in the United States. J Assoc Nurses AIDS Care 2023; 34:376-388. [PMID: 37199426 DOI: 10.1097/jnc.0000000000000411] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
ABSTRACT Breastfeeding affords numerous health benefits to mothers and children, but for women with HIV in the United States, avoidance of breastfeeding is recommended. Evidence from low-income countries demonstrates low risk of HIV transmission during breastfeeding with antiretroviral therapy, and the World Health Organization recommends exclusive breastfeeding and shared decision making about infant feeding options in low-income and middle-income countries. In the United States, gaps in knowledge exist surrounding the experiences, beliefs, and feelings of women with HIV surrounding infant feeding decisions. Undergirded by a framework of person-centered care, this study describes the experiences, beliefs, and feelings of women with HIV in the United States surrounding recommendations for breastfeeding avoidance. Although no participants reported consideration of breastfeeding, multiple gaps were identified with implications for the clinical care and counseling of the mother-infant dyad.
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Affiliation(s)
- Jesica Pagano-Therrien
- Jesica Pagano-Therrien, PhD, RN, CPNP-PC is an Associate Professor, Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA. Michele K. Griswold, PhD, MPH, RN, IBCLC is an Assistant Professor, Department of Public Health, College of Health and Human Services, Southern Connecticut State University, New Haven, Connecticut, USA. Rita Amoah, PhD, RN, is an Assistant Professor, Tan Chingfen Graduate School of Nursing, UMass Chan Medical School, Worcester, Massachusetts, USA
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Csete J, Elliott R, Bernard EJ. So many harms, so little benefit: a global review of the history and harms of HIV criminalisation. Lancet HIV 2023; 10:e52-e61. [PMID: 36202138 DOI: 10.1016/s2352-3018(22)00248-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 08/22/2022] [Accepted: 08/22/2022] [Indexed: 11/07/2022]
Abstract
Since the early years of HIV, many jurisdictions have criminalised HIV non-disclosure, potential or perceived exposure, and transmission. Many of these laws and prosecutions are without a scientific basis and reflect an inaccurate understanding of HIV-related risk and harm. Numerous studies of HIV criminal prosecutions show that women, sex workers, racial minorities, gay and bisexual men, transgender people, immigrants, and Indigenous people are disproportionately charged and convicted, often resulting in long custodial sentences. Data from molecular HIV surveillance, used to track HIV outbreaks in marginalised populations, are prone to be misused in HIV criminal cases. Scientific consensus statements and international standards have helped to guide advocacy to repeal or reform a number of these laws, resulting in fewer prosecutions in some jurisdictions. Many successful reform efforts have been led by people living with HIV and are notable at a moment of reckoning on racism and inequality in global health.
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Affiliation(s)
- Joanne Csete
- Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY, USA.
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Patterson S, Nicholson V, Gormley R, Carter A, Logie CH, Closson K, Ding E, Trigg J, Li J, Hogg R, de Pokomandy A, Loutfy M, Kaida A. Impact of Canadian human immunodeficiency virus non-disclosure case law on experiences of violence from sexual partners among women living with human immunodeficiency virus in Canada: Implications for sexual rights. WOMEN'S HEALTH 2022; 18:17455065221075914. [PMID: 35168410 PMCID: PMC8855424 DOI: 10.1177/17455065221075914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: People living with human immunodeficiency virus in Canada can face criminal
charges for human immunodeficiency virus non-disclosure before sex, unless a
condom is used and their viral load is <1500 copies/mL. We measured the
reported impact of human immunodeficiency virus non-disclosure case law on
violence from sexual partners among women living with human immunodeficiency
virus in Canada. Methods: We used cross-sectional survey data from wave 3 participant visits
(2017–2018) within Canadian HIV Women’s Sexual and Reproductive Health
Cohort Study; a longitudinal, community-based cohort of women living with
human immunodeficiency virus in British Columbia, Ontario and Quebec. Our
primary outcome was derived from response to the statement: ‘[HIV
non-disclosure case law has] increased my experiences of
verbal/physical/sexual violence from sexual partners’. Participants
responding ‘strongly agree/agree’ were deemed to have experienced increased
violence due to the law. Participants responding ‘not applicable’ (i.e.
