Serostatus Disclosure Research Articles

Multilevel factors associated with HIV-related stigma among women living with HIV in Guangdong Province, China: a social-ecological model-informed study

BackgroundHIV-related stigma continues to hinder optimal HIV care, and its determinants should be understood at multiple levels. Based on the social-ecological model, this study aimed to explore factors associated with HIV-related stigma among women living with HIV in Guangdong Province, China.MethodsA cross-sectional study was conducted from July to August 2022 to recruit newly reported women living with HIV with a history of pregnancy or current pregnancy in 2021 in 21 cities in Guangdong Province. HIV-related stigma was assessed using an abbreviated Chinese version of Berger's HIV Stigma Scale. Univariate and multivariable hierarchical regression analyses based on the social-ecological model were conducted to explore factors associated with HIV-related stigma and its four dimensions (personalized stigma, disclosure concerns, negative self-image and concerns about public attitudes) at the community/hospital, interpersonal, and individual levels.ResultsA moderate level of HIV-related stigma was found among the 360 participants included, with a mean score of 45.26. Multivariable hierarchical regression analysis showed that at the community/hospital-level, individuals were more likely to experience high levels of HIV-related stigma if they had experienced the discriminatory behaviors from health care workers (aOR = 2.34, 95%CI: 1.48–3.70) and if they rated serostatus disclosure services as less helpful (aOR = 0.69, 95%CI: 0.48–0.98). At the interpersonal-level, individuals with an HIV-positive partner (aOR = 1.71, 95%CI: 1.01–2.90) were more likely to experience high levels of HIV-related stigma than those with an HIV-negative or unknown partner. Individuals with high resilience (aOR = 0.22, 95%CI: 0.13–0.35) had lower levels of HIV-related stigma at the individual-level. In addition, ever experiencing discriminatory behaviors from health care workers, thinking serostatus disclosure services helpful, having ever seen publicity about personal interest protection services and complaint channels for people living with HIV(PLHIV), knowing about care and support services for PLHIV from social organizations at the community/hospital-level, partner notification and support at the interpersonal-level, and violations of personal interests, resilience at the individual-level were also associated with different dimensions of HIV-related stigma.ConclusionsHIV-related stigma was moderate among women living with HIV. The social-ecological model can facilitate a better understanding of factors associated with HIV-related stigma. Multilevel intervention strategies need to be tailored to reduce HIV-related stigma.

Sociodemographic associated factors with non-disclosure of HIV sero-status to sexual partners in Maputo, Mozambique

The HIV prevalence in Maputo city is 16.2%. There is a lack of data describing associated factors with disclosure or non-disclosure of HIV-positive sero-status to sexual partners. This analysis describes associated factors of non-disclosure of HIV sero-status to sexual partners among people living with HIV (PLHIV) participating in a serostatus disclosure support program at three health facilities in Maputo, Mozambique. We used a cross-sectional design of PLHIV aged over 18 years. Datas were collected between December 2019 and September 2020. Univariate and multivariable logistic regression models were used to evaluate factors associated of non-disclosure of HIV sero-status. A total of 377 patients were enrolled in the HIV sero-status disclosure Program. Of these, nearly two-thirds (61.5%) were women, 52.9% had completed secondary school, 47.7% were 25–34 years old, 50.9% had informal employment with low income, and 73.2% were married. Univariate logistic regression model showed greater odds of non-disclosure among patients who had an employment contract with a maximum wage (Crude Odds Ratio [cOR] 2.02, 95% confidence interval [CI] 1.15–3.55, p = 0.015); were single (cOR 3.85, 95% CI 2.22–6.69, p < 0.001); were living with parents (cOR 2.30, 95% CI 1.07–4.93, p = 0.033); received financial support for their monthly household expenses from parents or a close relative (cOR 7.15, 95% CI 2.19–23.36, p = 0.001); or brought a parent/close relative and/or a friend as a confidant during HIV care(cOR 3.17, 95% CI 1.74–5.76, p < 0.001; and cOR 5.97, 95% CI 1.57–22.66, p = 0.009, respectively). Multivariable logistic regression model showed: from parents/close relative and from partner (Adjusted Odds Ratio [aOR] 8.19, 95% CI 1.44–46.46, p = 0.018; and aOR 4.34, 95% CI 1.05–17.17, p = 0.043), respectively); in those who brought a parent/close relative and/or a friend as a confidant during HIV care (aOR 8.86, 95% CI 2.16–36.31, p = 0.002; and 195 aOR 21.68, 95% CI 3.02–155.87, p = 0.002, respectively). Non-disclosure of serostatus is a critical issue for HIV care and treatment programs, given that non-disclosure of HIV serostatus increases risk of HIV transmission. Understanding the factors associated with non-disclosure is crucial for designing strategies to address these factors and end the HIV epidemic by 2030. Our findings suggest that HIV serostatus disclosure programs might target the sociodemographic factors strongly associated with non-disclosure.

