Pregnant women and disclosure to sexual partners after testing HIV-1-seropositive during antenatal care.

Abstract

In African countries highly affected by human immunodeficiency virus-1 (HIV-1) women are more likely to be tested for HIV-1 than men due to scale-up of antenatal testing programs to prevent mother-to-child transmission (PMTCT) of HIV-1. As part of standard post-test counseling HIV-1 seropositive women are advices to disclose their status to their partners and refer them for testing. Disclosure to male partners antenatally has been associated with improved adherence to prevention of PMTCT regimens better infant feeding practices safer sex practices and increase male partner testing. Despite these findings promotion of male partner disclosure is not a central component of most PMTCT programs. While barriers to female-to-male disclosure are well-described and include socio-economic vulnerability fear of violence of abandonment and family stigma little has been published describing how to promote disclosure to male partners after antenatal testing. This study followed Kenyan HIV-1 – seropositive women enrolled in a randomized clinical trial of herpes suppression during pregnancy until 1 year postpartum to determine disclosure rates and to assess timing and correlates of disclosure. Our hypothesis was that women who were counseled and supported to disclose their HIV-1 status as part of a longitudinal research study would over time be more likely to disclose to partners. There is clear evidence that promoting disclosure to partners in the antenatal setting can lead to both individual and public health benefits but little is known about how to achieve this goal. The research indicates that rather than focusing on strategies that focus on strategies that promote disclosure by women such as counseling there should be an emphasis on strategies that make HIV-1 testing more appealing to men in this setting such as shifts in infrastructure promoting ease and availability of testing and reduction of stigma and barriers to male partner HIV-1 testing and treatment. In conclusion the research shows that mothers diagnosed with HIV-1 antenatally face challenges in disclosing to their male partners.