Kate Taylor1, Matthew Lamb1,2, Maria Lahuerta1,2, Laurence Ahoua3, Fatima Abacassamo4, Batya Elul1. 1. Department of Epidemiology, Mailman School of Public Health, Columbia, University, New York, NY. 2. ICAP at Columbia University, Mailman School of Public Health, Columbia University, New York, NY. 3. ICAP at Columbia University, Maputo, Mozambique. 4. Center for Collaboration in Health, Maputo, Mozambique.
Abstract
BACKGROUND: HIV disclosure benefits people living with HIV, their partners, and HIV programs. However, data on the prevalence of disclosure and associated correlates have come largely from patients already in HIV care, potentially overestimating disclosure rates and precluding examination of the impact of disclosure on HIV care outcomes. SETTING: We used data from an implementation study conducted in Maputo City and Inhambane Province, Mozambique. Adults were enrolled at HIV testing clinics after diagnosis and traced in the community 1 and 12 months later when they reported on disclosure and other outcomes. METHODS: We examined patterns of participants' disclosure to their social networks (N = 1573) and sexual partners (N = 1024) at both follow-up assessments and used relative risk regression to identify correlates of nondisclosure. RESULTS: Disclosure to one's social network and sexual partners was reported by 77.8% and 57.7% of participants, respectively, at 1 month and 92.9% and 72.4% of participants, respectively, at 12 months. At both time points, living in Inhambane Province, being single or not living with a partner, having high levels of anticipated stigma, and not initiating HIV treatment were associated with increased risks of nondisclosure to social networks. Nondisclosure to sexual partners at both follow-up assessments was associated with being women, living in Inhambane Province and in a household without other people living with HIV, and reporting that posttest counseling addressed disclosure. CONCLUSIONS: Although reported disclosure to social networks was high, disclosure to sexual partners was suboptimal. Effective and acceptable approaches to support partner disclosure, particularly for women, are needed.
BACKGROUND: HIV disclosure benefits people living with HIV, their partners, and HIV programs. However, data on the prevalence of disclosure and associated correlates have come largely from patients already in HIV care, potentially overestimating disclosure rates and precluding examination of the impact of disclosure on HIV care outcomes. SETTING: We used data from an implementation study conducted in Maputo City and Inhambane Province, Mozambique. Adults were enrolled at HIV testing clinics after diagnosis and traced in the community 1 and 12 months later when they reported on disclosure and other outcomes. METHODS: We examined patterns of participants' disclosure to their social networks (N = 1573) and sexual partners (N = 1024) at both follow-up assessments and used relative risk regression to identify correlates of nondisclosure. RESULTS: Disclosure to one's social network and sexual partners was reported by 77.8% and 57.7% of participants, respectively, at 1 month and 92.9% and 72.4% of participants, respectively, at 12 months. At both time points, living in Inhambane Province, being single or not living with a partner, having high levels of anticipated stigma, and not initiating HIV treatment were associated with increased risks of nondisclosure to social networks. Nondisclosure to sexual partners at both follow-up assessments was associated with being women, living in Inhambane Province and in a household without other people living with HIV, and reporting that posttest counseling addressed disclosure. CONCLUSIONS: Although reported disclosure to social networks was high, disclosure to sexual partners was suboptimal. Effective and acceptable approaches to support partner disclosure, particularly for women, are needed.