Partner Disclosure Research Articles

Risky sexual transmission behavior and its influencing factors among HIV-positive MSM population in Shanghai and Chengdu in China

To investigate the sexual transmission behaviors among HIV-positive MSM population engaging in unprotected sexual behaviors, as well as the relationship with health conditions and partner notification. A total of 308 HIV-positive MSM participants engaged in unprotected sexual behaviors were recruited by "snowballing" sampling in Shanghai and Chengdu. The questionnaire covered such items as the time of HIV infection diagnosis, CD4⁺ T cells count, viral load, antiviral therapy, anxiety and depressive symptoms, sexual partner types and sexual behaviors in the past six months, disclosure to fixed sexual partners and casual sexual partners among others. Of the 308 participants surveyed, the report rate of those having at least one-time sexual transmission behaviors during the past 6 months was 70.1% (216/308). Participants who had primary sexual partners and casual sexual partners following their HIV infection diagnosis accounted for 89.0% (274/308) and 68.2% (210/308) respectively. Of the aforementioned participants, 59.1% (162/274) and 94.3% (198/210) respectively had not disclosed their HIV infection to primary and casual sexual partners. Of thoes who did not disclose their HIV infection to primary sexual partners, 91.9% (147/162) reported sexual transmission behaviors. Of thoes who did not disclose their HIV infection to casual sexual partners, 89.9% (178/198) continue sexual transmission. As found in a multi-factor analysis, the infection risk exposure of those with heterosexual sexual orientation and engagement in sexual transmission behaviors was six times higher than those with homosexual orientation (aOR = 5.896, 95% CI: 1.808-19.232). For those who did not, or partially disclose their HIV infection to male casual sexual partners or commercial sexual partners, the risk exposure of further transmission was 29 times and 19 times higher than those disclose it to their sexual partners (no disclosure: aOR = 28.957, 95% CI: 7.511-65.004; partial disclosure: aOR = 18.956, 95% CI: 6.995-57.417). The highest risk came from those who continue their sexual transmission behavior within six months of their HIV infection diagnosis; the lowest risk came from those continue such behavior more than one year and within two years of their diagnosis (aOR = 0.048, 95% CI: 0.033-0.788); such risk rose to some extent for those continue such behavior over two years of their diagnosis. Compared to those without antiviral therapy, participants with the therapy pose less risk in sexual transmission behaviors. More than two-thirds of HIV-positive MSM population who engage in unprotected sexual behaviors reported sexual transmission behaviors. In this regard, increasing antiviral therapy and promoting sexual partner disclosure constituted an effective strategy to minimize further transmission among HIV-positive MSM population. Intervention of sexual transmission behaviors should be addressed to those diagnosed of HIV infection within six months.

Assessing the Acceptability and Willingness to Use HIV Self-Testing among Student Nurses in a Private Nursing College, Gauteng Province, South Africa

Globally, there is increasing evidence that HIV self-testing (HIVST) is commonly practiced among health care workers (HCWs). Although HIVST kits are available in South Africa, their distribution and use remain unregulated and its acceptability, undocumented. The aim of the study was to explore the acceptability of HIV self-testing among student nurses, examine their willingness to use self-testing, and evaluate their views on the implementation of a regulated HIV self-testing programme. This was a qualitative explorative study, and six focus group discussions were conducted with 67 student nurses recruited from a private nursing college, in Pretoria, South Africa. Thematic analysis and NVivo10 qualitative software were used for data analysis. The nurses perceived HIVST as an acceptable option for HIV testing and most were willing to self-test. Self-testing will provide confidential and accessible HIV testing services, reduce the stigma associated with the condition, and increase partner testing and disclosure. HIVST is more likely to be practised if self-testing kits are easily accessible and affordable, and there are strategies to educate people before the adoption of HIVST. The lack of pre- and post-test counselling, the risk of inaccurate test results, and lack of strategies for the confirmation of self-testing results were the main arguments against HIVST. The high acceptance of HIVST among nurses suggests that HIVST is a feasible option to increase the uptake of HIV-testing among HCWs. However, pre- and post-test counselling should be considered important components in the implementation of self-testing services. Educational and awareness campaigns should precede the roll-out of the self-testing programs.

Acceptance of and experiences utilising expedited partner therapy among African-American juvenile girls.

