Disclosure Of HIV-positive Status Research Articles

Factors influencing adherence to antiretroviral therapy among young adults in Limpopo province.

South Africa is among the countries with the greatest burden of human immunodeficiency virus (HIV) in the world. The introduction of antiretroviral therapy (ART) has made HIV a manageable chronic health condition with a return to normal life expectancy. Adherence to ART is a prerequisite to realising these benefits. A qualitative study was conducted using individual semi-structured interviews to understand factors influencing adherence to ART among young adults. The study was conducted at three busy primary care clinics around Mankweng Hospital. Participants aged 18-35 years who had been on ART for more than a year were purposefully selected. Open-ended questions were used to explore factors that influence ART. Recorded interviews were transcribed verbatim and translated. The coded transcripts were thematically analysed. Eight major themes were identified to influence ART adherence among young adults: medication-related factors, healthcare system factors, attitudes of healthcare workers, economic factors, disclosure, acceptance, mobile phone reminders and family support. Adherence to ART is a major problem in our communities, and people living with HIV are still finding it challenging to optimally adhere to their ART medication because of the identified factors that influence ART adherence. Family support is a significant factor that was identified to positively influence ART as it leads to disclosure and acceptance of HIV-positive status, better emotional well-being and subsequently improved ART adherence.Contribution:This study underscores the importance of a family-oriented, patient-centred care approach in managing HIV and ART adherence.

Estimating HIV Disclosure and Its Impact on Social Relations: A Cross-Sectional Study in Gujarat, India

Background: The disclosure of HIV-positive status can significantly impact social relationships. This study aimed to evaluate the prevalence of self-disclosure of HIV status and its effects on social relations among individuals living with HIV (PLHIV) in Gujarat, India. Methods: Conducted from April to June 2021, this cross-sectional study involved 383 PLHIV attending a tertiary-care medical college hospital in Gujarat, India. The sample size was determined using Epi Info software version 7. Data collection utilized a structured questionnaire covering socio-demographic information, HIV disclosure status, and its impact on social relationships. Multiple logistic regression analysis identified predictors of non-disclosure of HIV status to spouses. Results: Among the 383 participants, 83% disclosed their HIV status to their spouse, while disclosure rates to other social contacts varied. Post-disclosure, 7% reported strained or broken relationships with their spouses. Factors associated with non-disclosure to spouses included older age (adjusted odds ratio [aOR] 1.13, 95% confidence interval [CI] 1.07-1.20), female gender (aOR 6.00, 95% CI 1.81-19.88), lack of post-test counselling (aOR 3.29, 95% CI 1.01-10.70), and spouse being HIV-negative (aOR 3.60, 95% CI 1.27-10.25). Conclusion: In conclusion, while a significant proportion of PLHIV disclosed their HIV status to spouses, a notable proportion experienced strained relationships post-disclosure. Addressing barriers to disclosure, especially among older individuals and females, and ensuring adequate post-test counselling, may facilitate open communication and support among PLHIV and their social networks.

Disclosure of diagnosis by parents and caregivers to children infected with HIV in Hawassa, southern Ethiopia: a multicentre, cross-sectional study.

