scholarly journals The act of telling: South African women’s narratives of HIV status disclosure to intimate partners in the HPTN 071 (PopART) HIV prevention trial

2021 ◽  
Vol 17 ◽  
pp. 174550652199820
Author(s):  
Lario Viljoen ◽  
Dillon Wademan ◽  
Graeme Hoddinott ◽  
Virginia Bond ◽  
Janet Seeley ◽  
...  
Keyword(s):  
Public Health ◽  
Hiv Prevention ◽  
Hiv Testing ◽  
Hiv Treatment ◽  
Treatment As Prevention ◽  
Hiv Status ◽  
Women Living With Hiv ◽  
Adherence Support ◽  
Hiv Status Disclosure ◽  
Status Disclosure

Background: Public health programming often frames HIV status disclosure as a means to negotiate condom- and abstinence-based prevention or to involve intimate partners in HIV care to garner treatment adherence support. HIV treatment can be used to ensure viral suppression and prevent onward transmission, which provides strong evidence to encourage disclosure. The ideological shift towards HIV treatment as prevention is expected to facilitate disclosure. Purpose: There is a lack of research on how the scale-up of universal HIV testing and treatment influences disclosure practices in high burden settings. In this manuscript, we aim to address this gap. Methods: To this end, we conducted a two-phased narrative performative analysis of the disclosure scripts of 15 women living with HIV in three communities of Western Cape, South Africa where the HPTN 071 (PopART) HIV prevention trial implemented a universal HIV testing and treatment model as part of the intervention. The women were part of a larger cohort nested in the trial. We use Goffman’s dramaturgical metaphor, which understands social interactions as ‘performances’ by ‘actors’ (people) guided by ‘scripts’ (anticipated dialogues/interactions), to explore how women living with HIV manage their status disclosure. Conclusion: We describe how these women perform HIV status disclosure (or deliberate non-disclosure) to retain, reaffirm or redefine existing social scripts with partners. Their performances reveal priorities other than those imagined by public health programmes driving HIV disclosure (or non-disclosure): establishing trust, resenting betrayal and ensuring self-preservation while simultaneously (re)constructing self-identity. None of the women engaged with the concept of treatment as prevention in their disclosure narratives, either to facilitate disclosure or to ‘justify’ non-disclosure. HIV prevention, in general, and treatment adherence support were rarely mentioned as a reason for disclosure. To date, there has been a missed opportunity to ease and support disclosure in health programmes by tapping into existing social scripts, impeding potential patient and public health benefits of universal HIV testing and treatment.

scholarly journals The Paradoxes of PrEP: Rejection, Reluctancy, and Novel Gay Identities in Biomedical HIV Prevention in Serbia

2022 ◽  
pp. 34-51
Author(s):  
Zoran Milosavljević
Keyword(s):  
Hiv Prevention ◽  
Gay Men ◽  
Hiv Transmission ◽  
Gay Identity ◽  
Hiv Status ◽  
Social Significance ◽  
Gay Communities ◽  
Hiv Status Disclosure ◽  
Status Disclosure ◽  
Hiv Negative

This article explores the different ways in which gay men in Serbia perceive PrEP as a novel method of HIV prevention. In the article, I draw on data from my research on PrEP use among thirty gay men in Belgrade. The use of PrEP is still very low amongst gay communities in Serbia due to their rejection of PrEP and due to the stigma around PrEP use. In Serbia, the social significance of PrEP relates to HIV status disclosure on gay social/dating media. Paradoxically, on gay dating sites, the signifier "PrEP" blurs the line between HIV positive gay men – who have achieved undetectable HIV status through a potent ARV therapy – and those HIV negative gay men who use PrEP as a preventative tool against HIV transmission. In the article, I will argue that a new form of gay identity has emerged on gay dating apps in Serbia – "undetectable, on PrEP." This new identity emerges from confusion in HIV risk assessment. The use of PrEP has been seen as a marker to denote someone’s HIV negative status and to protect them from HIV transmission. However, some gay men with an undetectable HIV status would like to be regarded as HIV negative even though they are not, and thus they use the signifier "on PrEP" to highlight their desire to claim an HIV negative status. PrEP has many symbolic valences: from HIV status disclosure to assumed promiscuity. As I will argue, while the health paradigm is of utmost importance for Serbian gay men, internalized stigma additionally drives the low uptake of PrEP amongst gay communities in Serbia, thus contributing to the confusion regarding PrEP use and the overall approach to HIV prevention. This article finds that those respondents who accept PrEP without stigma or confusion regarding their HIV status are also more willing and ready to recommend using PrEP to other gay men.

scholarly journals Trends in HIV Treatment Adherence Before and After HIV Status Disclosure to Adolescents in Botswana

2020 ◽  
Vol 67 (4) ◽  
pp. 502-508 ◽  
Author(s):  
Harriet Okatch ◽  
Knashawn Morales ◽  
Rachel Rogers ◽  
Jennifer Chapman ◽  
Tafireyi Marukutira ◽  
...  
Keyword(s):  
Treatment Adherence ◽  
Hiv Treatment ◽  
Hiv Status ◽  
Before And After ◽  
Hiv Status Disclosure ◽  
Status Disclosure

scholarly journals Exploring pathways from violence and HIV disclosure without consent to depression, social support, and HIV medication self-efficacy among women living with HIV in Metro Vancouver, Canada

