How reliable are self-reports of HIV status disclosure? Evidence from couples in Malawi

Abstract

Introduction The majority of research on human immunodeficiency virus (HIV) disclosure utilizes the perspective from a single individual, which cannot be substantiated in the absence of supporting data such as from a primary partner. Objectives The objectives of this study were to evaluate: (1) the extent to which self-reported HIV disclosure was confirmed by a primary partner; (2) individual and relationship-level predictors of self-reported versus confirmed disclosure; and (3) whether confirmed disclosure was a stronger predictor of correctly assessing a partner's HIV status compared to self-reported disclosure. Methods As part of an 8-wave longitudinal study from 2009-2011 in southern Malawi, 366 individuals (183 couples) were interviewed about their primary relationship (wave 3), individually tested for HIV (wave 4), and then asked whether they disclosed to their primary partner (wave 5). Results While 93% of respondents reported that they disclosed, only 64% of respondents had confirmed reports from their partner. Having communicated with partner about HIV was positively associated with self-reported disclosure; this association remained significant but became more precise in the models for confirmed disclosure. Confirmed disclosure, but not self-report, was a significant predictor of correctly assessing a partner's HIV status. Being male, having lower perceived partner infidelity, having higher relationship unity, and testing HIV-negative were positively and significantly associated with correct assessment. Dyadic data from two partners provide an improved measure of disclosure as compared to a single individual's self-report and could be used to identify behavioral and biomedical opportunities to prevent HIV transmission within couples.

Measuring couple relationship quality in a rural African population: Validation of a Couple Functionality Assessment Tool in Malawi

“…Of the 89 couples included in the present study, 70 (79%) agreed that they had both received an HIV test and disclosed their results. Rates of HIV testing were similarly high in a previous study in rural southern Malawi which found that in 87% of couples both partners reported that they had been tested for HIV and disclosed to their partners [ 35 ].…”

‘I told her this is your life’: relationship dynamics, partner support and adherence to antiretroviral therapy among South African couples

“…As such, positive relationship dynamics (e.g., intimacy, trust) enhance couples’ capacity for successful coordination of health behaviors, while negative relationship dynamics (e.g., IPV) make it difficult for couples to work together. In South Africa and Malawi, relationship dynamics such as commitment, unity, equality, trust, and communication have been linked to increased HIV testing and disclosure in couples (Darbes, Dladla, and Mogale 2006, Conroy 2014a, b, van Rooyen et al 2014, Conroy and Wong 2015). Less is known about the intersection between relationship dynamics and adherence in sub-Saharan Africa; however; evidence from resource-rich settings suggests that higher relationship quality is positively associated with ART adherence and virologic control (Knowlton et al 2011, Johnson et al 2012).…”

Relationship Dynamics and Partner Beliefs About Viral Suppression: A Longitudinal Study of Male Couples Living with HIV/AIDS (The Duo Project)

“…For example, the results could be biased by the increased participation of higher-functioning couples who stayed together over the study period—which has been noted as a limitation in other couples studies on primary relationships (15, 63). However, our modeling approach was robust enough to account for missing data under the relatively mild MAR assumption and made use of all data available from participants at each visit, which would enhance generalizability.…”

“…Indeed, there is evidence to suggest that partner beliefs about viral load could be inaccurate. Studies on heterosexual couples conducted outside of the U.S. have found that perceptions of a partner's HIV status and actual serostatus are often mismatched (12) and that there can be discrepancies between partners about whether HIV status disclosure has occurred (13-15). Yet, little research, if any, has examined the accuracy of partner beliefs about viral suppression and whether these beliefs change as treatment and relationship trajectories evolve over time.…”