In recent years, the life expectancy of human immunodeficiency virus (HIV)-infected children has increased with the availability of highly active antiretroviral therapy (ART). Regardless of the clinical recommendations encouraging HIV status disclosure, the practice of caregiver disclosure is frequently challenging due to many constraints associated with caregivers and healthcare personnel. As studies suggest, disclosure of the HIV-positive status of children is low, particularly in sub-Saharan Africa, where the majority of infected children reside. Thus the primary objective of this study was to evaluate the prevalence of HIV-positive status disclosure to infected children and the pertinent factors associated with caregivers of these children. Moreover, unlike previous studies conducted in Ethiopia, this study included children residing in orphanages. We assessed HIV-positive status disclosure and associated factors among infected children in Hawassa, southern Ethiopia, from 25 May to 20 July 2021. A facility-based cross-sectional study was conducted in six public health facilities that provide HIV treatment and care. Data were collected from 355 randomly selected caregivers using interviewer-administered questionnaires and record reviews. Binary and multiple logistic regression was used to explore the association between independent variables and the outcome. The adjusted odds ratio (aOR) with 95% confidence interval (CI) was computed to determine the strength of the association and a p-value <0.05 was considered statistically significant. Of the 355 children, 132 (37.2%) were informed about their HIV-positive status. Being of young age (≤12y) (aOR 0.52 [95% CI 0.28 to 0.98]), having caregivers who were not familiar with anyone who disclosed children's HIV status (aOR 0.28 [95% CI 0.16 to 0.49]), children with a family that had a primary education (aOR 0.46 [95% CI 0.23 to 0.89]) and being a child who has taken ART for <5y (aOR 0.47 [95% CI 0.28 to 0.80]) had a significant association with non-disclosure of HIV-positive status to infected children. The findings show that disclosure of HIV-positive status to infected children is low. This suggests the need to provide support and education to caregivers, facilitate experience-sharing sessions between caregivers who disclosed the HIV status to infected children and implement age-specific disclosure interventions for young children. In addition, it is important to provide support and counselling to the children when their HIV status is disclosed.

Completion rate of tuberculosis preventive therapy and incidence of tuberculosis among people living with the Human Immunodeficiency Virus on antiretroviral therapy in Ekurhuleni East subdistrict, Gauteng province.

the World Health Organization (WHO) has recommended the use of tuberculosis preventive therapy (TPT) as part of a comprehensive care package for the reduction of tuberculosis (TB) incidence among people who are living with human immunodeficiency virus (PLWHA). When used optimally, TPT efficacy ranges between 60% and 90% among adults and children who are living with HIV. Despite the wide adoption of this intervention in South Africa, the country remains heavily burdened with high rates of TB/HIV co-infections, reported to be 59% in 2018. Reported challenges include low uptake and completion rates. This study aimed to determine the TPT completion rate and investigate the incidence of TB among antiretroviral therapy (ART) patients who were initiated on TPT. this descriptive cross-sectional retrospective cohort study was conducted among HIV-positive patients who were on ART, 18 years old and above, and had been initiated on TPT between June 2019 and June 2021 at the selected PHC facilities in Ekurhuleni East sub-District. We conducted record reviews and face-to-face interviews to collect data. These were captured onto a Microsoft Excel spreadsheet, cleaned, and coded before importation onto the Epiinfo version 7 statistical software package for statistical analyses. the study found a majority of female participants, (60.5%). The median age of participants was 39.0 years (IQR=15), with most aged 50 years old and above, (21.3%). The treatment course of TPT was completed at the prescribed 12 months by 196 (30%) of the 395 participants. Only 12 (3%) of the participants were found to have TB, half 6 (50%) of which were breakthrough cases of TB. The reasons for non-completion of TPT included clinicians not offering it to patients, (46/276 (16.7%)). The barriers to TPT completion included not having a treatment supporter, (73.2%); p<0.001, while disclosure of positive HIV status was found to facilitate TPT completion (83.2%); p<0.001. the observed TPT completion rate of 30% needs to be addressed as it is far below the national threshold of 85%. The barriers and facilitators to TPT completion also require attention to help improve the TPT completion rate.

Investigating coping and stigma in people living with HIV through narrative medicine in the Italian multicentre non-interventional study DIAMANTE

Antiretroviral therapy (ART) significantly reduced Human Immunodeficiency Virus (HIV) morbidity and mortality; nevertheless, stigma still characterises the living with this condition. This study explored patients’ coping experience by integrating narrative medicine (NM) in a non-interventional clinical trial. From June 2018 to September 2020 the study involved 18 centres across Italy; enrolled patients were both D/C/F/TAF naïve and previously ART-treated. Narratives were collected at enrolment (V1) and last visit (V4) and then independently analysed by three NM specialist researchers through content analysis. One-hundred and fourteen patients completed both V1 and V4 narratives. Supportive relationships with clinicians and undetectable viral load facilitated coping. Conversely, lack of disclosure of HIV-positive status, HIV metaphors, and unwillingness to narrate the life before the diagnosis indicated internalised stigma. This is the first non-interventional study to include narratives as patient reported outcomes (PROs). Improving HIV awareness and reducing the sense of guilt experienced by patients helps to overcome stigma and foster coping.