Background The aim of this study was to describe acceptance of and experiences utilising expedited partner therapy (EPT) among African-American girls recruited from short-term juvenile detention centres. Ninety-five detained African-American girls (aged 13-17 years) completed audio computer-assisted self-interviews (ACASI) and self-collected vaginal swab specimens assayed for chlamydia and gonorrhoea. EPT was offered to sexually transmissible infection (STI)-positive participants (n=51); follow-up phone interviews assessed medication delivery to partners. Summary statistics described EPT acceptance frequency. Generalised estimating equations assessed correlates of acceptance. Nine semi-structured interviews elicited EPT experiences. EPT was offered 69 times, accepted by 70% (n=37) girls and provided to 68% (n=36) of girls. Acceptance was significantly associated with sexual risk behaviours such as infrequent partner STI prevention discussion (OR=3.2, 95% CI: 1.0,-10.1, P=0.048) and≥4 lifetime sex partners (OR=3.3, 95% CI: 1.0-11.0, P=0.048). Discontinued relationships were the most common barrier to EPT acceptance. Emergent interview themes included sense of responsibility, which appeared to motivate acceptance and help overcome identified discomfort with partner disclosure conversations. Future research is needed to determine EPT efficacy among African-American juvenile populations and feasibility of its use outside of research settings.

Partner testing, linkage to care, and HIV-free survival in a program to prevent parent-to-child transmission of HIV in the Highlands of Papua New Guinea

Background To eliminate new pediatric HIV infections, interventions that facilitate adherence, including those that minimize stigma, enhance social support, and mitigate the influence of poverty, will likely be required in addition to combination antiretroviral therapy (ART). We examined the relationship between partner testing and infant outcome in a prevention of parent-to-child transmission of HIV program, which included a family-centered case management approach and a supportive environment for partner disclosure and testing. Design We analyzed routinely collected data for women and infants who enrolled in the parent-to-child transmission of HIV program at Goroka Family Clinic, Eastern Highlands Provincial Hospital, Papua New Guinea, from 2007 through 2011. Results Two hundred and sixty five women were included for analysis. Of these, 226 (85%) had a partner, 127 (56%) of whom had a documented HIV test. Of the 102 HIV-infected partners, 81 (79%) had been linked to care. In adjusted analyses, we found a significantly higher risk of infant death, infant HIV infection, or loss to follow-up among mother–infant pairs in which the mother reported having no partner or a partner who was not tested or had an unknown testing status. In a second multivariable analysis, infants born to women with more time on ART or who enrolled in the program in later years experienced greater HIV-free survival. Conclusions In a program with a patient-oriented and family-centered approach to prevent vertical HIV transmission, the majority of women's partners had a documented HIV test and, if positive, linkage to care. Having a tested partner was associated with program retention and HIV-free survival for infants. Programs aiming to facilitate diagnosis disclosure, partner testing, and linkage to care may contribute importantly to the elimination of pediatric HIV.

Unravelling the quality of HIV counselling and testing services in the private and public sectors in Zambia.

Background Despite the substantial investment for providing HIV counselling and testing (VCT) services in Zambia, there has been little effort to systematically evaluate the quality of VCT services provided by various types of health providers. This study, conducted in 2009, examines VCT in the public and private sectors including private for-profit and NGO/faith-based sectors in Copperbelt and Luapula.Methods The study used five primary data collection methods to gauge quality of VCT services: closed-ended client interviews with clients exiting VCT sites; open-ended client interviews; interviews with facility managers; review of service statistics; and an observation of the physical environment for VCT by site. Over 400 clients and 87 facility managers were interviewed from almost 90 facilities. Sites were randomly selected and results are generalizable at the provincial level.Results The study shows concerning levels of underperformance in VCT services across the sectors. It reveals serious underperformance in counselling about key risk-reduction methods. Less than one-third of clients received counselling on reducing number of sexual partners and only approximately 5% of clients received counselling about disclosing test results to partners. In terms of client profiles, the NGO sector attracts the most educated clients and less educated Zambians seek VCT services at very low rates (7%). The private for-profit performs equally or sometimes better than other sectors even though this sector is not adequately integrated into the Zambian national response to HIV.Conclusion The private for-profit sector provides VCT services on par in quality with the other sectors. Most clients did not receive counselling on partner reduction or disclosure of HIV test results to partners. In a generalized HIV epidemic where multiple concurrent sexual partners are a significant problem for transmitting the disease, risk-reduction methods and discussion should be a main focus of pre-test and post-test counselling.

