Prevalence and Predictors of HIV Disclosure to Adult Family Members: A Cross-Sectional Survey Among People Living with HIV in South Africa
DOI:
https://doi.org/10.12974/2313-1047.2021.08.6Keywords:
HIV disclosure, Adult family members, People living with HIV, Survey, Prevalence, Predictors, South AfricaAbstract
Disclosure in the context of HIV is the sharing of information about one’s HIV-positive status, and many factors influence the decision to do so. This study examined the prevalence and predictors of HIV disclosure to adult family members using data collected from the South African 2014 People Living with HIV (PLHIV) Stigma Index. A purposive sample consisting of 10 473 PLHIV were recruited into the study from 18 districts across all of the nine provinces (two districts per province) out of a total of 52 districts found in South Africa. All respondents were linked to an institution for PLHIV accessing support or care related to HIV. Bivariate and multivariate logistic regression models were used to assess the association between HIV disclosure to family members and selected explanatory variables. A large majority (85°§1%) of the 9874 PLHIV who responded to the question on disclosure to adult family members reported that they had done so. Significant positive predictors of HIV disclosure to adult family members included reporting an age between 25 - 49 years [OR=1°§5: 95% CI (1°§2-1°§8), p<0.001], aged 50 years and older [OR=1°§5: 95% °§CI (1°§1 - 2°§0), p=0012], unemployment [OR=1°§3: 95% CI (1°§1 - 1°§5), p=0.002] and living with HIV for 5 and more years [OR=1°§6: 95% CI (1°§2 - 2°§0), p<.0.001]. On the other hand, significant negative predictors of disclosure included HIV testing decision taken under pressure from others [OR=0.6: 95% CI (0.5-0.8), p<0.001], testing without own knowledge [OR=0.3: 95% CI (0.2-0.5), p<0.001], only receiving pre-test HIV counselling [OR=0.4: 95% CI (0.3-0.5), p<0.001], and not receiving any counselling when testing for HIV [OR=0.6: 95% CI (0.4-0.9), p=0.012]. Overall, the majority of study participants had disclosed their HIV positive status to family members. However, there is a need to equip younger PLHIV and those who were recently diagnosed with HIV with the necessary positive coping mechanisms and self-esteem strategies in order to facilitate disclosure among this population group. Involuntary or forced HIV testing and poor/lack of pre- and post-test counselling should be discouraged since they have been shown to have negative consequences for disclosure.
References
Bouillon K, Lert F, Sitta R, Schmaus A, Spire B, Dray-Spira R. Factors correlated with disclosure of HIV infection in the French Antilles and French Guiana: results from the ANRSEN13- VESPA-DFA Study. AIDS (London, England) 2007; 21: S89. https://doi.org/10.1097/01.aids.0000255091.29050.13
Atuyambe LM, Ssegujja E, Ssali S, et al. HIV/AIDS status disclosure increases support, behavioural change and, HIV prevention in the long term: a case for an Urban Clinic, Kampala, Uganda. BMC Health Services Research 2014; 14(1): 276. https://doi: 10.1186/1472-6963-14-276. https://doi.org/10.1186/1472-6963-14-276
Obermeyer CM, Baijal P, Pegurri E. Facilitating HIV disclosure across diverse settings: a review. American Journal of Public Health 2011; 101(6): 1011-23. https://doi.org/10.2105/AJPH.2010.300102
Batterham P, Rice E, Rotheram-Borus MJ. Predictors of serostatus disclosure to partners among young people living with HIV in the pre-and post-HAART eras. AIDS and Behavior 2005; 9(3): 281-7. https://doi.org/10.1007/s10461-005-9002-5
Li L, Wu S, Wu Z, Sun S, Cui H, Jia M. Understanding family support for people living with HIV/AIDS in Yunnan, China. AIDS and Behavior 2006; 10(5): 509-17. https://doi.org/10.1007/s10461-006-9071-0
Smith R, Rossetto K, Peterson BL. A meta-analysis of disclosure of one's HIV-positive status, stigma and social support. AIDS Care 2008; 20(10): 1266-75. https://doi.org/10.1080/09540120801926977
Bird JD, Voisin DR. A conceptual model of HIV disclosure in casual sexual encounters among men who have sex with men. Journal of Health Psychology 2011; 16(2): 365-73. https://doi.org/10.1177/1359105310379064
Rochat TJ, Mkwanazi N, Bland R. Maternal HIV disclosure to HIV-uninfected children in rural South Africa: a pilot study of a family-based intervention. BMC Public Health 2013; 13(1): 147. https://doi.org/10.1186/1471-2458-13-147
Serovich JM, Craft SM, Reed SJ. Women's HIV disclosure to family and friends. AIDS Patient Care and STDs 2012; 26(4): 241-9. https://doi.org/10.1089/apc.2011.0319