The Psychosocial Profile of Women Who Defaulted Option B+ HIV Treatment: An Interpretive Phenomenological Analysis Study.

The study explored the psychosocial profile of women who defaulted Option B+ HIV treatment at Chitungwiza Municipality clinics in Zimbabwe. Option B+ is a strategy to prevent mother-to-child transmission (PMTCT) of HIV to reduce MTCT rate to less than or equal to 5%. An interpretive phenomenological analysis (IPA) design was used. Data were collected from 04 September to 12 October 2020 on twelve purposively selected HIV-positive breastfeeding women aged 18 to 40 years, who defaulted Option B+ HIV treatment. Unstructured individual face-to-face interviews were utilised. Data were analysed thematically using the interpretive phenomenological analysis framework for data analysis. The study findings revealed that participants experienced the following: psychosocial and emotional challenges due to HIV positive results, shown emotional distress and suicidal tendencies which affected their mental health. Their relationship was derailed due to abuse, infidelity, partner's high-risk behaviour and to lack of support stemming from their partners and family members. Strengthening adherence support interventions and effective counselling on HIV-positive status disclosure and male partner involvement is important for retaining women in care and for improving their quality of life. Comprehensive, integrated, and tailor-made interventions should be adopted. Couple HIV counselling and testing should be encouraged. Psychosocial and mental health should be encouraged. Furthermore, community sensitization, risk reduction behaviour, education on purpose and side effects of ART as well as the benefits of Option B+ to new enrolments should be intensified and strengthened to minimize defaulting of treatment and LTFUP. Vigorous patient tracing and visit reminders help retain women in care.

Evaluating the Efficacy of the Sudita Model for Enhancing HIV Disclosure Among Couples in Jambi City, Indonesia

This study aimed to assess the impact of the Sudita Model on the frequency and timeliness of HIV-positive status disclosure to partners in Jambi City, Indonesia. A quasi-experimental design employing a non-equivalent control group with a pre-test and post-test approach was utilized. The research was conducted in Jambi City, Jambi Province, Indonesia, beginning in June 2021. The ADDIE model approach, which includes 1) Analysis, 2) Design, 3) Development, 4) Implementation, and 5) Evaluation, was employed for model development. A sample size of 78 individuals was divided into two groups: an intervention group utilizing the Sudita Model and a control group using the Ministry of Health Module (M. Kemenkes). The research variables included the number of HIV status disclosures to partners and the time (in days) required for disclosing HIV status to partners between the intervention and control groups before, after one month, and after three months of intervention. Data analysis was performed using the General Linear Model Repeated Measures multivariate test. The results indicated a significant increase in the average number of HIV-positive status disclosures to partners after one and three months of intervention, rising from an average of 16 individuals (at month one) to 26 individuals (at month three), with a p-value of 0.000. The Sudita Model intervention results demonstrated a significant enhancement in the timeliness of HIV-positive status disclosure to partners, with an average disclosure time of 28.9 days for the Sudita Model compared to 54.4 days for the Ministry of Health Module. In conclusion, the Sudita Model is more effective in increasing the frequency and speed of HIV-positive status disclosure among couples than the Ministry of Health Model. The Sudita Model's influence on accelerating HIV-positive status disclosure to partners suggests that changes in the behavior of people living with HIV/AIDS (PLWHA) can be facilitated by providing comprehensive information about HIV/AIDS and continuous support tailored to the evolving needs of PLWHA via persuasive communication approaches.

Human Rights of the HIV-Infected Persons in India: Issues and Concerns

Human rights are basic rights of human beings regardless of gender, religious identity and nationality. Human beings and their rights are constitutionally and legally protected. Though safeguards are there against human rights violations, Human Immunodeficiency Virus (HIV) infected people have to face several injustices in our society. People living with HIV are usually subjected to discrimination in the society even in the 21st century. Society’s attitude towards these people is that of stigma and discrimination. They are provided with the right to privacy according to the current human rights standards. However, the fact is that for the prevention of further spread of HIV, disclosure of HIV-positive status is imperative. Unless the society’s attitude towards HIV-infected persons changes, an HIV/AIDS-free world cannot be dreamt of.