those without sexual partners) were excluded. Multivariate logistic
regression identified factors independently associated with increased
violence from sexual partners due to human immunodeficiency virus
non-disclosure case law. Results: We included 619/937 wave 3 participants. Median age was 46 (interquartile
range: 39–53) and 86% had experienced verbal/physical/sexual violence in
adulthood. Due to concerns about human immunodeficiency virus non-disclosure
case law, 37% had chosen not to have sex with a new partner, and 20% had
disclosed their human immunodeficiency virus status to sexual partners
before a witness. A total of 21% self-reported that human immunodeficiency
virus non-disclosure case law had increased their experiences of
verbal/physical/sexual violence from sexual partners. In adjusted analyses,
women reporting non-White ethnicity (Indigenous; African/Caribbean/Black;
Other), unstable housing and high human immunodeficiency virus–related
stigma had significantly higher odds of reporting increased violence from
sexual partners due to human immunodeficiency virus non-disclosure case
law. Conclusion: Findings bolster concerns that human immunodeficiency virus criminalization
is a structural driver of intimate partner violence, compromising sexual
rights of women living with human immunodeficiency virus. Human
immunodeficiency virus non-disclosure case law intersects with other
oppressions to regulate women’s sexual lives.
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Affiliation(s)
- Sophie Patterson
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- Faculty of Health and Medicine,
University of Lancaster, Lancaster, UK
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | | | - Allison Carter
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- Kirby Institute, University of New
South Wales, Sydney, NSW, Australia
- Australian Human Rights Institute,
University of New South Wales, Sydney, NSW, Australia
| | - Carmen H Logie
- Women’s College Research Institute,
Women’s College Hospital, Toronto, ON, Canada
- Factor-Inwentash Faculty of Social
Work, University of Toronto, Toronto, ON, Canada
| | - Kalysha Closson
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
- School of Population and Public Health,
The University of British Columbia, Vancouver, BC, Canada
| | - Erin Ding
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Jason Trigg
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Jenny Li
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Robert Hogg
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- BC Centre for Excellence in HIV/AIDS,
Vancouver, BC, Canada
| | - Alexandra de Pokomandy
- McGill University Health Centre and
Department of Family Medicine, McGill University, Montreal, QC, Canada
| | - Mona Loutfy
- Women’s College Research Institute,
Women’s College Hospital, Toronto, ON, Canada
- Department of Medicine, University of
Toronto, Toronto, ON, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon
Fraser University, Burnaby, BC, Canada
- Women’s Health Research Institute
(WHRI), Vancouver, BC, Canada
- Angela Kaida, Faculty of Health Sciences,
Simon Fraser University, 8888 University Drive, Burnaby, BC V5A 1S6, Canada.
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Khan S, Kennedy VL, Loutfy M, MacGillivray J, Yudin M, Read S, Bitnun A. "It's Not Easy": Infant Feeding in the Context of HIV in a Resource-Rich Setting: Strengths, Challenges and Choices, a Qualitative Study. J Assoc Nurses AIDS Care 2021; 32:105-114. [PMID: 33177433 DOI: 10.1097/jnc.0000000000000216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Sarah Khan
- Sarah Khan, MD, MSc, is an Assistant Professor, Department of Pediatrics, McMaster University, Hamilton, Canada. V. Logan Kennedy, RN, MD, is a Research Associate and Clinical Nursing Specialist, Women's College Research Institute, Women's College Hospital and Maple Leaf Medical Clinic, Toronto, Canada. Mona Loutfy, MD, MPH, is a Senior Scientist and Director, Women HIV Research Program, Women's College Research Institute, Women's College Hospital, and Professor, Department of Medicine, University of Toronto, Toronto, Canada. Jay MacGillivray, RM, is a Registered Midwife and Adjunct Professor, Ryerson University, Co-Director Positive Pregnancy Program, St. Michael's Hospital, Toronto, Canada. Mark Yudin, MD, MSc, is an Associate Scientist and Staff Physician, Li Ka Shing Knowledge Institute, St. Michael's Hospital, and Associate Professor, Department of Obstetrics and Gynecology, University of Toronto, Toronto, Canada. Stanley Read, MD, MSc, PhD, is the Chair of CANFAR's Scientific Advisory Committee and Professor Emeritus, Department of Pediatrics and Pathobiology, University of Toronto, Toronto, Canada. Ari Bitnun, MD, MSc, is an Academic Clinician, The Hospital for Sick Children, and Professor, Department of Paediatrics, University of Toronto, Toronto, Canada
