Sex and secrecy: How HIV-status disclosure affects safe sex among HIV-positive adolescents

Abstract

HIV-positive adolescents who engage in unsafe sex are at heightened risk for transmitting or re-acquiring HIV. Disclosure of HIV-status to sexual partners may impact on condom use, but no study has explored the effects of (i) adolescent knowledge of one's HIV-status, (ii) knowledge of partner status and (iii) disclosure to partners, on safer sex behaviour. This study aimed to identify whether knowledge of HIV-status by HIV-positive adolescents and partners was associated with safer sex. Eight fifty eight HIV-positive adolescents (10–19 years old, 52% female, 68.1% vertically infected) who had ever initiated antiretroviral treatment in 41 health facilities in the Eastern Cape, South Africa, were interviewed using standardised questionnaires. Quantitative analyses used multivariate logistic regressions, controlling for confounders. Qualitative research included interviews, focus group discussions and observations with 43 HIV-positive teenagers and their healthcare workers. N = 128 (14.9%) of the total sample had ever had sex, while N = 109 (85.1%) of sexually active adolescents had boy/girlfriend. In total, 68.1% of the sample knew their status, 41.5% of those who were sexually active and in relationships knew their partner's status, and 35.5% had disclosed to their partners. For adolescents, knowing one's status was associated with safer sex (OR = 4.355, CI 1.085–17.474, p = .038). Neither knowing their partner's status, nor disclosing one's HIV-status to a partner, were associated with safer sex. HIV-positive adolescents feared rejection, stigma and public exposure if disclosing to sexual and romantic partners. Counselling by healthcare workers for HIV-positive adolescents focused on benefits of disclosure, but did not address the fears and risks associated with disclosure. These findings challenge assumptions that disclosure is automatically protective in sexual and romantic relationships for HIV-positive adolescents, who may be ill-equipped to negotiate safer sex. There is a pressing need for effective interventions that mitigate the risks of disclosure and provide HIV-positive adolescents with skills to engage in safe sex.

Resourcing resilience: social protection for HIV prevention amongst children and adolescents in Eastern and Southern Africa

“…Furthermore, there is a dearth of research on what social protection combinations may be best suited to address the compounded vulnerabilities of HIV-positive children and adolescents. Preliminary findings from a community-traced study in South Africa, indicate that access to in-kind cash benefits and care such as parenting supervision and supported disclosure may have positive effects on adherence to ART (Cluver, Hodes, Toska, et al, 2015; Cluver, Toska, et al, 2016) and safe sex (Toska, Cluver, Hodes, & Kidia, 2015). In light of potential linkages between poor adherence and sexual risk-taking among HIV-positive adolescents (Marhefka, Elkington, Dolezal, & Mellins, 2010), it is crucial to identify policy and programmatic interventions that can address the vulnerabilities of HIV-positive children as they become adolescents.…”

“…Mixed-methods investigations provide increased recognition of the associations between gender inequality, transactionality, poverty and HIV-risk behaviours. Girls and young women tolerate condom refusal and sexual concurrency to maintain relationships with male sexual partners who supported them materially (Toska, Cluver, Hodes, et al, 2015). However, critics note that dominant discourses around gender inequalities and the ability of women and girls to protect themselves can be reductionist, and there is a need for more nuanced understandings of the relationships between HIV prevention and gender inequalities, including how they articulate with poverty and other factors (Govender, 2011; Jewkes & Morrell, 2012; Shefer, Kruger, & Schepers, 2015).…”

Enrolling HIV-positive adolescents in mental health research: A case study reflecting on legal and ethical complexities

“…Data were collected on tablet computers to improve reporting of sensitive questions. [57,58] • HRECs reviewing adolescent protocols should consult with one another to facilitate uniformity in response to similar research protocols.…”

Changing Donor Funding and the Challenges of Integrated HIV Treatment

“…We examine some of the consequences of changing resources from three perspectives: first, through an analysis of developments in the political economy of health care financing; second, through an account of changing priorities for HIV treatment in South Africa; and third, through a description of clinical consequences. Our perspective on the ethical dilemmas that health care workers might confront in the aftermath of shifts in donor funding for health care is based on our research on the socioeconomic and experiential aspects of HIV treatment in South Africa; we run the largest known longitudinal, community-based study on medicines-taking and sexual health among HIV-positive adolescents [5][6][7][8]. And with an HIV-prevalence rate of 18.9 percent among adults aged 15 to 49 [9] and approximately 5.9 million South Africans who are HIV-positive, South Africa has the world's largest HIV epidemic [2].…”