Factors associated with low antiretroviral therapy enrollment of children in the Simiyu region: A cross-sectional Creswell mixed-methods sequential explanatory design.

Despite substantial antiretroviral therapy (ART) coverage in other groups with the human immunodeficiency virus (HIV) in Tanzania, there is a progressive decline in ART enrollment among HIV-infected children. This study aimed to determine the factors affecting the enrollment of children with HIV in ART and to identify an effective, sustainable intervention to address children's ART care enrollment. To achieve this, we conducted a cross-sectional study using a mixed-method sequential explanatory design, including children with HIV aged 2 to 14 years in the Simiyu region. Stata™ and NVIVO™ software were used to perform quantitative and qualitative data analyses, respectively. In the quantitative analyses, we considered 427 children, with a mean age of 8.54 ± 3.54 years and a median age of 3 years (interquartile range: 1-6 years). The mean length of ART initiation delay was 3.71 ± 3.21 years. Additionally, independent child enrollment predictors included distance to the facility (adjusted odds ratio [AOR]: 3.31; 95% confidence interval [CI]:1.14-9.58), caregivers' income (AOR: 0.17; 95% CI: 0.07-0.43), and fear of stigma (AOR: 3.43; 95% CI: 1.14-10.35). In qualitative analyses, 36 respondents reported that stigma, distance, and lack of HIV-positive status disclosure to their fathers were causes for low enrollment in ART. Overall, this study demonstrated that a caregiver's income, distance to obtain HIV care services, HIV-positive status non-disclosure to the father, and fear of stigma played a significant role in children's enrollment in HIV care. As such, HIV/acquired immunodeficiency syndrome programs would benefit from having intensive interventions to address distance, such as scaling up care and treatment centers, as well as techniques to reduce stigma in the population.

Human immunodeficiency virus positive status disclosure among children in northwest Ethiopia: a cross-sectional study.

Human Immunodeficiency Virus positive status disclosure is an essential component of pediatric care and longterm disease management. However, one of the greatest challenges that caregiver/mothers and health care workers face is the disclosure of HIV positive status to children living with the virus. Therefore, the objective of this study was to assess HIV positive status disclosure and associated factors among HIV positive children in northwest Ethiopia. Institutional based cross-sectional study was conducted among 417 sampled HIV positive children attending pediatric ART clinics of public health facilities from February 01 to March 30 2020 in northwest Ethiopia. Simple random sampling technique was used to select study participants. A structured interviewer administered questionnaire was used for data collection and the collected data entered into Epi data software. Binary logistic regression analysis was done and variables with P-value <0.05 was considered as a significant predictors of HIV positive status disclosure of HIV positive children. From 417 sampled population, 390 were involved in this study making 93.5% response rate. The study revealed that 53.6% with 95% CI (0.486-0.586) of HIV positive children knew their HIV positive sero status. Caregiver/mothers who had greater than three family sizes (AOR=1.984, 95% CI=1.046-3.762), children whose ages greater than 10 years (AOR=6.679, 95% CI=3.372-13.227) and children on ART for more than 5 years (AOR=8.96, 95% CI=6.402-12.257) were predictors of HIV positive status disclosure. The HIV positive status disclosure was high in the study area relative to other studies. Family size, children age, and length of children on ART were predictors of HIV positive status disclosure for HIV positive children. Health care providers, especially those working at pediatrics ART clinics should keep these factors in mid while working with caregivers to encourage disclosure of HIV positive status.

Pediatrics HIV-positive status disclosure and its predictors in Ethiopia: a systematic review and meta-analysis.

