HIV sero-status disclosure and associated factors among HIV positive women in East Africa: Systematic review and meta-analysis. Implications for prevention of mother-to-child HIV transmission

HIV self-testing and HIV nondisclosure to male sexual partners among adolescent girls and young women living with HIV in semi-rural northern Uganda: a cross-sectional study

BACKGROUND

The burden of HIV remains disproportionally high among the adolescent girls and young women. This is often coupled with nondisclosure of HIV status partly due to delayed knowledge of HIV status which affects entry into HIV prevention interventions. HIV self-testing which provides instant knowledge of HIV status is being promoted to enable early disclosure. However, previous studies about the association between HIV self-testing (HIVST) and HIV disclosure are scarce. We, therefore, set out to determine the prevalence of HIVST, nondisclosure of HIV status to male partners, and the predictors among adolescent girls and young women living with HIV (AGYWLHIV) in Uganda.

METHODS

In a cross-sectional study design, a stratified random sample of AGYWLHIV were recruited from ART clinics in semi-rural northern Uganda between November 2022 and April 2023. The participants received an interviewer-administered questionnaire. HIV self-testing was defined as the use of the HIVST method by the AGYWLHIV to discover their HIV status. Similarly, HIV nondisclosure was defined as the AGYWLHIV's failure to disclose her initial HIV status to her current male sexual partner before their first sexual intercourse regardless of the use of condoms.

RESULTS

A total of 423 participants with a mean age of 21.6 ± 2.5 years participated in the study. The study found that only 3.8% of the AGYWLHIV discovered their HIV status through HIVST. Furthermore, 26.7% of the AGYWLHIV did not disclose their status to their current male partners, 35.5% experienced non-disclosure from their current male partners, and 16.5% experienced bidirectional non-disclosure. The predictors for non-disclosure of initial HIV status were found to include the AGYWLHIV's knowledge of their initial negative HIV status [APR 0.3 (0.2-0.5), p 0.001], the AGYWLHIV's knowledge of their initial positive HIV status [APR 0.5 (0.3-0.7), p 0.002], the AGYWLHIV's prior knowledge of the positive initial HIV status of the male partner [APR 0.4 (0.2-0.8), p 0.010] and the male partner's nondisclosure of their initial HIV status to the AGYWLHIV [APR 2.0 (1.2-3.5), p 0.008].

CONCLUSIONS

The prevalence of HIVST and HIV nondisclosure to male sexual partners among the AGYWLHIV in semi-rural Uganda stood at 38 in 1000 and 267 in 1000 respectively. The HIVST wasn't associated with HIV nondisclosure but the women's initial negative or positive HIV status, the male partner's initial positive HIV status and the male partners' nondisclosure of their initial HIV status to the AGYWLHIV were found to be independent predictors. These findings point to the need for health workers to target the distribution of HIVST kits at the AGYWLHIV attending ART clinics to give them to men in their sexual and social networks to expand access to HIV testing, improve chances of two-way HIV disclosure and entry into the HIV prevention, treatment, and care services.

HIV status disclosure to male sexual partners and predictors among young women living with HIV in rural Uganda: a cross-sectional study

Background

In 2020 in sub-Saharan Africa, 25% of new human immunodeficiency virus (HIV) infections occurred among young women (15-24 years). In Uganda, the HIV prevalence is three times higher among young women at 2.9% compared to 0.8% among their male counterparts. HIV status disclosure is a gateway to preventive services.

Objectives

We set out to estimate the prevalence of HIV status disclosure to current male partners, and the predictors among the adolescent girls and young women living with HIV (AGYWLHIV) in a semi-rural northern Uganda.

Design

In a cross-sectional study design, a consecutive sample of the AGYWLHIV was recruited from six antiretroviral therapy clinics between November 2022 and April 2023.

Methods

Participants were administered an interviewer-guided questionnaire. They were asked whether they have ever disclosed their HIV status to their current male partners. They were also asked about their socio-demographics, sexual and reproductive health profiles, knowledge and perceptions of dual protection, and safer conception methods for AGYWLHIV. Percentages to estimate prevalence, Chi-square tests to assess associations, simple and multivariate modified Poisson regression to identify predictors at p < 0.05 and 95% confidence intervals (CI) were considered.

Results

Overall, 423 participants with a median age of 22 (IQR 4) years participated in the study. The prevalence of HIV status disclosure to the current male partners was found at 73.3% (95% CI 69.0-77.5). The predictors for HIV status disclosure were found to include the women's knowledge of their HIV status (APR 1.1 (95% CI 1.0-1.2), p 0.032), knowledge of their male partner's HIV status (APR 0.8 (95% CI 0.7-0.9), p 0.003), and the male partners' disclosure of their HIV status to the women (APR 0.7 (95% CI 0.5-0.9), p <0.016).

Conclusion

About three-fourths of the AGYWLHIV in semi-rural northern Uganda disclosed their HIV status to their male partners. The predictors of disclosure included the women's knowledge of their HIV status, knowledge of their male partner's HIV status, and the male partner's reciprocal disclosure of their HIV status. To enhance disclosure rates, post-test, and disclosure counseling for both individuals and couples is recommended as part of the routine HIV testing, treatment, and care programs.

Factors Associated With Feeling Ashamed of Disclosure of HIV-Positive Status Among Women Who Self-Reported to Health Facilities for HIV Testing in Kenya: Analysis of 2022 Kenya Demographic and Health Survey

Background

This study aimed to determine the factors associated with feeling ashamed of disclosing HIV-positive status among females who self-reported to health facilities for HIV testing in Kenya.

