HIV Serostatus Disclosure to Sexual Partners Among Sexually Active People Living with HIV in South Africa: Results from the 2012 National Population-Based Household Survey

Simbayi, Leickness C.; Zungu, Nompumelelo; Evans, Meredith; Mehlomakulu, Vuyelwa; Kupamupindi, Takura; Mafoko, Goitseone; Zuma, Khangelani

doi:10.1007/s10461-015-1278-5

Cited by 23 publications

(11 citation statements)

References 46 publications

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“…However, this may be because participants who had not disclosed were not in a stable or committed relationship, as all participants in this study reported being sexually active. This is consistent with findings from the 2012 South African National HIV Prevalence, Incidence and Behaviour survey, where the analysis showed that those who were not married, including those living in common-law relationships, were 60% less likely to disclose their HIV-positive status when compared to those who were married [27,28].…”

Section: Discussionsupporting

confidence: 87%

Human Immunodeficiency Virus (HIV) Disclosure and Sexual Behaviors among Kenyan Women

et al. 2019

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Background: Disclosure of HIV status is crucial to the adoption of preventive behaviors for HIV transmission. This study was conducted to investigate HIV status disclosure and its impact on sexual practices among HIV-positive women in Nairobi, Kenya. Methods: A cross-sectional study was conducted among HIV-positive women seeking care at two hospitals in Nairobi. A questionnaire and known self-efficacy scales were administered to eligible women to collect information on sociodemographic factors, HIV disclosure and beliefs, healthcare provider advice on disclosure, sexual practices, and self-efficacy. Results: Of 497 women who were included in this analysis, 95.8% had disclosed their HIV status to someone. Women who disclosed were more likely to be in a relationship (p 0.0017) and to be the heads of their households (p 0.0042). Women who reported that their healthcare provider advised them to disclose and told them of ways to disclose were significantly more likely to have disclosed (p=0.0237 and p=0.0294, respectively). The belief that HIV status disclosure is important for HIV prevention and control and that the benefits of disclosure outweigh the risks was also significantly associated with disclosure (p<0.0001 for both). Conclusion: The prevalence of disclosure among HIV-positive individuals’ in hospital settings in Nairobi is high. These findings indicate that encouraging and suggesting ways to disclose by healthcare providers and individuals’ beliefs about the benefits of disclosure can increase the rate of HIV disclosure. Prospective studies to assess these observations would provide reliable guidance on how to increase disclosure by all women.

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Section: Discussionsupporting

confidence: 87%

Human Immunodeficiency Virus (HIV) Disclosure and Sexual Behaviors among Kenyan Women

et al. 2019

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“…Interestingly, similar to the RapIT study results, a higher proportion of men was diagnosed with HIV and initiated ART, suggesting that the offer of immediate ART may be more attractive to men than women [14]. Being in a partnership may signify access to social support in some cases, but being in an insecure partnership may amplify fears associated with HIV status disclosure, and limit ART adherence [38‐44]. Fears of HIV stigma also compel some patients to access HIV care further away to avoid being identified at a nearby clinic [45].…”

Section: Discussionmentioning

confidence: 89%

Attrition in HIV care following HIV diagnosis: a comparison of the pre‐UTT and UTT eras in South Africa