IntroductionHIV-positive status disclosure for children is challenging for family members, guardians, and healthcare professionals. Disclosure is very challenging, particularly for children, yet no systematic synthesis of evidence accurately measures HIV-positive status disclosure in children. This systematic review and meta-analysis study aimed to quantify the national prevalence of pediatric HIV-positive status disclosure in Ethiopia and identify factors associated with HIV-positive status disclosure.MethodWe systematically searched PubMed, EMBASE, Web of Science databases, and google scholar for relevant published studies. Studies published in the English language and conducted with cohort, case-control, and cross-sectional designs were eligible for the review. The primary and secondary outcomes of the study were HIV-positive status disclosure and factors associated with HIV-positive status disclosure, respectively. The quality of the included studies was assessed using the Joanna Briggs Institute critical appraisal tools. A random effect- model was used to estimate the pooled prevalence of HIV-positive status disclosure. Heterogeneity and publication bias of included studies was determined using I2 and Egger’s test, respectively.ResultFrom 601 records screened, nine relevant studies consisting of 2,442 HIV-positive children were included in the analysis. The overall pooled prevalence of HIV-positive status disclosure among children living with HIV/AIDS in Ethiopia was 31.2% (95% CI [23.9–38.5]). HIV-negative status of caregivers (AOR: 2.01; 95% CI [1.28–3.18]), long duration on ART (greater than 5 years) (AOR: 3.2; 95% CI [1.77–5.78]) and older age of the child (>10 years) (AOR: 7.2; 95% CI [4.37–11.88]) were significantly associated with HIV-positive status disclosure.ConclusionLow prevalence of pediatric HIV-positive status disclosure was observed in Ethiopia. The longer duration of ART, the HIV-negative status of the caregiver, and older age greater than 10 years were the predictors of pediatric HIV-positive status disclosure. Health system leaders and policymakers shall design training and counseling programs for healthcare professionals and caregivers to enhance their awareness about HIV-positive status disclosure.Trial registrationThis review was registered under PROSPERO and received a unique registration number, CRD42019119049.

Factors associated with children’s HIV- positive status disclosure in Wolaita Zone, Southern Ethiopia: a cross-sectional study

BackgroundChildren’s HIV-positive status disclosure is an essential component of chronic care & long-term disease management. The modalities of status disclosure are complex and vary across different communities. Although data from various settings are necessary to overcome this problem, evidence is limited, specifically in the in the study areas. Therefore, this study aimed to assess the prevalence of HIV-positive status disclosure and associated factors among children on antiretroviral therapy (ART).MethodsA mixed-method, facility-based study was conducted: among 203 caregivers with children in Wolaita Zone, Southern Ethiopia. We used in-depth interviews for qualitative data in addition to structured questionnaires. Simple random sampling for quantitative and purposive sampling for qualitative parts was applied. We used Content or Thematic analysis for qualitative and Binary logistic regression for quantitative.ResultsAll the caregivers were interviewed and majorities (84.7%) of them were female. One hundred twelve children (55.2%) were below 12 years of age. In this study, the overall prevalence of children with HIV-positive status disclosure was 46.8%. Being 12 or more years of age (AOR = 7.5, 95% CI: 2.9–15.6), duration on ART 72 or more months (AOR = 3.8, 95% CI: 1.7–6.7), death of the parent (AOR = 2.0, 95% CI: 1.1- 3.8), and having follow up in the hospital (AOR = 2.1, 95% CI: 1.3–4.7) were associated with disclosure. Being an immature child was the commonest reason cited by caregivers for non-disclosure. Frequent questions by the child about why they are taking drugs, for better self-care, and treatment adherence were the commonest reason of caregivers for disclosing their children’s HIV-positive status.ConclusionIn our study, children’s HIV-positive status disclosure was significantly low. This study identified different factors (Health facility, children, and caregivers-related factors) as the main reason for disclosing children’s HIV-positive status. Hence, health care workers should give special attention to children’s HIV-positive status disclosure, which helps to increase the effectiveness of treatment and prevent further HIV transmission.

Assessment of Predictors and Effect of Disclosure of HIV Seropositive Status to Sexual Partner among HIV Positive Pregnant Women Attending Antenatal Care in Four Teaching Hospitals in Addis Ababa