Stigma, serostatus disclosure, coping strategies, and the role of social capital resources among HIV care-nonadherent MSM in Russia: a qualitative analysis

ABSTRACT The HIV epidemic continues to expand in Russia, with suboptimal levels of care uptake. This qualitative study aimed to characterize social capital resources and lived stigma experiences, coping, and disclosure among care-nonadherent men who have sex with men (MSM) living with HIV in Russia. Twenty-five HIV-positive MSM – recruited online – completed in-depth interviews over Zoom, with data analyzed using MAXQDA software. Stigma was more likely to be encountered in interactions with persons with whom social ties were weaker such as medical providers and relatives, particularly males. Close friends – often other HIV-positive MSM and female relatives – were the most supportive and least stigmatizing. Similar persons were most often considered for HIV serostatus disclosure. Coping strategies to reduce the impact of stigma included ignoring stigmatizing experiences, seeking support from members of one's social circle, minimizing contact with stigmatizing persons, seeking new relationships with persons who are also HIV-positive, proactively reducing stigma through involvement in advocacy roles, and correcting myths and educating others about HIV infection. These findings underscore the need for interventions to assist HIV-positive MSM in building accepting social capital resources to reduce the impact of stigma and to build support within their social networks, often with other HIV-positive MSM.

Factors Associated with Outcomes of Status Disclosure among Antiretroviral Therapy (ART) Attendees in Public Health Facilities of Mekelle City, Tigray, Ethiopia

INTRODUCTION: Positive status disclosure is considered a central strategy and a critical gateway in the prevention and treatment of the Human Immunodeficiency Virus. Disclosure of serostatus plays a significant role in preventing transmission and provides early care services for people with the virus. It also improves adherence to treatment and the quality of life in Human Immunodeficiency Virus-positive clients. However, research on the outcome of seropositive status disclosure has been uneven, both in time and geography, and is limited, particularly in the Tigray region. OBJECTIVE: To assess the factors associated with outcomes of status disclosure among antiretroviral therapy attendees in public health facilities of Mekelle City. METHOD: An institution-based cross-sectional study was conducted. A systematic random sampling technique with K=6 was used to select study participants, recruiting a total sample size of 273. The data were collected based on face-to-face interviews using structured questionnaires. Bivariate and multivariable logistic regression analysis with a 95% confidence interval and a cut-off point p-value &lt; 0.25 were used to assess the associated factors. SPSS version 21 was used to analyze the data. RESULT: Of the total respondents in this study, 231 (84.6%) reported that the outcome of discussing their HIV seropositive result was positive. Conversely, 15.4% reported negative outcomes of disclosure. In the multivariable analysis, the outcome of disclosure was significantly associated with gender (AOR=3.5, 95% CI [1.110-11.272]) and the quality of the relationship with a partner before disclosure of status (AOR=0.172, 95% CI [0.045-0.647]). CONCLUSION: Although the majority of the people experienced positive outcomes, a significant proportion of individuals are experiencing negative outcomes from positive status disclosure. Therefore, healthcare providers should be aware of both the benefits and the negative consequences of disclosure. They should also identify women most at risk for negative outcomes and provide counseling and support throughout the entire disclosure process.

The role of internalised HIV stigma in disclosure of maternal HIV serostatus to children perinatally HIV-exposed but uninfected: a prospective study in the United States.