Gender differences in HIV disclosure, stigma, and perceptions of health

HIV disclosure is a gateway to HIV prevention – particularly among couples living in regions severely affected by the HIV epidemic. This cross-sectional study utilizes data collected from 862 people living with HIV across three countries (Ethiopia, Mozambique, and Uganda) in 2011 to determine the role of partner disclosure on self-reported health perceptions and changes in sexual risk behavior. The study's secondary aims are to understand whether or not internalized stigma mediates this relationship and if there is a different pattern of results by gender. The multivariate analysis reveals that the three key HIV-related independent variables, belonging to a support group, doing volunteer work, and disclosing to one's spouse or partner, were significantly associated with lower levels of internalized stigma. Internalized stigma was associated with self-perceptions of poorer health for both women and men, with women reporting higher levels of internalized stigma than men. Disclosure to spouse was positively associated with perceptions of better health for women but not for men. For men, doing HIV-related volunteer work and disclosing their status to their spouse were positively associated with self-reported changes in sexual risk behavior, although stigma was not found to mediate this relationship. Findings from this study suggest that disclosure and stigma have gender-specific effects on individual well-being and changes in sexual risk behaviors. As such, programs must address gender inequity in disclosure patterns and stigma to enhance prevention efforts.

Disclosure of Microbicide Gel Use to Sexual Partners: Influence on Adherence in the CAPRISA 004 Trial

Young women in sub-Saharan Africa are disproportionately affected by HIV, making the development of women initiated and controlled methods of prevention, including microbicides, a priority. Adherence is pivotal to microbicide efficacy and partner related factors are known to impact adherence. An analysis of disclosure of gel use to sexual partners and adherence in CAPRISA 004 women was conducted to better understand this relationship. Partner disclosure was significantly associated with a modest 4.2 % increased adherence (71.0 vs. 66.8 %, p = 0.03). Most women rated the experience of disclosure as positive, despite 6.7 % of partners expressing a negative reaction.Participants who disclosed were more likely to reside with their regular partner (14.4 vs. 8.4 %; p = 0.01) and reported consistent condom use at baseline (32.9 vs. 20.9 %; p < 0.01). Partner disclosure needs to be better understood as a potential facilitator or barrier to microbicide adherence.

Seropositive status disclosure to partners and safer sexual behaviours among people living with HIV: An issue in prevention and treatment

The objective of this study was to determine the rate of disclosure to sexual partners and consequent safer sexual practices among people living with HIV (PLHIV). This was a cross-sectional study. A semi-structured interviewer administered questionnaire was used to collect demographic data of age, gender, marital status as well as HIV status disclosureand consistent condom use. This information was collected from consenting consecutive antiretroviral-therapynaive PLHIV accessing care at the Lagos State University Teaching Hospital (LASUTH), southwest Nigeria. Collected data were analysed using statistical package for social sciences (version 10.0, spss) and group comparisons were done with chi square tests. A total of 443 respondents were interviewed. The age of the respondents ranged from 18 to 75 years with a mean of 46.5±9. Majority 268 (60.5%) of respondents were females while 175 (39.5%) were males. The disclosure rate to sexual partners was 43 (9.7%) among studied PLHIV. Consistent condom use was highest (12.7%) among PLHIV who had disclosed to sexual partners while inconsistent use was highest (93.3%) among the undisclosed.p=0.26 CONCLUSION: This study reveals that there is a low sexual partner disclosure rate among studied PLHIV. Seropositive status disclosure to sexual partners was associated with consistent condom use.

Addressing gender inequality and intimate partner violence as critical barriers to an effective HIV response in sub-Saharan Africa.

IntroductionIn Africa, women and girls represent 57% of people living with HIV, with gender inequality and violence being an important structural determinant of their vulnerability. This commentary draws out lessons for a more effective combination response to the HIV epidemic from three papers recently published in JIAS.DiscussionHatcher and colleagues present qualitative data from women attending ante-natal clinics in Johannesburg, describing how HIV diagnosis during pregnancy and subsequent partner disclosure are common triggers for violence within relationships. The authors describe the challenges women face in adhering to medication or using services. Kyegombe and colleagues present a secondary analysis of a randomized controlled trial in Uganda of SASA! – a community violence prevention programme. Along with promising community impacts on physical partner violence, significantly lower levels of sexual concurrency, condom use and HIV testing were reported by men in intervention communities. Remme and her colleagues present a systematic review of evidence on the costs and cost-effectiveness of gender-responsive HIV interventions. The review identified an ever-growing evidence base, but a paucity of accompanying economic analyses, making it difficult to assess the costs or value for money of gender-focused programmes.ConclusionsThere is a need to continue to accumulate evidence on the effectiveness and costs of different approaches to addressing gender inequality and violence as part of a combination HIV response. A clearer HIV-specific and broader synergistic vision of financing and programming needs to be developed, to ensure that the potential synergies between HIV-specific and broader gender-focused development investments can be used to best effect to address vulnerability of women and girls to both violence and HIV.

