HIV disclosure patterns, predictors, and psychosocial correlates among HIV positive women in Zimbabwe

Abstract

Disclosure of positive HIV status in Sub-Saharan Africa has been associated with safer sexual practices and better antiretroviral therapy (ART) adherence, but associations with psychosocial function are unclear. We examined patterns and psychosocial correlates of disclosure in a Zimbabwean community. Two hundred HIV positive women at different stages of initiating ART participated in a cross-sectional study examining actual disclosures, disclosure beliefs, perceived stigma, self-esteem, depression, and quality of life. Ninety-seven percent of the women disclosed to at least one person, 78% disclosed to their current husband/partner, with an average disclosure of 4.0 persons per woman. The majority (85–98%) of disclosures occurred in a positive manner and 72–95% of the individuals reacted positively. Factors significantly correlated with HIV disclosure to partners included being married, later age at menses, longer duration of HIV since diagnosis, being on ART, being more symptomatic at baseline, ever having used condoms, and greater number of partners in the last year. In multivariate analysis, being married and age at menses predicted disclosure to partners. Positive disclosure beliefs, but not the total number of disclosures, significantly correlated with lower perceived stigma (rho=0.44 for personalized subscale and rho=0.51 for public subscale, both p<0.0001), higher self-esteem (rho=0.15, p=0.04), and fewer depressive symptoms (rho=−0.14, p=0.05). In conclusion, disclosure of positive HIV status among Zimbabwean women is common and is frequently met with positive reactions. Moreover, positive disclosure beliefs correlate significantly with psychosocial measures, including lower perceived stigma, higher self-esteem, and lower depression.

Types and predictors of partner reactions to HIV status disclosure among HIVinfected adult Nigerians in a tertiary hospital in the Niger Delta

“…Other comparable studies conducted in Burkina Faso, Tanzania, Kenya, Ethiopia and United States of America also reported predominant supportive partner reactions of 62-92%. [2][3][4][5][6]15 It is also noteworthy that our results reveal an increase in supportive partner reactions overtime, with majority of partners who initially reported negative initial partner reaction subsequently reporting positive partner reactions. This subsequent change from negative to positive partner reactions may be used as a counselling strategy to allay fears and concerns of patients who initially experience negative partner reactions following disclosure.…”

“…12 Failure to disclose has been attributed to fear of abandonment, broken relationships, physical and emotional abuse, discrimination and loss of economic support. 2 Despite these disclosure-related fears, studies from both developed and developing countries [2][3][4][5][6][7] , Nigeria inclusive [8][9][10][11][12][13] , have revealed predominant positive or supportive reactions to disclosure, with 50-100% of sexual partners eliciting positive reactions following disclosure. The few reports of negative reactions such as disruption of relationships, violence and discrimination were more commonly reported among unmarried sexual partners and sero-discordant couples, as well as among people from low economic status and in those with history of violence in their relationships.…”

HIV Status Disclosure Among People Living with HIV in the Era of Combination Antiretroviral Therapy (cART)

“…In a study done by Yonah G et al, 93.3% had disclosed their HIV serostatus to someone [13]. A study from Zimbabwe states that 193 (96.5%) out of 200 women had disclosed their HIV status to at least one person [14]. According to Erku TA et al, and Amoran OE, 76.6% and 50.9% PLHIV had disclosed their HIV status to their main sexual partner [3,15].…”

“Trust Me, It’s Different”: Experiences of Peer Case Management of Women Living with HIV in Ontario, Canada

“…After meeting with a peer and opening up dialogue about HIV, this woman felt a sense of relief. Similar responses have been documented in research throughout the world, whereby positive disclosure beliefs are associated with lower perceived stigma, higher self-esteem, and fewer depressive symptoms (Kako & Dubrosky, 2013;Patel et al, 2012).…”

“…From a meso-level, through peer support, women equip themselves with knowledge and confi dence to navigate care landscapes in their region, streamlining the process to accessing services and receiving support. Through disclosure and sharing with another woman living with HIV, women gain confi dence and self-esteem to challenge notions about HIV stereotypes and HIV-related stigma (Kako & Dubrosky, 2013;Patel et al, 2012). Peer case management can strengthen and mobilize communities of WLWH across Ontario to challenge sexism, racism, and HIV-related stigma and to shift how support is provided to WLWH at a macro-level.…”