Background: It is very crucial that women have the ability to disclose safely the status of being HIV-positive to male partners for the uptake as well the continued use of methods of mother-to-child transmission (PMTCT) services. The majority of the women are afraid to disclose their serostatus to their partners due to denial, blame, physical violence, and lack of financial support. Because of these reasons they discontinue the ANC follow-up and ARV medication for them as well as the baby. In Ethiopia, there are not many studies done to exploring HIV positive status disclosure to partners, the predictors, and the effects of disclosure of HIV positive status among HIV positive women during pregnancy. Method: A cross-sectional study was conducted among 328 HIV-positive pregnant women who were attending ANC in four teaching Hospitals in Addis Ababa. Data was collected using a pretested structured questionnaire and SPSS- 21 version was used to analyze the data. Result: Among the study participants 80% of the women had disclosed their HIV status to their partner. Presence of partner discussion before HIV test, the duration of the relationship between the couples, and knowing partner’s HIV status were found to be strongly associated with their disclosure and those with status disclosure to the partners are 12 times more likely to utilize the PMTCT services than those with no disclosure (COR 12.01(3.64-39.81). Conclusions: The HIV-positive status disclosure among pregnant women is found to be high in our study. It is showed that those women with no disclosure were found to have less in PMTCT programs. It is very important to note that proper uptake of and continued utilization of all PMTCT programs is hugely affected by women's disclosure of their HIV-positive status to their partners.

Predictors and consequences of HIV status disclosure to adolescents living with HIV in Eastern Cape, South Africa: a prospective cohort study.

IntroductionThe World Health Organization recommends full disclosure of HIV‐positive status to adolescents who acquired HIV perinatally (APHIV) by age 12. However, even among adolescents (aged 10–19) already on antiretroviral therapy (ART), disclosure rates are low. Caregivers often report the child being too young and fear of disclosure worsening adolescents’ mental health as reasons for non‐disclosure. We aimed to identify the predictors of disclosure and the association of disclosure with adherence, viral suppression and mental health outcomes among adolescents in sub‐Saharan Africa.MethodsAnalyses included three rounds (2014–2018) of data collected among a closed cohort of adolescents living with HIV in Eastern Cape, South Africa. We used logistic regression with respondent random‐effects to identify factors associated with disclosure, and assess differences in ART adherence, viral suppression and mental health symptoms between adolescents by disclosure status. We also explored differences in the change in mental health symptoms and adherence between study rounds and disclosure groups with logistic regression.ResultsEight hundred and thirteen APHIV were interviewed at baseline, of whom 769 (94.6%) and 729 (89.7%) were interviewed at the second and third rounds, respectively. The proportion aware of their HIV‐positive status increased from 63.1% at the first round to 85.5% by the third round. Older age (adjusted odds ratio [aOR]: 1.27; 1.08–1.48) and living in an urban location (aOR: 2.85; 1.72–4.73) were associated with disclosure between interviews. There was no association between awareness of HIV‐positive status and ART adherence, viral suppression or mental health symptoms among all APHIV interviewed. However, among APHIV not aware of their status at baseline, adherence decreased at the second round among those who were disclosed to (N = 131) and increased among those not disclosed to (N = 151) (interaction aOR: 0.39; 0.19–0.80). There was no significant difference in the change in mental health symptoms between study rounds and disclosure groups.ConclusionsAwareness of HIV‐positive status was not associated with higher rates of mental health symptoms, or lower rates of viral suppression among adolescents. Disclosure was not associated with worse mental health. These findings support the recommendation for timely disclosure to APHIV; however, adherence support post‐disclosure is important.

HIV serostatus disclosure to sexual partner: a survey among women in Tehran, Iran

BackgroundDisclosure of HIV-positive status in women is associated with many factors. Consequently, status disclosure remains a challenge for Iranian women living with HIV. This study aimed to assess the prevalence, related factors, and reflections of HIV-positive status disclosure to a sexual partner(s) among Iranian women living with HIV.MethodsA cross-sectional study was conducted on 170 HIV-seropositive women. Participants were selected from patients registered in the largest HIV clinic and HIV-positive club of Iran. The “HIV disclosure” questionnaire had 38-items and all the interviews were administered by the researcher. Data were analyzed using SPSS version 21.0 software. We used a logistic regression method to calculate the crude odds ratio (COR) and the adjusted odds ratio (AOR) for self-disclosure as the independent predictor variable and the dependent variable, respectively.ResultsOne hundred and seventy HIV-positive women were enrolled. Most of them had disclosed their HIV status to at least one person (94.1%) and their sexual partners (86.5%). In the univariate analysis, being married (COR = 18.66, 95% CI 5.63–61.87), living with a sexual partner (COR = 4.72, 95% CI 1.92–11.62), being aware of sexual partners’ HIV status (COR = 6.20, 95% CI 1.79–21.49), and gaining the support of sexual partner (COR = 9.08, 95% CI 3.48–23.64) were associated with higher odds of HIV status disclosure. In the multivariate analysis, being aware of sexual partners’ HIV status, and gaining the support of sexual partners remained associated with HIV status disclosure. Most women reported a positive reflection from their sexual partners after disclosure, however, negative reflections from society were more common compared to sexual partners and family members.ConclusionThis study shows high overall HIV disclosure proportions. It should be noted that a large number of women were infected by their sexual partners, especially by their spouses. The high rate of transmission in married people indicates an urgent need for more emphasis on appropriate prevention behaviors by infected partners.