Decisions to disclose HIV serostatus may be complicated by internalised HIV stigma. We evaluated the association of internalised HIV stigma in biological mothers living with HIV with disclosure of their serostatus to their children perinatally HIV-exposed but uninfected (CHEU). Mothers and their CHEU were enrolled in the United States (U.S.)-based Surveillance Monitoring for Antiretroviral Therapy (ART) Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study (PHACS), a longitudinal study of outcomes related to in utero exposure to HIV and ART among CHEU. Mothers completing at least one stigma and disclosure assessment starting at the child's age 11-, 13-, 15- and/or 17-year study visits between 16 August 2016 and 1 October 2020 were eligible. Stigma was measured with the 28-item Internalised HIV Stigma Scale (IHSS). Mean stigma scores were linearly transformed to a range of 0-100, with higher scores indicating greater levels of stigma. At each visit, mothers were asked if their child was aware of their HIV diagnosis and at what age the child became aware. The Kaplan-Meier estimator evaluated the cumulative probability of disclosure at each child age. Logistic regression models with generalised estimating equations to account for repeated measures were fit to examine the association between stigma and disclosure, controlling for relevant socio-demographic variables. Included were 438 mothers of 576 children (mean age 41.5 years, 60% U.S.-born, 60% Black/African American and 37% with household income ≤$10,000). The prevalence of disclosure across all visits was 29%. Mothers whose children were aware versus not aware of their serostatus reported lower mean IHSS scores (38.2 vs. 45.6, respectively). The cumulative proportion of disclosure by age 11 was 18.4% (95% CI: 15.5%, 21.8%) and 41% by age 17 (95% CI: 35.2%, 47.4%). At all child ages, disclosure was higher among children of U.S.-born versus non-U.S.-born mothers. After adjusting for age, marital status and years since HIV diagnosis, higher IHSS scores were associated with lower odds of disclosure (OR = 0.985, 95% CI: 0.975, 0.995). Providing support to women as they make decisions about serostatus disclosure to their children may entail addressing internalised HIV stigma and consideration of community-level factors, particularly for non-U.S.-born mothers.

Tailoring a skills-based sero-status disclosure intervention for transgender women in South Africa: A protocol for a usability and feasibility study (Preprint)

Tailoring a skills-based sero-status disclosure intervention for transgender women in South Africa: A protocol for a usability and feasibility study (Preprint)

Factors Associated with HIV Positive Serostatus Disclosure to Sexual Partners Among Sexually Active Young People on Anti-Retroviral Therapy in Central Uganda.

HIV serostatus disclosure is a fundamental HIV prevention and care strategy yet with a paucity of literature. This study comprehended the factors associated with HIV serostatus disclosure to sexual partners among young people aged 15-24 years on anti-retroviral therapy (ART). This explanatory sequential study utilized quantitative data from 238 young people who had been on ART for over 12 months and were sexually active for at least 6 months in seven districts of Central Uganda. Pearson's Chi-square and multinomial logistic regression analysis at α=0.05 was used to determine the factors associated with serostatus disclosure among study participants. Qualitative data from 18 young people were collected using an in-depth interview guide and analyzed thematically. Non-disclosure was at 26.9%, one-way disclosure was at 24.4%, and two-way disclosure was at 48.7%. Participants who contracted HIV from their partners were three times more likely (RRR=2.752; 95% CI: 1.100-6.888) to have one-way disclosure than non-disclosure, compared to those who had a perinatal infection. Those who contracted HIV from their partners were twice more likely (RRR=2.357; 95% CI: 1.065-5.214) to have two-way disclosure than non-disclosure, compared to those who had a perinatal infection. Participants who stayed with their partners were four times more likely (RRR=3.869; 95% CI: 1.146-13.060) to have two-way disclosure than non-disclosure, compared to those who stayed with their parents. Young people disclosed because they were tired of secrecy and desired treatment adherence and did not disclose due to fear of stigma and losing their partners' support. Many sexually active young people on ART did not disclose their HIV-positive status to sexual partners mainly due to poverty, having multiple-sexual partners, and stigma. Interventions fighting stigma, multiple-sexual relationships, and poverty among sexually active young people on ART should be strengthened.

High Acceptability and Perceived Feasibility of Long-Acting Injectable Antiretroviral Treatment Among People Living with HIV Who Are Viremic and Health Workers in Uganda.