Bidirectional links between HIV and intimate partner violence in pregnancy: implications for prevention of mother-to-child transmission.

IntroductionPrevention of mother-to-child transmission (PMTCT) has the potential to eliminate new HIV infections among infants. Yet in many parts of sub-Saharan Africa, PMTCT coverage remains low, leading to unacceptably high rates of morbidity among mothers and new infections among infants. Intimate partner violence (IPV) may be a structural driver of poor PMTCT uptake, but has received little attention in the literature to date.MethodsWe conducted qualitative research in three Johannesburg antenatal clinics to understand the links between IPV and HIV-related health of pregnant women. We held focus group discussions with pregnant women (n=13) alongside qualitative interviews with health care providers (n=10), district health managers (n=10) and pregnant abused women (n=5). Data were analysed in Nvivo10 using a team-based approach to thematic coding.FindingsWe found qualitative evidence of strong bidirectional links between IPV and HIV among pregnant women. HIV diagnosis during pregnancy, and subsequent partner disclosure, were noted as a common trigger of IPV. Disclosure leads to violence because it causes relationship conflict, usually related to perceived infidelity and the notion that women are “bringing” the disease into the relationship. IPV worsened HIV-related health through poor PMTCT adherence, since taking medication or accessing health services might unintentionally alert male partners of the women's HIV status. IPV also impacted on HIV-related health via mental health, as women described feeling depressed and anxious due to the violence. IPV led to secondary HIV risk as women experienced forced sex, often with little power to negotiate condom use. Pregnant women described staying silent about condom negotiation in order to stay physically safe during pregnancy.ConclusionsIPV is a crucial issue in the lives of pregnant women and has bidirectional links with HIV-related health. IPV may worsen access to PMTCT and secondary prevention behaviours, thereby posing a risk of secondary transmission. IPV should be urgently addressed in antenatal care settings to improve uptake of PMTCT and ensure that goals of maternal and child health are met in sub-Saharan African settings.

A multidimensional scale to measure the reproductive concerns of young adult female cancer survivors

Concerns about fertility and parenthood are important to many young adult (YA) female cancer survivors and are associated with poorer quality of life. We aimed to develop a new scale to comprehensively measure these concerns so that they can be better addressed. Scale development involved: (1) seven focus groups to identify reproductive concerns among YA female cancer survivors and develop potential scale items followed by pilot testing and cognitive interviews to refine items, (2) administering surveys to 204 YA female survivors and conducting principal components analysis (PCA) with oblique rotation to identify underlying factors in the multidimensional scale, and (3) identification of preliminary construct validity evidence. We subjected 37 potential scale items to PCA, which indicated a six-factor solution. After removing low-loading and cross-loading items, we selected the three top loading items representing each factor. The 18-item Reproductive Concerns After Cancer scale (α = 0.82) assesses concerns about fertility potential, partner disclosure, child's health, personal health, acceptance, and becoming pregnant. As hypothesized, women who wanted to have a baby (p < 0.001) and those for whom having a biological child was very important (p < 0.05) had higher mean scores, indicating higher concerns. The scale demonstrated good internal consistency and evidence of construct validity and holds promise for future clinical and research applications. An effective tool to identify concerns related to fertility and parenthood is essential for meeting the long-term reproductive health needs of young women who have survived cancer.

Facilitating HIV status disclosure for pregnant women and partners in rural Kenya: a qualitative study

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.

Nonadherence Factors and Sociodemographic Characteristics of HIV-Infected Adults Receiving Antiretroviral Therapy in Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria

Adherence to treatment instructions with antiretroviral therapy (ART) is very crucial for successful treatment outcome. However, sticking to treatment instructions pose-great challenges to HIV/AIDS patients. This cross-sectional study was on HIV infected adults attending ART clinic in Nigeria to explore nonadherence factors in relation to their socioeconomic characteristics. Validated structured questionnaire was administered to 221 participants. Results showed a high nonadherence rate of 85.1%. The commonest occurring factors of non-adherence were forgetfulness (53.8%), busy schedule (38.8%), side effects of drugs (31.9%), and stigma (31.9%). Males were more likely to complain from busy schedule, feeling healthy, fear of partner disclosure, long waiting period, and long term regimen. Patients with no formal education were more likely to attribute non-adherence to poor communication, side effects of drugs, and stigma. Employed patients seemed to miss their drugs more than the unemployed and artisans. The high non-adherence rate has serious implications for the control of HIV in infected individuals and management of HIV in general. Nurses should intensify efforts on patient education and counseling.