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Griswold MK, Pagano-Therrien J. Women Living With HIV in High Income Countries and the Deeper Meaning of Breastfeeding Avoidance: A Metasynthesis. J Hum Lact 2020; 36:44-52. [PMID: 31895603 DOI: 10.1177/0890334419886565] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Recommendations to avoid breastfeeding for women living with HIV in high income countries has resulted in a gap in the literature on how healthcare professionals can provide the highest standard of lactation counseling. RESEARCH AIMS (1) Describe social and emotional experiences of infant feeding for women living with HIV in high income countries; (2) raise ethical considerations surrounding the clinical recommendation in high income countries to avoid breastfeeding. METHODS A systematic literature search was conducted between January 1, 2008 and June 20, 2019. A total of 900 papers were screened and six met the inclusion criteria: (a) the sample was drawn from a high-income country regardless of the nativity of participants; (b) some or all participants were women living with HIV. Metasynthesis, according to Noblit and Hare (1988), was used to synthesize the experiences of women living with HIV in high-income countries and their experiences in infant feeding decisions. RESULTS Participants in this sample suffered a substantial emotional burden associated with infant feeding experiences potentially leading to risk of internalized stigma, suggesting that infant feeding considerations may contribute to HIV stigma in unique ways. Four overarching themes were identified expressing the meaning of avoidance of breastfeeding: maternal self-worth, deculturalization, surveillance, and intersectionality. CONCLUSION Women in high-income countries living with HIV deserve the highest standard of lactation care and counseling available. Healthcare professionals in high-income countries are ethically obligated to provide evidenced-based lactation care and counseling to women living with HIV.
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Affiliation(s)
- Michele K Griswold
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
| | - Jesica Pagano-Therrien
- Graduate School of Nursing, University of Massachusetts Medical School, Worcester, MA, USA
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Awareness and Understanding of HIV Non-disclosure Case Law and the Role of Healthcare Providers in Discussions About the Criminalization of HIV Non-disclosure Among Women Living with HIV in Canada. AIDS Behav 2020; 24:95-113. [PMID: 30900043 DOI: 10.1007/s10461-019-02463-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
In 2012, the Supreme Court of Canada ruled that people with HIV are legally obligated to disclose their serostatus before sex with a "realistic possibility" of HIV transmission, suggesting a legal obligation to disclose unless they use condoms and have a low HIV viral load (< 1500 copies/mL). We measured prevalence and correlates of ruling awareness among 1230 women with HIV enrolled in a community-based cohort study (2015-2017). While 899 (73%) participants had ruling awareness, only 37% were both aware of and understood ruling components. Among 899 aware participants, 34% had never discussed disclosure and the law with healthcare providers, despite only 5% being unwilling to do this. Detectable/unknown HIV viral load, lack of awareness of prevention benefits of antiretroviral therapy, education ≤ high-school and high HIV-related stigma were negatively associated with ruling awareness. Discussions around disclosure and the law in community and healthcare settings are warranted to support women with HIV.
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Herder T, Agardh A. Navigating between rules and reality: a qualitative study of HIV positive MSM's experiences of communication at HIV clinics in Sweden about the rules of conduct and infectiousness. AIDS Care 2019; 31:1304-1310. [PMID: 30632772 DOI: 10.1080/09540121.2019.1566590] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
The rules of conduct given to people living with HIV in Sweden in accordance with the Swedish Communicable Diseases Act stipulate disclosure obligation to sexual partners and mandatory condom use. Since 2013, treating physicians have the possibility to exempt patients from this disclosure obligation when no considerable risk of transmission is present. This study explored experiences of communication with clinical staff at HIV clinics regarding rules of conduct and infectiousness among men who have sex with men (MSM) living with HIV in Sweden. In-depth interviews were carried out with 10 MSM living with HIV in Sweden. Study participants all reported unmeasurable viral loads. Data were analyzed using qualitative content analysis. Five categories and one theme, "Navigating between rules and reality", were identified. We found that MSM living with HIV had good relationships with clinical staff at HIV clinics. Inconsistencies emerged regarding how they experienced receiving information about the rules of conduct and infectiousness. The findings indicate that lack of sound routines regarding how information and rules of conduct are communicated negatively affects MSM living with HIV and poses potential risks for the individual. The participants' expressed trust in staff at HIV clinics can provide a good basis for improved communication.