Long-acting injectable antiretroviral treatment (LAI ART), such as a bimonthly injection of cabotegravir/rilpivirine, is a promising HIV treatment option. LAI ART may particularly benefit people who are reluctant to initiate or are poorly adherent to daily oral pills and not virally suppressed. However, the acceptability and feasibility of LAI ART among individuals with viremia in Africa has not been well studied. We conducted qualitative in-depth interviews with 38 people living with HIV with viral load ≥1000 copies/mL and 15 medical and nursing staff, and 6 focus group discussions with peer health workers, to examine acceptability and feasibility of LAI ART in south-central Uganda. Transcripts were thematically analyzed through a team-based framework approach. Most people living with HIV reacted positively toward LAI ART and endorsed interest in taking it themselves. Most felt LAI ART would make adherence easier by reducing the challenge with remembering daily pills, particularly in the context of busy schedules, travel, alcohol use, and dietary requirements. Participants also appreciated the privacy of injections, reducing the likelihood of stigma or inadvertent HIV serostatus disclosure with pill possession. Concerns about LAI ART included side effects, perceived medication effectiveness, fear of injection, and medical mistrust and conspiracy beliefs. Health workers and participants with viremia also noted health system challenges, such as stockouts and monitoring treatment failure. However, they felt the health system could overcome these challenges. Implementation complexities must be addressed as LAI ART is introduced and expanded in Africa to best support viral suppression and address HIV care continuum gaps.

Male and female Asians living with HIV: a text-mining analysis comparing their concerns.

Asians are "a forgotten population" whose HIV prevention and treatment needs have long been ignored. Studies on people living with HIV/AIDS (PLWHA) have primarily reported on physical and psychological conditions among men and gender minorities. We used data-mining to select words and word patterns from pooled in-depth interviews conducted with 33 women and 12 men (n = 45) who were HIV positive and residing in San Francisco, United States, Shanghai, Beijing, or Taipei, China. We analyzed gender-based data (male vs. female) within the participant responses. Disclosure of HIV serostatus was discussed by both genders of PLWHA. Participants were concerned whether they should disclose their diagnosis and how to disclose it to their family members. Specifically, for women, family relationships and financial burdens were discussed most often. In terms of men, HIV disclosure was the key concern followed by disclosure of their sexual preference and concerns over what people were saying about them in the community. This project compared and contrasted concerns of Asian HIV-positive men and women. As healthcare providers promoting self-management by HIV-positive individuals of both genders, it is important to consider that there may be significant differences between them. Future interventions should consider how gender role influences self-management strategies in PLWHA and how support can be targeted to achieve a better quality of life for PLWHA.

Incidence and predictors of loss to follow-up among women on option B+ PMTCT program in northwest Ethiopia. A retrospective follow-up study.

Loss to follow-up from lifelong antiretroviral therapy continued to be a major challenge affecting virtual elimination of mother-to-child transmission of human immunodeficiency virus, especially in Sub-Saharan Africa. Although there was a study conducted in Ethiopia, loss to follow-up was not clearly defined and some important variables were not addressed. Thus, this study was conducted to determine the incidence of loss to follow-up and its predictors among women on option B+ lifelong antiretroviral therapy program in Pawi district health facilities, northwest Ethiopia. An institutional-based retrospective follow-up study was conducted among 365 women who were enrolled for option B+ prevention of mother-to-child transmission service between June 2013 and March 2021 in Pawi district health facilities. A standard pretested checklist was used to extract data from all eligible women's records. The Kaplan-Meier survival curve for estimating survival probability and Cox proportional hazards model to identify independent predictors of loss to follow-up were employed after checking for proportional hazards assumptions using STATA-14 statistical software. The overall incidence of loss to follow-up was 12.04 (95% CI: 9.50, 15.20) per 1000 person-months of observation time. Residing outside the catchment area (adjusted hazard ratio (AHR): 3.08, 95% CI: 1.59, 5.98), lactating at enrollment (AHR: 2.43, 95% CI: 1.24, 4.77), living in a sero-discordant relationship (AHR: 2.5, 95% CI: 1.13, 5.53), lack of sero-status disclosure (AHR: 2.59, 95% CI: 1.15, 5.85), new enrollment to lifelong antiretroviral therapy (AHR: 2.07, 95% CI: 1.05, 4.11), and fair (AHR: 2.69, 95% CI: 1.2, 6.04) or poor (AHR: 5.78, 95% CI: 2.76, 12.12) antiretroviral drug adherence level were independent predictors of loss to follow-up. We found a higher incidence of loss to follow-up relative to previous studies in Ethiopia. Thus, strengthening adherence support interventions, and effective counseling on sero-status disclosure and male partner involvement are important to retain women in care.