A systematic review of the effects of intimate partner violence on HIV-positive pregnant women in sub-Saharan Africa

BackgroundIntimate partner violence (IPV) affects more than one in three women in sub-Saharan Africa (SSA). It is associated with both pregnancy and HIV, adversely affecting women in this region. This is the first systematic examination of the effects of IPV on HIV-positive (HIV+) pregnant women in SSA.MethodsA systematic review of the literature on HIV+ pregnant women experiencing IPV in SSA was carried out. Searches were carried out in PubMed, Web of Science and African Journals Online databases. Articles published between January 2010 and June 2020, in English, were included. Data extraction included details on study locations, study design, study participants and the study outcome variables (depression, IPV, medication adherence, postpartum unsafe sex, and HIV disclosure).ResultsFourteen studies (ten cross-sectional studies, four cohort studies) were included. Results indicate a high prevalence of IPV amongst pregnant women with HIV in SSA (18.0 to 63.1%). The results suggest an association between HIV-positive status and consequences of IPV during pregnancy, particularly mental health effects, such as depression symptoms and suicidal ideation. HIV-related stigma has a key role within the relationship between HIV and IPV during pregnancy. One study described that the presence of IPV reduces adherence to Prevention of Mother-To-Child Transmission (PMTCT) medication. Three studies reported no association between HIV positive status or HIV status disclosure and IPV during pregnancy.Discussion/conclusionsThe systematic review confirms interconnections between IPV and HIV seropositivity amongst pregnant women in SSA. Importantly, stigma, social isolation and poor mental health hinder help-seeking, disclosure, and treatment adherence among HIV+ pregnant women exposed to IPV in SSA. As a result, the potential of community interventions to tackle issues associated with IPV in HIV-positive pregnant women in this area should be explored in research, policy, and practice.

Voluntary HIV Counselling and Testing Amongst Trainee Nurses and Midwives in Ghana and their Perception of Disclosure of HIV Positive Status to Partners

Voluntary Counseling and Testing (VCT) is the best strategy for a successful HIV prevention, care, and support service implementation among HIV-negative and positive individuals. VCT is also recognized as a critical component in the reduction of risk among sexually active young people. This study aims to assess the voluntary HIV counseling, testing, and utilization amongst student nurses and midwives in Ghana and their perception of the disclosure of HIV-positive status to partners. This study used a cross-sectional quantitative descriptive survey amongst 98 nursing and midwifery students at the Nursing and Midwifery Training College, Koforidua. A simple random sampling was used in selecting the participants. Data collection was done using a structured questionnaire. Females dominated the study with the majority of respondents being single. VCT uptake among the respondents was low. Only 26.5% had ever undertaken VCT. It was observed that their willingness to accept VCT does not translate into actual testing. The majority (83%) of respondents perceived that HIV-infected persons should disclose their status to a sexual partner. Fear of stigma (96.0%), fear of loss of friends (98.0%), and fear of being abused (88.8%) were identified as the barriers to HIV status disclosure. To promote VCT services among trainees, these services need to be periodically included in school activities. A comprehensive VCT training module needs to be included in the school curriculum. More emphasis should be placed on the benefits of VCT so that students will understand the importance of implementing VCT services.

