HIV-disclosure in the context of vertical transmission: HIV-positive mothers in Johannesburg, South Africa

Abstract

HIV-disclosure among childbearing women remains poorly understood, particularly in sub-Saharan Africa. This paper chronicles disclosure experiences of 31 women attending prevention of mother-to-child HIV transmission services in Johannesburg. Data collection entailed repeat in-depth interviews over a nine-month period. Virtually all women (93.5%) had told at least one person (usually a partner), most voluntarily and within a week of the test result. Secondary disclosure was most likely with female family members, through indirect means and involuntary. Confidentiality breach by primary targets likely contributed to the observed high rates of involuntary secondary disclosure and negative secondary disclosure experiences. For most mothers, voluntary disclosure was driven by the desire to ensure adequate infant care and avoid vertical HIV transmission. The impact of disclosure was not always clear-cut. While most primary disclosure experiences were ultimately constructive, secondary disclosure more likely led to rejection, stigmatization and the withholding of financial support. Our data illustrate the influence of social contextual factors on disclosure patterns and impact. For these mothers, socio-cultural norms, the current media and political environment surrounding HIV/AIDS, household composition and social networks and childbearing status shaped disclosure experiences; sometimes constraining disclosure circumstances and sometimes creating a safe space to disclose. Programmatic implications are also discussed.

HIV serostatus disclosure and associated factors among HIV positive pregnant women attending antenatal care services in northwest Ethiopia

“…At the same time, they may belief that HIV positive serostatus disclosure creates opportunities to discuss and implement HIV risk reduction strategies with their sexual partner, improves access to necessary medical treatment and care, and increases opportunities for financial and psychosocial support. 5,16 In this and other studies, pregnant women from rural settings were less likely to disclose their HIV positive serostatus to sexual partners as compared to those from urban settings. 15 This indicates that women from rural settings are unaware of the importance of disclosing HIV serostatus.…”

Disclosure in times of ART: A relational analysis of social practices

“…While quantitative studies on disclosure rates tell us something about practices among PLWHA (see, for instance: Akani & Erhabor 2006;Varga, Sherman & Jones 2006;Wong, Rooyen, Modiba, Richter, Gray, McIntyre, et al 2009), they face two main methodological challenges: (1) disclosure rates strongly depend on the duration of the recall/study period; (2) Alongside the rational motivations for disclosure emphasized by public health recommendations, the choice of disclosing -and to whom -often reflects power differentials within social relationships. Disclosing one's HIV status has been described as particularly risky for women, as (fear of) accusations of infidelity, rejection, abandonment, discrimination and violence may follow The situations presented and analyzed in this special issue add to our empirical knowledge of disclosure, helping to document the wide range of social contexts that influence practice and the ethical issues involved.…”

Mothers’ infant feeding experiences: constraints and supports for optimal feeding in an HIV-impacted urban community in South Africa

“…Despite the fear of discrimination associated with disclosure, mothers living with HIV who disclose their status have been found to experience positive outcomes (11) . Varga et al (12) view disclosure as a dynamic process, as outlined in Table 1.…”