Health-related quality of life among people living with HIV/AIDS on highly active antiretroviral treatment

Introduction: The knowledge of the effect of sociodemographic and disease-related factors on health-related quality of life (HRQoL) among people living with HIV/AIDS (PLWHA) is important for planning comprehensive health-care services for them. Material and Methods: Two hundred PLWHA on antiretroviral therapy (ART) volunteered to complete a self-reported World Health Organization's Quality of Life[FIGURE DASH]HIV brief questionnaire (WHOQoL-HIV-BREF) that examines six domains each with four items (physical, psychological, level of independence, social, environmental, and spiritual) with 25 facets and additional 5 facets specific to PLWHA (symptoms of HIV, social inclusion, forgiveness, worries about the future, and death and dying). Results: Only 135 questionnaires from 73 (53.3%) men and 63 (46.7%) women (male: female – 1.14:1) aged 20–82 years (mean ± standard deviation: 42.9 ± 10.5 years) were found complete. Eighty-five (63%) individuals were aged 41–60 years, 78 (57.8%) individuals were matriculates, graduates, or postgraduates, 76 (56.3%) respondents were married, and 38 (28.1%) were widows/widowers. Staying-alone workers comprised 43 (31.8%) individuals. Overall health and HRQoL were rated satisfactory (n = 85.2%) and good/very good (n = 74.8%) by a significantly greater number of individuals (P = 0.001). Pearson's Chi-squared test showed no statistically significant (P &gt; α) associations between good HRQoL and variables such as age &gt;40 years, gender, education, marital status, duration of disease, disclosure of serostatus to family, ART for &gt;3 years, and CD4 &gt;200 cells/mL. Conclusion: Regular ART can result in adequate control of immunosuppression and no comorbidities in a majority of PLWHA, family and social acceptance, and financial security can result in overall good HRQoL in all six domains within the WHOQoL-HIV-BREF. The study is limited by its cross-sectional study design and small sample size.

Fatores associados à retenção de travestis e mulheres trans vivendo com HIV em uma intervenção com navegação de pares em São Paulo, Brasil

Travestis and transgender women (TrTGW) constitute the groups with the highest HIV prevalence in the world, with higher probability of infection compared with the general population and lower adherence to prevention and treatment strategies than other vulnerable groups. Considering these challenges, this study describes the factors associated with the retention of TrTGW with HIV to the TransAmigas project. Participants were recruited from April 2018 to September 2019 in a public health service in São Paulo, Brazil. A total of 113 TrTGW were randomly assigned to either a peer navigation intervention (75) or a control group (38) and followed up for nine months. To analyze the association between the selected variables and the outcome (“retention at nine months”, regardless of contact at three months, defined by the “full completion of the final questionnaire”), bivariate and multivariate logistic regression models were used. Peer contact forms were qualitatively assessed to validate and complement the previous selection of quantitative component variables. Of the 113 participants, 79 (69.9%) participated in the interview after nine months, of which 54 (72%) were from the intervention group and 25 (66%) from the control group. In the final multivariate model, contact at three months (adjusted odds ratio - aOR = 6.15; 95% confidence interval - 95%CI: 2.16-17.51) and higher schooling level (≥ 12 years) (aOR = 3.26; 95%CI: 1.02-10.42) remained associated with the outcome, adjusted by race/skin color, age ≤ 35 years, and HIV serostatus disclosure. Future studies with TrTGW should include contact at regular intervals, with additional efforts aimed at participants with lower schooling level.

Factors associated with the retention of travestis and transgender women living with HIV in a peer navigation intervention in São Paulo, Brazil.

Travestis and transgender women (TrTGW) constitute the groups with the highest HIV prevalence in the world, with higher probability of infection compared with the general population and lower adherence to prevention and treatment strategies than other vulnerable groups. Considering these challenges, this study describes the factors associated with the retention of TrTGW with HIV to the TransAmigas project. Participants were recruited from April 2018 to September 2019 in a public health service in São Paulo, Brazil. A total of 113 TrTGW were randomly assigned to either a peer navigation intervention (75) or a control group (38) and followed up for nine months. To analyze the association between the selected variables and the outcome ("retention at nine months", regardless of contact at three months, defined by the "full completion of the final questionnaire"), bivariate and multivariate logistic regression models were used. Peer contact forms were qualitatively assessed to validate and complement the previous selection of quantitative component variables. Of the 113 participants, 79 (69.9%) participated in the interview after nine months, of which 54 (72%) were from the intervention group and 25 (66%) from the control group. In the final multivariate model, contact at three months (adjusted odds ratio - aOR = 6.15; 95% confidence interval - 95%CI: 2.16-17.51) and higher schooling level (≥ 12 years) (aOR = 3.26; 95%CI: 1.02-10.42) remained associated with the outcome, adjusted by race/skin color, age ≤ 35 years, and HIV serostatus disclosure. Future studies with TrTGW should include contact at regular intervals, with additional efforts aimed at participants with lower schooling level.