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Affiliation(s)
- Tobias Herder
- a Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University , Malmö , Sweden
| | - Anette Agardh
- a Division of Social Medicine and Global Health, Department of Clinical Sciences, Lund University , Malmö , Sweden
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Zeluf-Andersson G, Eriksson LE, Schönnesson LN, Höijer J, Månehall P, Ekström AM. Beyond viral suppression: the quality of life of people living with HIV in Sweden. AIDS Care 2018; 31:403-412. [PMID: 30444140 DOI: 10.1080/09540121.2018.1545990] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Sweden has one of the best HIV treatment outcomes in the world and an estimated 95% of all diagnosed people living with HIV are virally suppressed, but the quality of life (QoL) is understudied. The aim of this study was to examine the associations between variables within sociodemographic, behavioural, clinical, psychological, sexual life, social support and personal resource component and the QoL of people living with HIV in Sweden. Data were derived from a cross-sectional, nation-wide survey completed by 15% (n = 1096) of all people living with HIV and collected at 15 infectious disease clinics and 2 needle exchange sites during 2014. Ordinal univariate and multivariate logistic regression analyses were used to examine associations between potential contributors and QoL. Respondents reported high QoL: 63% rated their QoL 7 or higher on a scale ranging from 0 to 10. QoL was independent of gender, age, mode of HIV transmission and country of origin. Lower QoL was associated with recent homelessness, hazardous alcohol consumption, comorbidities, treatment side-effects, HIV-related physical symptoms, hopelessness, negative self-image, sexual dissatisfaction, and negative changes in sex life after HIV. The QoL of people living with HIV in Sweden was high overall, but still significantly influenced by HIV.
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Affiliation(s)
| | - Lars E Eriksson
- b Department of Learning, Informatics, Management and Ethics , Karolinska Institutet , Stockholm , Sweden.,e City, University of London , London , United Kingdom.,f Department of Infectious Diseases , Karolinska University Hospital , Stockholm , Sweden
| | | | - Jonas Höijer
- c Unit of Biostatistics, Institute of Environmental Medicine , Karolinska Institutet , Stockholm , Sweden
| | | | - Anna Mia Ekström
- a Department of Public Health Sciences , Karolinska Institutet , Stockholm , Sweden.,e City, University of London , London , United Kingdom
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Schönnesson LN, Zeluf G, Garcia-Huidobro D, Ross MW, Eriksson LE, Ekström AM. Sexual (Dis)satisfaction and Its Contributors Among People Living with HIV Infection in Sweden. ARCHIVES OF SEXUAL BEHAVIOR 2018; 47:2007-2026. [PMID: 29441436 PMCID: PMC6097728 DOI: 10.1007/s10508-017-1106-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 10/23/2017] [Accepted: 10/24/2017] [Indexed: 06/08/2023]
Abstract
Earlier research reports lower sexual satisfaction among people living with HIV (PLHIV) compared to HIV-negative persons. A number of psychosocial factors directly associated with sexual dissatisfaction have been identified. Little is known about sexual satisfaction and their contributors among PLHIV in Sweden. The aim of this study was to examine direct and indirect effects of variables within sociodemographic, clinical HIV-related, psychological, and sexual domains on sexual (dis)satisfaction among PLHIV in Sweden. Data for this study were derived from a nationally representative, anonymous survey among PLHIV conducted in 2014 (n = 1096). Statistical analysis included four steps: descriptive analyses, identification of variables associated with sexual (dis)satisfaction, identification of variables associated with those contributors of sexual (dis)satisfaction, and a path model integrating all these analyses. A total of 49% of participants reported being sexually dissatisfied, and no significant differences were observed when non-heterosexual men, heterosexual men, and women were compared. Among women, a negative change in sex life after HIV diagnosis and distress with orgasmic difficulties was directly associated with sexual dissatisfaction. For men, hopelessness, high HIV stigma, sexual inactivity in the last 6 months, and a negative change in sex life after HIV diagnosis were directly associated with sexual dissatisfaction. Path analyses showed in both men and women significant indirect associations between not being involved in an intimate relationship, lower self-reported CD4 cell counts, and perceiving obligation to disclose HIV status to sexual partners as a barrier to look for a long-term partner and sexual dissatisfaction. Our results show that despite good treatment outcomes, the HIV diagnosis has a negative bearing on sexual satisfaction. The need for gender-tailored interventions and clinical implications of these findings are discussed.