Sulstarova B, Poglia Mileti F, Mellini L, Villani M, Singy P. HIV disclosure and nondisclosure among migrant women from sub-Saharan Africa living in Switzerland. AIDS Care 2015; 27(4): 451-7. https://doi.org/10.1080/09540121.2014.963497
Adeniyi OV, Ajayi AI, Selanto-Chairman N, et al. Demographic, clinical and behavioural determinants of HIV serostatus non-disclosure to sex partners among HIVinfected pregnant women in the Eastern Cape, South Africa. PloS one 2017; 12(8): e0181730. https://doi.org/10.1371/journal.pone.0181730
Adeniyi VO, Thomson E, Ter Goon D, Ajayi IA. Disclosure, stigma of HIV positive child and access to early infant diagnosis in the rural communities of OR Tambo District, South Africa: a qualitative exploration of maternal perspective. BMC Pediatrics 2015; 15(1): 98. https://doi.org/10.1186/s12887-015-0414-8
Wong LH, Van Rooyen H, Modiba P, et al. Test and tell: correlates and consequences of testing and disclosure of HIV status in South Africa (HPTN 043 Project Accept). Journal of Acquired Immune Deficiency Syndromes 2009; 50(2): 215. https://doi.org/10.1097/QAI.0b013e3181900172
Gilbert L, Walker L. 'My biggest fear was that people would reject me once they knew my status: stigma as experienced by patients in an HIV/AIDS clinic in Johannesburg, South Africa. Health & Social Care in the Community 2010; 18(2): 139-46. https://doi.org/10.1111/j.1365-2524.2009.00881.x
Greeff M, Phetlhu R, Makoae LN, et al. Disclosure of HIV status: experiences and perceptions of persons living with HIV/AIDS and nurses involved in their care in Africa. Qualitative Health Research 2008; 18(3): 311-24. https://doi.org/10.1177/1049732307311118
Wouters E, van Loon F, van Rensburg D, Meulemans H. Community support and disclosure of HIV serostatus to family members by public-sector antiretroviral treatment patients in the Free State Province of South Africa. AIDS Patient Care and STDs 2009; 23(5): 357-64. https://doi.org/10.1089/apc.2008.0201
South African National AIDS Council (SANAC). The People Living with HIV Stigma Index. South Africa. 2014. Pretoria. South Africa: SANAC; 2015.
Rodkjaer L, Sodemann M, Ostergaard L, Lomborg K. Disclosure decisions: HIV-positive persons coping with disease-related stressors. Qualitative Health Research 2011; 21(9): 1249-59. https://doi.org/10.1177/1049732311405803
Tam M, Amzel A, Phelps BR. Disclosure of HIV serostatus among pregnant and postpartum women in sub-Saharan Africa: a systematic review. AIDS Care 2015; 27(4): 436-50. https://doi.org/10.1080/09540121.2014.997662
Zou J, Yamanaka Y, John M, Watt M, Ostermann J, Thielman N. Religion and HIV in Tanzania: influence of religious beliefs on HIV stigma, disclosure, and treatment attitudes. BMC Public Health 2009; 9: 75-2458-9-75. https://doi.org/10.1186/1471-2458-9-75
Yonah G, Fredrick F, Leyna G. HIV serostatus disclosure among people living with HIV/AIDS in Mwanza, Tanzania. AIDS Research And Therapy 2014; 11(1): 5. https://doi.org/10.1186/1742-6405-11-5
Shacham E, Small E, Onen N, Stamm K, Overton ET. Serostatus disclosure among adults with HIV in the era of HIV therapy. AIDS Patient Care and STDs 2012; 26(1): 29- 35. https://doi.org/10.1089/apc.2011.0183
Simbayi LC, Kalichman SC, Strebel A, Cloete A, Henda N, Mqeketo A. Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa. Sexually Transmitted Infections 2007; 83(1): 29-34. https://doi.org/10.1136/sti.2006.019893
Kadowa I, Nuwaha F. Factors influencing disclosure of HIV positive status in Mityana district of Uganda. African Health Sciences 2009; 9(1): 26-33.
Norman A, Chopra M, Kadiyala S. HIV disclosure in South Africa: Enabling the gateway to effective response. Washington DC: International Food Policy Research Institute 2005.
Medley A, Garcia-Moreno C, McGill S, Maman S. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bulletin of the World Health Organization 2004; 82(4): 299-307.
SANAC. National Strategic Plan on HIV, STIs and TB, 2017- 2021. Pretoria: Department of Health; 2016.
Gillett HJ, Parr J. Disclosure among HIV-positive women: The role of HIV/AIDS support groups in rural Kenya. African Journal of AIDS Research 2010; 9(4): 337-44. https://doi.org/10.2989/16085906.2010.545633
Deribe K. Woldemichael K. Wondafrash M. Haile A. Amberbir A. Disclosure experience and associated factors among HIV positive men and women clinical service users in southwest Ethiopia. BMC Public Healthl 2008; 8: 1-34. https://doi.org/10.1186/1471-2458-8-81
Greeff M, Phetlhu R, Makoae LN, Dlamini PS, Holzemer WL, Naidoo JR, Kohi TW, Uys LR, Chirwa ML. Disclosure of HIV status: Experiences and perceptions of people living with HIV/AIDS and nurses involved in their care in Africa. Qualitative Health Research. 2008; 18: 311-324. https://doi.org/10.1177/1049732307311118