Experiences of Caring for Adolescents Living with HIV (ALHIV): A Qualitative Interview with Caregivers.

This study aims at exploring experiences of people caring for adolescents living with HIV, also known as caregivers. By 2021, 150,000 adolescents were living with HIV and 32,000 adolescents were dying of AIDS related causes. HIV/AIDS remains one of the most serious public health problems, especially among the adolescents. This has placed a heavy burden on many caregivers, yet they are essential in caring for ALHIV. However, focus of all interventions has excluded caregivers of ALHIV. Thus, this is the reason why this study is being conducted to find out caregivers' experience in caring for ALHIV. A phenomenological study was carried out. Purposive sampling was used to select a total of 15 caregivers to participate in the study. These participants were subjected to in-depth semi-structured interviews. Their responses were recorded, transcribed and translated for thematic analysis. While analyzing the results, six themes emerged. They include: diagnosis and reaction to diagnosis, experiences on adolescent's HIV serostatus disclosure, stigma and discrimination, care disengagement, and lastly, challenges during care and coping strategies. Caregivers experienced feelings of fear, Guilt, suicidal thoughts after diagnosis. Stigma and discrimination of adolescents living with HIV which was common at school and from the neighbors and the adolescent stage were some of the challenges experienced by the caregivers and it makes it hard to retain ALHIV in care. Families are the main source of caregiving to the adolescents living with HIV (ALHIV). The study's findings indicate that caregivers in the families experience challenges related to family needs, and psychological challenges resulting from the adolescence stage. So, families should not be left to shoulder the burden of caring for ALHIV. As a way forward, social network and financial support should also be strengthened for most caregivers as a coping strategy.

HIV Status Disclosure and Quality of Life of People Living with HIV/AIDS in the Ho Municipality, Ghana

Background. Quality of life (QoL) and HIV/AIDS serostatus disclosure are vital HIV outcome indicators. This study examined factors associated with QoL, HIV status disclosure, and the relationship between QoL and disclosure among people living with HIV (PLWHIV) at the Ho Teaching Hospital. Methods. We conducted a hospital-based cross-sectional survey among 311 PLWHIV. The World Health Organization WHOQOL-HIV BREF questionnaire was used to measure QoL. A semistructured questionnaire was used to gather information on socio-demographics and HIV serostatus disclosure. Multivariate logistic and multiple linear regressions were used to determine predictors of HIV serostatus disclosure and QoL in six domains, respectively. Results. Overall, 88.7% of participants disclosed their HIV status to a significant relation. The majority (98.1%) presented with good QoL, high (83.3%) among participants who disclosed their HIV seropositive status. Patients on antiretroviral therapy (ART) for more than a year were 8.64 times more likely to disclose their HIV status as compared to those on ART for less than a year (AOR = 8.64 (95% CI: 2.00–37.27), p = 0.004 ). Increasing years on ART (β = 0.37) and being employed (β = 1.31) positively predicted good QoL in the physical domain, whereas higher educational level positively predicted good QoL in the social domain (β = 0.66). QoL was not associated with HIV serostatus disclosure. Conclusion. HIV status disclosure was high. Increasing years on ART increased the odds of disclosure. Although there was no significant relationship between QoL and disclosure, good QoL was high among those who disclosed their HIV status. Increasing years on ART, higher education, and being employed predicted good QoL.

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.