Women's choices regarding HIV testing, disclosure and partner involvement in infant feeding and care in a rural district of Malawi with high HIV prevalence

The influence of HIV-related stigma on women's choices with regard to HIV testing, disclosure and partner involvement in infant feeding and care is not well understood in rural Malawi but may influence the risk of vertical HIV transmission and infant health. In a study of HIV-infected and -uninfected women in 20 rural locations in Zomba District, Malawi, mothers were questioned at 18–20 months post-partum about these issues. Ten per cent of women claimed unknown HIV status in labour so HIV testing should be routinely offered in Labour & Delivery wards. HIV-infected women were somewhat less likely to disclose to their partners than HIV-uninfected women (89 and 97%, respectively; p = 0.007) or to be cohabiting with partners during pregnancy (74 and 86%, respectively; p = 0.03). Partners of women were less inclined to disclose their HIV testing or HIV status (49 and 66% of partners of HIV-infected and -uninfected women, respectively). Greater partner testing and disclosure may improve prevention of mother to child transmission of HIV (PMTCT) in this population. A majority of women were inclined to make feeding decisions on their own, whereas most felt that other health-related decisions should also involve the father. Most mothers believe that exclusive breast feeding (EBF) is the best infant feeding method (for the first six months) but it was actually practiced by a minority of women (20% of HIV-infected and 5% of HIV-uninfected mothers; p = 0.01). EBF needs systematic support in order to be practised.

Cancer-specific Relationship Awareness, Relationship Communication, and Intimacy Among Couples Coping with Early Stage Breast Cancer.

If couples can maintain normalcy and quality in their relationship during the cancer experience, they may experience greater relational intimacy. Cancer-specific relationship awareness, which is an attitude defined as partners focusing on the relationship and thinking about how they might maintain normalcy and cope with cancer as a couple or "team", is one factor that may help couples achieve this goal. The main aim of this study was to evaluate the associations between cancer-specific relationship awareness, cancer-specific communication (i.e., talking about cancer's impact on the relationship, disclosure, and responsiveness to partner disclosure), and relationship intimacy and evaluate whether relationship communication mediated the association between relationship awareness and intimacy. Two hundred fifty four women diagnosed with early stage breast cancer and their partners completed measures of cancer-specific relationship awareness, relationship talk, self-and perceived partner disclosure, perceived partner responsiveness, and relationship intimacy. Results indicated that patients and spouses who were higher in cancer-specific relationship awareness engaged in more relationship talk, reported higher levels of self-disclosure, and perceived that their partner disclosed more. Their partners reported that they were more responsive to disclosures. Relationship talk and perceived partner responsiveness mediated the association between cancer-specific relationship awareness and intimacy. Helping couples consider ways they can maintain normalcy and quality during the cancer experience and framing coping with cancer as a "team" effort may facilitate better communication and ultimately enhance relationship intimacy.

HIV status disclosure to families for social support in South Africa (NIMH Project Accept/HPTN 043)

Literature on HIV status disclosure among persons living with HIV/AIDS (PLWHA) is dominated by research on the rates, barriers and consequences of disclosure to sexual partners, because of the assumed preventive health benefits of partner disclosure. Disclosure of HIV status can lead to an increase in social support and other positive psychosocial outcomes for PLWHA, but disclosure can also be associated with negative social outcomes including stigma, discrimination, and violence. The purpose of this article is to describe the HIV status disclosure narratives of PLWHA living in South Africa. Thirty in-depth interviews were conducted with 13 PLWHA (11 women, 2 men) over a three-year period. We explored disclosure narratives of the PLWHA through questions about who they chose to disclose to, how they disclosed to these individuals, and how these individuals reacted. Narratives focused on disclosure to family members and contained relatively little discussion of disclosure to sexual partners. Participants often disclosed first to one trusted family member, and news of the diagnosis remained with this person for a long period of time, prior to sharing with others. This family member helped the PLWHA cope with the news of their diagnosis and prepared them to disclose to others. Disclosure to one's partner was motivated primarily by a desire to encourage partners to test for HIV. Two participants described overtly negative reactions from a partner upon disclosure, and none of the PLWHA in this sample described very supportive relationships with their partners after disclosure. The critical role that family members played in the narratives of these PLWHA emphasizes the need for a greater focus on disclosure to families for social support in HIV counseling protocols.

