Abstract
BackgroundWomen’s ability to safely disclose their HIV-positive status to male partners is essential for uptake and continued use of prevention of mother-to-child transmission (PMTCT) services. However, little is known about the acceptability of potential approaches for facilitating partner disclosure. To lay the groundwork for developing an intervention, we conducted formative qualitative research to elicit feedback on three approaches for safe HIV disclosure for pregnant women and male partners in rural Kenya.MethodsThis qualitative acceptability research included in-depth interviews with HIV-infected pregnant women (n = 20) and male partners of HIV-infected women (n = 20) as well as two focus groups with service providers (n = 16). The participants were recruited at health care facilities in two communities in rural Nyanza Province, Kenya, during the period June to November 2011. Data were managed in NVivo 9 and analyzed using a framework approach, drawing on grounded theory.ResultsWe found that facilitating HIV disclosure is acceptable in this context, but that individual participants have varying expectations depending on their personal situation. Many participants displayed a strong preference for couples HIV counseling and testing (CHCT) with mutual disclosure facilitated by a trained health worker. Home-based approaches and programs in which pregnant women are asked to bring their partners to the healthcare facility were equally favored. Participants felt that home-based CHCT would be acceptable for this rural setting, but special attention must be paid to how this service is introduced in the community, training of the health workers who will conduct the home visits, and confidentiality.ConclusionPregnant couples should be given different options for assistance with HIV disclosure. Home-based CHCT could serve as an acceptable method to assist women and men with safe disclosure of HIV status. These findings can inform the design and implementation of programs geared at promoting HIV disclosure among pregnant women and partners, especially in the home-setting.
Highlights
Women’s ability to safely disclose their HIV-positive status to male partners is essential for uptake and continued use of prevention of mother-to-child transmission (PMTCT) services
Of the participants who chose to share information about their HIV-positive status, most (60%) had been diagnosed within the last 4 years and 75% had disclosed their status to their sexual partners (Table 1)
We found that no one method of facilitated HIV disclosure will be appropriate for every pregnant woman and the contexts in which women live must be taken into consideration when HIV disclosure is being recommended
Summary
Women’s ability to safely disclose their HIV-positive status to male partners is essential for uptake and continued use of prevention of mother-to-child transmission (PMTCT) services. Studies have shown that when male partners are involved in HIV testing and antenatal care (ANC), women are more likely to accept antiretroviral (ARV) prophylaxis [12,13,14,15], give birth in a health facility [16], and adhere to recommended HIV-related care [17]. Testing women and their partners during pregnancy, along with support for mutual disclosure, could prevent HIV transmission both vertically and horizontally [14,20,21]. Most PMTCT programs test pregnant women alone at the antenatal clinic and offer little support for facilitating safe disclosure of an HIV-positive diagnosis to male partners [22,23]
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