Women's HIV-positive disclosure plays a pivotal role to achieve the goal of preventing mother-to-child transmission (PMTCT) among pregnant women in particular. Although several primary studies were conducted in the different countries of East Africa, no study concluded the prevalence of women's HIV status disclosure and associated factors in East Africa. Therefore, the current study aimed to assess the pooled prevalence of disclosure status and associated factors among women in East Africa. To assess the pooled prevalence of HIV sero-status disclosure and associated factors among women in East Africa. HINARI, PubMed, and Cochrane Library databases were searched. The data were extracted using a Microsoft Excel spreadsheet and STATA v 14.1 was used for the analysis. The Funnel plots and Egger's statistical test was used to check publication bias. Heterogeneity was assessed by conducting sensitivity and subgroup analyses. The pooled prevalence of sero-status disclosure among women in East Africa was 73.77% (95%CI 67.76, 79.77). Knowing partner's sero-status (OR = 10.04(95%CI 3.36, 31.84), married (OR = 2.46 (95%CI 1.23, 4.89), smooth relationship (OR = 3.30 (95%CI 1.39, 7.84), and discussion on HIV before the test (OR = 6.96 (95%CI 3.21, 15.05) were identified determinants of HIV sero-status disclosure. The current systematic and meta-analysis revealed that nearly one-fourth of women had not disclosed HIV sero-status to at least one individual. Knowing the partner's HIV sero-status, being married, having a smooth relationship, and discussing on HIV before the test were determinants of disclosure status. Therefore, disclosure of HIV-positive sero-status among women living with HIV needs to be strengthened.

Incidence, survival time and associated factors of virological failure among adult HIV/AIDS patients on first line antiretroviral therapy in St. Paul's Hospital Millennium Medical College-A retrospective cohort study.

Human Immune deficiency Virus or Acquired Immune deficiency Syndrome (HIV/AIDS) is a pandemic affecting millions around the world. The 2020 the Joint United Nations Programme on HIV/AIDS report stated that the estimated number of people living with HIV (PLHIV) is 38 million globally by 2019. Ethiopia is among HIV high burden countries in Africa. By 2021, PLHIV in Ethiopia is estimated to be 754, 256. Globally out of 25.4 million PLHIV on ART, 41% reported virally non-suppressed. According to UNAIDS, the estimated viral non-suppression in Ethiopia is about 27%. A hospital based retrospective cohort study was conducted among 323 patients who were enrolled to ART from July 2016 to December 2020. The medical records of study participants were selected using simple random sampling technique & data was collected using data extraction checklist. The collected data was entered and cleaned using SPSS V.25. Kaplan-Meier is used to estimate the cumulative hazard of virological failure at different time points. During bivariate analysis variables with p<0.25 were taken for Multivariate Cox regression analysis to assess predictors of virological failure & statistically significant association was declared at p<0.05 with 95% confidence interval. The overall incidence rate of virological failure was 1.75 per 1000 months of observations. The mean survival time of virological failure was 14.80 months. Disclosure of sero-status (AHR = 0.038, 95% CI: 0.008-018), poor adherence (AHR = 4.24, 95% CI: 1.04-16), having OIs (Opportunistic infections) (AHR = 4.59, 95% CI: 1.17-18) and use of cotrimoxazole (CPT) prophylaxis (AHR = 0.13, 95% CI: 0.026-0.68) have shown statistically significant association with virological failure. The incidence of virological failure among patients on first line ART in St. Paul's hospital is low. Disclosure of sero-status, poor adherence, having OIs and use of CPT prophylaxis were associated with virological failure. Therefore, a due attention needs to be given to these factors in order to minimize virological failure in patients on ART.

The sexual and reproductive health needs of young people living with HIV in Gauteng, South Africa.

BackgroundHIV has been the focus of health systems strengthening in South Africa for the past two decades. Despite progress, sexual and reproductive health (SRH) challenges such as contraception, condom usage and HIV disclosure of young people living with HIV (YPLHIV) remain inadequately addressed. Therefore, the purpose of the study was to describe the SRH needs of YPLHIV and make recommendations to address identified gaps.ObjectivesTo explore and describe the SRH needs and potential systemic gaps of YPLHIV with an aim to make recommendations for improvement and contribute to the development of an integrated approach to SRH care in HIV programming.MethodA quantitative cross-sectional research design with purposive sampling was utilised. YPLHIV were recruited from five healthcare facilities in Gauteng, South Africa, for face-to-face interviews.ResultsOne hundred and six YPLHIV with a median age of 18 years were enrolled. A large proportion (57/106; 53.8%) of respondents reported being either single or double orphaned. Sex-related discussions with parents were reported by only 36/106 (34.0%). History of teenage pregnancy was reported in 39/70 (56.0%) of female respondents. A high prevalence of multiple sexual partnerships 41/97 (42.2%) was noted. Consensual partner HIV disclosure was low at 47/97 (48.4%) and the male gender was associated with low 10/35 (28.6%) disclosure of serostatus to sexual partners.ConclusionMultiple SRH needs were identified. Interventions are needed to improve parental guidance on SRH issues, increase contraception knowledge and access, and provide better male-centred care.

