Demographic, clinical and behavioural determinants of HIV serostatus non-disclosure to sex partners among HIV-infected pregnant women in the Eastern Cape, South Africa

Abstract

ObjectivesDrawing from a baseline sample of a cohort study, the study examines the extent and correlates of serostatus non-disclosure to sex partners and family members, and reasons for non-disclosure among HIV-infected pregnant women in the Eastern Cape Province, South Africa.MethodsThis longitudinal cohort study recruited 1709 pregnant women living with HIV who attended three of the largest maternity centres in the Eastern Cape, South Africa, for delivery between September 2015 and May 2016. Relevant items on demographics, serostatus awareness, disclosure to sex partners and family members, and lifestyle behaviours were obtained using structured interviews. Age-stratified binary logistic regression models were used to determine the significant correlates of non-disclosure among the participants.ResultsA higher rate of HIV serostatus non-disclosure to sex partners (25.6%) in comparison to family members (20%) was reported by the participants. Younger age, not living with partners and alcohol use were significantly associated with non-disclosure of HIV serostatus to sex partners. Non-disclosure of HIV serostatus to sex partners was significantly (p<0.05) associated with poor adherence to the highly active anti-retroviral therapy (HAART), failure to keep clinic appointments and high viral load at the delivery of the baby. Perceived fear of intimate partner violence, fear of rejection, guilt of not disclosing at the onset of the relationship, sex partner’s non-disclosure of HIV serostatus, and guilt of unfaithfulness were some of the reasons for non-disclosure of HIV serostatus to sex partners.ConclusionsNon-disclosure of HIV serostatus is a public health concern with serious implications for both mother-to-child transmission, as well as horizontal transmission, in our setting. Strategic efforts toward ending the epidemic of HIV and AIDS in South Africa should address the sociocultural and behavioural determinants of non-disclosure.

HIV positive status disclosure to a sexual partner: the influence of marital status and partner communication

“…Reasons for non-disclosure among the participants were fear of rejection and violent reactions of partners, and not being ready to disclose. These are consistent with previous studies in a similar setting in South Africa [24] and elsewhere [26,31]. Addressing these reasons through counselling will further increase the rate of disclosure in the study setting.…”

“…Status disclosure to partners should be strengthened in order to prevent HIV breastmilk transmission in the region by consolidating the counselling sessions at the postnatal clinic visits. The high rate of disclosure in the present study (82.5%) is higher than the rate reported in the same population during the pregnancy period (74.4%) [24]. Similar disclosure rates were reported in the literature among pregnant and postpartum women [20,25,26].…”

Level and determinants of postpartum adherence to antiretroviral therapy in the Eastern Cape, South Africa

“…These maternity centres serve approximately 1.7 million people from rural, peri-urban and urban communities of the selected districts in the central region of the Eastern Cape. The detailed methodology of the East London Prospective Cohort Study has been published elsewhere [22].…”

Determinants of Immediate Postpartum Contraception among Parturient Women with HIV in the Eastern Cape, South Africa; A Prospective Cross-sectional Study

“…The larger study aimed to examine PMTCT outcomes in the province and was conducted between September 2015 and May 2016. The full detail of the methodology has been published elsewhere [22]. Brie y, this study was conducted in the three largest maternity facilities in the Buffalo/Amathole districts of the Eastern Cape Province, South Africa.…”