Onoya

Hendrickson

Sineke

et al. 2021

J. Intern. AIDS Soc.

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Introduction Policies for Universal Test & Treat (UTT) and same‐day initiation (SDI) of antiretroviral therapy (ART) were instituted in South Africa in September 2016 and 2017 respectively. However, there is limited evidence on whether these changes have improved patient retention after HIV diagnosis. Methods We enrolled three cohorts of newly diagnosed HIV‐infected adults from two primary health clinics in Johannesburg from April to November 2015 (Pre‐UTT, N = 144), May‐September 2017 (UTT, N = 178) and October‐December 2017 (SDI, N = 88). A baseline survey was administered immediately after HIV diagnosis after which follow‐up using clinical records (paper charts, electronic health records and laboratory data) ensued for 12 months. The primary outcome was patient loss to follow‐up (being >90 days late for the last scheduled appointment) at 12 months post‐HIV diagnosis. We modelled attrition across HIV policy periods with Cox proportional hazard regression. Results Overall, 410 of 580 screened HIV‐positive patients were enrolled. Overall, attrition at 12 months was 30% lower in the UTT guideline period (38.2%) compared to pre‐UTT (47.2%, aHR 0.7, 95% CI: 0.5 to 1.0). However, the total attrition was similar between the SDI (47.7%) and pre‐UTT cohorts (aHR 1.0, 95% CI: 0.7 to 1.5). Older age at HIV diagnosis (aHR 0.5 for ≥40 vs. 25 to 29 years, 95% CI: 0.3 to 0.8) and being in a non‐marital relationship (aHR 0.5 vs. being single, 95% CI: 0.3 to 0.8) protected against LTFU at 12 months, whereas LTFU rates increased with longer travel time to the diagnosing clinic (aHR 1.8 for ≥30 minutes vs. ≤15 minutes, 95% CI: 1.1 to 3.1). In analyses adjusted for the time‐varying ART initiation status, compared to the pre‐ART period of care, the hazard of on‐ART LTFU was 90% higher among participants diagnosed under the SDI policy compared to pre‐UTT (aHR 1.9, 95% CI: 1.1 to 2.9). Conclusions Overall, nearly two‐fifths of HIV positive patients are likely to disengage from care by 12 months after HIV diagnosis under the new SDI policy. Furthermore, the increase in on‐ART patient attrition after the introduction of the SDI policy is cause for concern. Further research is needed to determine the best way for rapidly initiating patients on ART and also reducing long‐term attrition from care.

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“…In one telling illustration of this, businesses with known HIV-positive workers were shown to lose up to half of their customers out of fear of transmission and disdain for people living with HIV (Chao et al 2017). Stigma also represents a significant barrier to testing and makes people reluctant to disclose their serostatus to partners (Simbayi et al 2017;Treves-Kagan et al 2017). Contemplating this topic, Rosa explained that people are afraid of HIV, and that when someone is infected, it is not spoken of and then becomes a secret to the extent that no one can know, 'not even your own family' (field notes).…”

Section: Sociocultural Estrangement and Stigmamentioning

confidence: 99%

Structural vulnerabilities and healthcare services integration

Steenberg¹

2020

MAT

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Home to one fifth of all people living with HIV, South Africa carries the world’s heaviest burden of this disease. While a significant proportion of those infected are immigrants from other African high-prevalence countries, little is known about how these migrants engage with healthcare systems in shifting cultural and clinical settings. This article draws on fieldwork from migrant communities and twenty-one ethnographic life histories told by HIV-positive Mozambicans in a major South African HIV clinic. From their collective narratives, a range of structural vulnerabilities are found that limit immigrants’ access to,and proper integration within,healthcare services. These include perilous migration, xenophobia and deportation, exclusion and exploitation, language barriers, medical pluralism, cultural estrangement, social isolation, and the stigmas of being HIV-positive. In conjunction, these structural factors may delay treatment-seeking and inhibit drug adherence, which could increase rates of morbidity and mortality as well as contribute to viral mutation and antiretroviral drug resistance.

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HIV Serostatus Disclosure to Sexual Partners Among Sexually Active People Living with HIV in South Africa: Results from the 2012 National Population-Based Household Survey

Cited by 23 publications

References 46 publications

Human Immunodeficiency Virus (HIV) Disclosure and Sexual Behaviors among Kenyan Women

Human Immunodeficiency Virus (HIV) Disclosure and Sexual Behaviors among Kenyan Women

Attrition in HIV care following HIV diagnosis: a comparison of the pre‐UTT and UTT eras in South Africa

Structural vulnerabilities and healthcare services integration

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