"I was still very young": agency, stigma and HIV care strategies at school, baseline results of a qualitative study among youth in rural Kenya and Uganda.

IntroductionAdolescents and young adults living with HIV (AYAH) have the lowest rates of retention in HIV care and antiretroviral therapy (ART) adherence, partly due to the demands of school associated with this life stage, to HIV‐related stigma and to fears of serostatus disclosure. We explore the implications of school‐based stigma and disclosure on the development of agency during a critical life stage in rural Kenya and Uganda.MethodsWe conducted a qualitative study in the baseline year of the SEARCH Youth study, a combination intervention using a life‐stage approach among youth (15–24 years old) living with HIV in western Kenya and southwestern Uganda to improve viral load suppression and health outcomes. We conducted in‐depth, semi‐structured interviews in 2019 with three cohorts of purposively selected study participants (youth [n = 83], balanced for sex, life stage and HIV care status; recommended family members of youth [n = 33]; and providers [n = 20]). Inductive analysis exploring contextual factors affecting HIV care engagement revealed the high salience of schooling environments.ResultsStigma within school settings, elicited by non‐consensual serostatus disclosure, medication schedules and clinic appointments, exerts a constraining factor around which AYAH must navigate to identify and pursue opportunities available to them as young people. HIV status can affect cross‐generational support and cohort formation, as AYAH differ from non‐AYAH peers because of care‐related demands affecting schooling, exams and graduation. However, adolescents demonstrate a capacity to overcome anticipated stigma and protect themselves by selectively disclosing HIV status to trusted peers and caregivers, as they develop a sense of agency concomitant with this life stage. Older adolescents showed greater ability to seek out supportive relationships than younger ones who relied on adult caregivers to facilitate this support.ConclusionsSchool is a potential site of HIV stigma and also a setting for learning how to resist such stigma. School‐going adolescents should be supported to identify helpful peers and selectively disclose serostatus as they master decision making about when and where to take medications, and who should know. Stigma is avoided by fewer visits to the clinic; providers should consider longer refills, discreet packaging and long‐acting, injectable ART for students.

HIV Serostatus Disclosure and Its Predictors Among Children Living With HIV in Ethiopia: A Systematic Review and Meta-Analysis.

BackgroundHIV disclosure among children refers to when the caregiver is having disclosed to the child that he or she has HIV specifically. Disclosure significantly improved adherence to treatment and quality of life among children living with HIV/AIDS. Even though, the benefits of disclosure are considerable, informing a child of his or her own HIV status is often delayed. There is a dearth of studies on HIV serostatus disclosure among children in Ethiopia. Therefore, this study aimed to assess the pooled prevalence of HIV serostatus disclosure and associated factors among children living with HIV in Ethiopia.Methods and MaterialsUsing a combination of search terms and Boolean operators, studies were retrieved from Pub Med/MEDLINE, EMBASE, CINAHL, Science Direct, Scopus, Web of Science, Cochran library, and Google Scholar. Five authors independently assessed the quality of each study using the modified Newcastle Ottawa Scale (NOS) for cross-sectional studies. STATA Version 11 software was used for statistical analyses. The random-effects (Der Simonian and Laird) method was used for the meta-analysis. The heterogeneity test was carried out with the help of I-squared (I2) statistics. A leave-one-out sensitivity analysis was carried out.ResultsA total of 12 articles with 3,410 participants were included in this systematic review and meta-analysis. The pooled prevalence of HIV serostatus disclosure among children was 36.87% (95% CI: 29.30, 44.44; I2 = 95.8%). Children aged older than 10 years (p = 0.003) and caregivers with primary and above education (p < 0.001) were factors significantly associated with HIV serostatus disclosure among children.ConclusionsThe finding of this study showed that HIV serostatus disclosure among children is relatively low. Therefore, developing clear guideline on HIV serostatus disclosure among children, strengthening public health education or community awareness creation about HIV/AIDS to promote the benefits of disclosure and extensively provision of counseling by health care providers are essential to enhance HIV serostatus disclosure among children.Systematic Review Registrationhttps://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021239035.