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Affiliation(s)
- Lena Nilsson Schönnesson
- Department of Public Health (Global Health/IHCAR), Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden.
| | - Galit Zeluf
- Department of Public Health (Global Health/IHCAR), Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
| | - Diego Garcia-Huidobro
- Departamento de Medicina Familiar, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Michael W Ross
- Program in Human Sexuality, Department of Family Medicine and Community Health, University of Minnesota Medical School, Minneapolis, MN, USA
| | - Lars E Eriksson
- Department of Learning, Informatics, Management and Ethics, Karolinska Institutet, Stockholm, Sweden
- School of Health Sciences, City, University of London, London, UK
| | - Anna Mia Ekström
- Department of Public Health (Global Health/IHCAR), Karolinska Institutet, Widerströmska huset, Tomtebodavägen 18A, 171 77, Stockholm, Sweden
- Department Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden
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Patterson S, Kaida A, Ogilvie G, Hogg R, Nicholson V, Dobrer S, Kerr T, Shoveller J, Montaner J, Milloy MJ. Awareness and understanding of HIV non-disclosure case law among people living with HIV who use illicit drugs in a Canadian setting. THE INTERNATIONAL JOURNAL OF DRUG POLICY 2017; 43:113-121. [PMID: 28363120 DOI: 10.1016/j.drugpo.2017.02.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2016] [Revised: 02/06/2017] [Accepted: 02/21/2017] [Indexed: 12/21/2022]
Abstract
BACKGROUND In 2012, the Supreme Court of Canada (SCC) ruled that people living with HIV (PLWH) could face criminal charges if they did not disclose their serostatus before sex posing a "realistic possibility" of HIV transmission. Condom-protected vaginal sex with a low (i.e., <1500copies/mL) HIV viral load (VL) incurs no duty to disclose. Awareness and understanding of this ruling remain uncharacterized, particularly among marginalized PLWH. METHODS We used data from ACCESS, a community-recruited cohort of PLWH who use illicit drugs in Vancouver. The primary outcome was self-reported awareness of the 2012 SCC ruling, drawn from cross-sectional survey data. Participants aware of the ruling were asked how similar their understanding was to a provided definition. Sources of information from which participants learned about the ruling were determined. Multivariable logistic regression identified factors independently associated with ruling awareness. RESULTS Among 249 participants (39% female), median age was 50 (IQR: 44-55) and 80% had a suppressed HIV VL (<50copies/mL). A minority (112, 45%) of participants reported ruling awareness, and 44 (18%) had a complete understanding of the legal obligation to disclose. Among those aware (n=112), newspapers/media (46%) was the most frequent source from which participants learned about the ruling, with 51% of participants reporting that no healthcare providers had talked to them about the ruling. Ruling awareness was negatively associated with VL suppression (AOR:0.51, 95% CI:0.27,0.97) and positively associated with recent condomless sex vs. no sex (AOR:2.00, 95% CI:1.03,3.92). CONCLUSION Most participants were not aware of the 2012 SCC ruling, which may place them at risk of prosecution. Discussions about disclosure and the law were lacking in healthcare settings. Advancing education about HIV disclosure and the law is a key priority. The role of healthcare providers in delivering information and support to PLWH in this legal climate should be further explored.
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Affiliation(s)
- Sophie Patterson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Angela Kaida
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Gina Ogilvie
- Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Robert Hogg
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Valerie Nicholson
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Sabina Dobrer
- British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, Canada
| | - Thomas Kerr
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Jean Shoveller
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Julio Montaner
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - M-J Milloy
- Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada; Faculty of Medicine, University of British Columbia, Vancouver, Canada.
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