P4.034 Effects of Partner Disclosure on Clinical Outcomes Among HIV Infected Adult Initiating ART

BackgroundDisclosure of HIV status can influence clinical outcomes. Disclosure leads to social support, improved adherence and positive living which may affect immune reconstitution. Data on the effect of disclosure on...

P4.002 Major Barriers to Condom Use Among Clients Receiving Counselling on Sexually Transmitted Diseases (STIs) Prevention -The AIDS Support Organization (TASO) Operational Research Findings, a National NGO in Uganda

Background HIV/AIDS is most common among those in longstanding stable relationships, where condom use would play preventive role on transmission of sexually transmitted infections (STIs). A study to assess STIs programme successes and major barriers to condom use among clients receiving routine counselling on STI prevention was conducted. Methods The study was cross-sectional by design, using retrospective electronic data base review on all sexually active clients who had received at least one counselling session in the last six months by end of 31/02/2012. Results A total of 3509 clients were sexually active, 37% were males, 1582 (45%) received counselling on STI prevention; only 36% were males. Of those counselled on STIs, 1081(68%) disclosed HIV status to partners with 60% females, 350 (22%) diagnosed and treated of STIs with 11% males and only 512(32%) reported condoms use, with 39% males. Major barriers to condom use546 (34%) did not use condoms, of which 297 (54%), partner refused condoms, 148(27%) were faithful to their partners and only 73(13%) reported religion as a barrier. Type of partner reporting barriers to condom use; 404(76%) spouse, 93(17%) steady, 49 (7%) casual. Conclusions Being a spouse and faithfulness to the partner are major barriers to condom use as key STI prevention measure. People in spouse and steady partners are less likely to use condoms as opposed to those in casual sex partners. Regular counselling is a strong pillar for STI prevention, treatment success and enhancement of partner disclosure.

Do support groups members disclose less to their partners? The dynamics of HIV disclosure in four African countries

BackgroundRecent efforts to curtail the HIV epidemic in Africa have emphasised preventing sexual transmission to partners through antiretroviral therapy. A component of current strategies is disclosure to partners, thus understanding its motivations will help maximise results. This study examines the rates, dynamics and consequences of partner disclosure in Burkina Faso, Kenya, Malawi and Uganda, with special attention to the role of support groups and stigma in disclosure.MethodsThe study employs mixed methods, including a cross-sectional client survey of counselling and testing services, focus groups, and in-depth interviews with HIV-positive individuals in stable partnerships in Burkina Faso, Kenya, Malawi and Uganda, recruited at healthcare facilities offering HIV testing.ResultsRates of disclosure to partners varied between countries (32.7% – 92.7%). The lowest rate was reported in Malawi. Reasons for disclosure included preventing the transmission of HIV, the need for care, and upholding the integrity of the relationship. Fear of stigma was an important reason for non-disclosure. Women reported experiencing more negative reactions when disclosing to partners. Disclosure was positively associated with living in urban areas, higher education levels, and being male, while being negatively associated with membership to support groups.ConclusionsUnderstanding of reasons for disclosure and recognition of the role of support groups in the process can help improve current prevention efforts, that increasingly focus on treatment as prevention as a way to halt new infections. Support groups can help spread secondary prevention messages, by explaining to their members that antiretroviral treatment has benefits for HIV positive individuals and their partners. Home-based testing can further facilitate partner disclosure, as couples can test together and be counselled jointly.

Participation in research involving novel sampling and study designs to identify acute HIV-1 infection among minority men who have sex with men

HIV-1 infection disproportionally affects African-American and Latino men who have sex with men (MSM). Their inclusion in biomedical and behavioral research is critical to understanding and addressing HIV vulnerability. Using focus groups, we sought to understand the perceptions related to participating in biomedical research of acute/recent HIV-1 infection (AHI) using complex sampling and data collection methods to reach this hidden group at highest risk of acquiring and transmitting HIV. Given the potential impact of AHI on HIV transmission in MSM, it is important to understand this intersection for HIV prevention, care, and treatment purposes. The aim of this study was to understand how recruitment and data collection methods affect AHI research participation willingness particularly among MSM of color. Findings suggest that major barriers to research participation with complex sampling to identify AHI and intensive risk behavior collection such as diary methods are lack of anonymity, partner disclosure, and study fatigue. The authors explore implications for future study designs and development based on these findings.