HIV Positive status disclosure to sexual partners: a qualitative study to explore experiences and challenges among clients attending HIV care services in North-Western Tanzania

ABSTRACT HIV status disclosure rates to sexual partners are low in Tanzania, despite the benefits it confers to both partners. This qualitative study drew on the Disclosure Decision Model to explore the decision by people living with HIV (PLHIV) to disclose, or not, their HIV status to their partner. Six focus group discussions and thirty in-depth interviews were conducted in Mwanza, Tanzania in 2019 with PLHIV. Topics covered decision-making around disclosure and disclosure experiences. Thematic content analysis was conducted. Most respondents reported having disclosed their status to their partners. Disclosure was reported to facilitate or hinder the attainment of social goals including having intimate relationships, raising a family, relief from distress and accessing social support. Decisions made by PLHIV about whether to disclose their status were made after weighing up the perceived benefits and risks. The sense of liberty from a guilty conscious, and not “living a lie” were perceived as benefits of disclosure, while fears of stigma, family break-up or abandonment were perceived as risks. Many participants found disclosure was beneficial in promoting their adherence to treatment and clinic appointments. Interventions to support PLHIV with disclosure should include enhanced counselling, strengthening HIV support groups and enhanced assisted partner notification services.

HIV serodiscordant and nondisclosure rates among married women living with HIV in a Southern Nigerian region

Objectives: Intimate sexual partners’ disclosure of HIV positive status is vital in the control of HIV/AIDS pandemic globally. The disclosure rates vary from region to region. The aim of this study was to document the prevalence of HIV serodiscordance and partners disclosure rate; and also determine the associated factors among HIV positive married women living in Calabar region of Nigeria. Material and Methods: A cross-sectional survey was conducted among 260 married women, 18 years and above, receiving HIV care at various health institutions in the region. Data were analyzed using SPSS VERSION 23. Their demographic and health profile were presented in simple proportion and percentages while Chi-square test and logistic regression were used to determine the factors influencing patient’s HIV status disclosure with the level of significance set at 0.05. Results: A total of 254 compiled questionnaires were included in the analysis (response rate-97.7%). The serodiscordant rate was 50%. HIV status disclosure to partner was high, 89.4%. The main determinants of HIV status disclosure were good level of education (AOR = 2.2, 95% CI: = 1.75–2.53, P = 0.007) and long duration of ART use (AOR = 3.23, 95% CI = 2.78–4.15, P = 0.001) while women with high discordant rate were more likely to be divorced/separated (P = 0.012, OR = 1.67). Conclusion: Female education is an important factor in HIV control. Disclosure of HIV status is beneficial to the partner as it promotes safe sex practices and increases adherence to ART.

Disclosure Experiences and Challenges Among Children and Adolescents Living with HIV/AIDS in Nigeria-A Review of the Literature

Context: Disclosure of HIV positive infection status in children and Adolescents is multifaceted and should take into consideration their age, psychosocial maturity, cultural and clinical context. This study was conducted to examine disclosure experiences and challenges among children and ALWHA in Nigeria. Evidence Acquisition: We conducted narrative review of relevant literatures by searching PubMed, Google scholar and Medscape using predetermined keywords. Results: Findings are presented under themes of process of disclosure and age of disclosure, reasons and challenges of disclosure, reactions and responses to disclosure, consistent with various authors. This study shows that the mean age and reasons for HIV positive status disclosure are variable. Disclosure was mostly executed at home and mostly carried out by parents or caregivers of HIV-infected children. Reactions of children and ALWHA upon disclosure was mainly negative and ranged from feeling of anger to expression of shock to feeling of sadness and to crying. Barriers to HIV-positive status disclosure among caregivers were perceived sense immaturity and age of the child, fear of stigma, fear of child’s inability to cope, fear of blaming the parents and refusal to take antiretroviral (ARV) drugs. While caregivers highlighted several factors that affect disclosure of HIV status to children and adolescents, this study reveals both positive and negative impact on their emotions. Conclusions: It is of note that approach to disclosure is critical, therefore caregivers and healthcare workers should be properly trained and supported with resources required to effectively carry out disclosure. There is need for continuous research to understand and develop age and culture specific approaches to disclosure in children and adolescents in Nigeria.