Method

This study used the Kenya Demographic Health Survey data set for 2022. A total of 18,506 women aged 15-49 years were selected from the sample clusters; 13,815 had ever tested for HIV and 332 had positive results for HIV. The chi-squared test was applied to determine the association between the selected variables of interest and the outcome variable. Furthermore, to identify the explanatory variables that were associated with the outcome variable of interest, logistic binary regression was performed. A p > 0.05 and all statistical analyses were conducted using Microsoft Excel (xlsx) and STATA15.

Results

The analysis included 332 women who had tested positive during the survey out of which 125(38%) women agreed to have felt ashamed to disclose their HIV+ status. Agreed to stigma (AOR = 1.92, 95% CI: 1.15, 3.22; p < 0.05) and being intimidated by health workers (AOR = 2.49, 95% CI: 1.05, 5.93; p < 0.05) were significantly associated with feeling ashamed of disclosing HIV+ status. The remaining variables, such as age category, residence, marital status, educational attainment, total number of children born, access to information, sex partners excluding spouses in the last 12 months, and number of lifetime sex partners, were not associated with feeling ashamed.

Conclusion

Health stigmatization and intimidation Stigmatization had an almost two-fold likelihood of causing shame in the disclosure of HIV status among females with HIV who were studied.

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

BACKGROUND

HIV partner disclosure rates remain low among pregnant women living with HIV in many African countries despite potential benefits for women and their families. Partner disclosure can trigger negative responses like blame, violence, and separation. Women diagnosed with HIV late in pregnancy have limited time to prepare for partner disclosure. We sought to understand challenges around partner disclosure and non-disclosure faced by women diagnosed with HIV late in pregnancy in South Africa and Uganda and to explore pathways to safe partner disclosure.

METHODS

We conducted in-depth interviews and focus group discussions with pregnant women and lactating mothers living with HIV (n = 109), disaggregated by antenatal care (ANC) initiation before and after 20 weeks of gestation, male partners (n = 87), and health workers (n = 53). All participants were recruited from DolPHIN2 trial sites in Kampala (Uganda) and Gugulethu (South Africa). Topic guides explored barriers to partner disclosure, effects of non-disclosure, strategies for safe disclosure. Using the framework analysis approach, we coded and summarised data based on a socio-ecological model, topic guides, and emerging issues from the data. Data was analysed in NVivo software.

RESULTS

Our findings illustrate pregnant women who initiate ANC late experience many difficulties which are compounded by the late HIV diagnosis. Various individual, interpersonal, community, and health system factors complicate partner disclosure among these women. They postpone or decide against partner disclosure mainly for own and baby's safety. Women experience stress and poor mental health because of non-disclosure while demonstrating agency and resilience. We found many similarities and some differences around preferred approaches to safe partner disclosure among female and male participants across countries. Women and male partners preferred healthcare workers to assist with disclosure by identifying the 'right' time to disclose, mentoring women to enhance their confidence and communication skills, and providing professional mediation for partner disclosure and couple testing. Increasing the number of counsellors and training them on safe partner disclosure was deemed necessary for strengthening local health services to improve safe partner disclosure.

CONCLUSION

HIV diagnosis late in pregnancy amplifies existing difficulties among pregnant women. Late ANC initiation is an indicator for the likelihood that a pregnant woman is highly vulnerable and needs safeguarding. Respective health programmes should be prepared to offer women initiating ANC late in pregnancy additional support and referral to complementary programmes to achieve safe partner disclosure and good health.

Non-Disclosure of HIV-Positive Serostatus: Unmatched Case-Control Study in People Living with HIV in Public Health Facilities of Gedeo Zone, Southern Ethiopia

Background

Non-disclosure of HIV-positive status (NDHPSS) is the individual's experience of hiding their HIV status from other people or groups. People who fail to reveal their HIV-positive serostatus risk contracting the virus again, not receiving the best possible care, and even dying.

Purpose

To assess predictors of NDHPSS in people living with HIV in public health facilities in Gedeo-Zone, Southern-Ethiopia.

Methods

In Gedeo-Zone, Southern Ethiopia, a facility-based, unmatched, case-control study was carried out from the first of February to March 30, 2022GC. With a case-to-control ratio of 1:1, a total of 360 respondents (89 cases and 271 controls) were involved. The respondents were chosen using a sequential sampling technique. EpiData-V-3.1 was used to enter the data, and SPSS-V-25 was used to analyse it. To determine the factors that were connected to the result, a binary logistic regression analysis was performed. AOR at the 95% confidence interval and p-values under 0.05 were utilised to explain their statistical significance.

Results

The study had 360 participants in total-271 controls and 89 cases-resulting in a response rate of 97.6%. The average age of the participants was 35.6 years (SD: 8.3). After adjusting the possible confounders, sex (AOR = 2.8, 95% CI: 1.04-7.56), residence (AORs = 3.52, 95% CI: 2.83-9.39), WHO clinical stage I (AORs = 4.68, 95% CI: 1.9-22.1), short duration of ART follow-up care (AOR = 4.21, 95% CI: 1.65-10.73), and number of lifetime sexual partners (AOR = 6.9, 95% CI: 1.86-26.3) were significantly associated factors with the outcome.

Conclusion

According to this study, living in a rural area and being in WHO clinical stage one, in addition to being a woman and having multiple sexual partners during one's lifetime, were predictors of non-disclosure of an HIV-positive serostatus. As a result, encouraging people with HIV in WHO stage I and those who have had more than one sexual partner in their lifetime to disclose their status and expanding counselling services for rural residents and women have a substantial impact on reducing the HIV load.