2020 ◽  
Vol 7 (1) ◽  
pp. 205510291989738
Author(s):  
Kathleen N Deering ◽  
Melissa Braschel ◽  
Carmen Logie ◽  
Flo Ranville ◽  
Andrea Krüsi ◽  
...  
Keyword(s):  
Self Efficacy ◽  
Internalized Stigma ◽  
Hiv Status ◽  
Women Living With Hiv ◽  
Enacted Stigma ◽  
Verbal Violence ◽  
Hiv Status Disclosure ◽  
Living With Hiv ◽  
Status Disclosure ◽  
The Relationship

We used path analysis to investigate complex pathways from HIV status disclosure without consent, physical/verbal violence and depression, social support, and HIV medication self-efficacy through mediators of HIV stigma among women living with HIV in Canada. In the final model, internalized stigma fully mediated the relationship between physical/verbal violence and reduced medication self-efficacy. Enacted stigma fully mediated the relationship between HIV status disclosure without consent and depression. Internalized stigma (β = 0.252; p < 0.001) had a significant negative direct effect on medication self-efficacy. Enacted stigma had a significant direct effect on depression (β = 0.162; p = 0.037). Findings will help improve services and interventions to promote quality of life and well-being of women living with HIV.

scholarly journals Violence and the perceived risks of taking antiretroviral therapy in US jails and prisons

2014 ◽  
Vol 10 (2) ◽  
pp. 94-110 ◽  
Author(s):  
Gabriel J. Culbert
Keyword(s):  
Antiretroviral Therapy ◽  
Interpersonal Violence ◽  
Treatment Interruption ◽  
Hiv Treatment ◽  
Hiv Care ◽  
Treatment As Prevention ◽  
Hiv Status ◽  
Content Type ◽  
The Usa ◽  
Hiv Status Disclosure

Purpose – About one in five men living with HIV in the USA passes through a correctional center annually. Jails and prisons are seen therefore as key intervention sites to promote HIV treatment as prevention. Almost no research, however, has examined inmates’ perspectives on HIV treatment or their strategies for retaining access to antiretroviral therapy (ART) during incarceration. The purpose of this paper is to describe the results of an exploratory study examining men's perceptions of and experiences with HIV care and ART during incarceration. Design/methodology/approach – Semi-structured, in-depth interviews were conducted with 42 HIV positive male and male-to-female transgendered persons recently released from male correctional centers in Illinois, USA. Findings – Interpersonal violence, a lack of safety, and perceived threats to privacy were frequently cited barriers to one's willingness and ability to access and adhere to treatment. Over 60 percent of study participants reported missed doses or sustained treatment interruption (greater than two weeks) because of failure to disclose their HIV status, delayed prescribing, intermittent dosing and out-of-stock medications, confiscation of medications, and medication strikes. Research limitations/implications – Substantial improvements in ART access and adherence are likely to follow organizational changes that make incarcerated men feel safer, facilitate HIV status disclosure, and better protect the confidentiality of inmates receiving ART. Originality/value – This study identified novel causes of ART non-adherence among prisoners and provides first-hand information about how violence, stigma, and the pursuit of social support influence prisoner's decisions to disclose their HIV status or accept ART during incarceration.

scholarly journals Assessment of the proportion and the factors associated with partner and family based index case HIV testing in Woliso town, Oromia, Ethiopia: a cross-sectional study

2020 ◽  
Author(s):  
Teka Haile ◽  
Hanna Gulema
Keyword(s):  
Hiv Testing ◽  
Index Case ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Hiv Status ◽  
Cross Sectional ◽  
Family Based ◽  
Hiv Status Disclosure ◽  
Status Disclosure ◽  
Index Cases

Abstract Background: Despite the enormous expansion of HIV testing services (HTS), an estimated 40% of people with HIV infection remain undiagnosed. In Ethiopia, the current working UNAIDS spectrum estimate for PLHIV is 649,264, of the estimated PLHIV, only about 72% know their status. Methods: A facility based cross-sectional study design with internal comparison was conducted among randomly selected 346 people currently on ART in Woliso town. Data entry carried out by Epi Info™ version 7.2.3.1 and analyzed using SPSS version 21.0 statistical software for Windows.Results: Among 345 study participants, 333 (96.5%) with 95 % CI (94.5 - 98.3) of index cases have tested families. The odds of HIV testing were 7.22 times higher among those who disclosed their HIV status (AOR=7.22 95% CI: 1.45, 35.82) compared to those who did not disclosed. Those who have stayed <12 months on ART are 87% less likely to have tested families (AOR=0.13 95% CI: 0.03, 0.63) compared to those who stayed ≥12 months on ART. Conclusion: this study finding shows that higher proportions of families of index cases have been tested for HIV. It also shows that partner and family based index case HIV testing has significant association with HIV status disclosure of index cases and the length of the duration that the index cases stayed on ART. It is essential to sustain the platform of partner and family based index case HIV testing service through strengthening disclosure counselling and assisting HIV status disclosure in health facilities with fully trained provider and qualified health providers. It also suggests the need to focus on those who received ART for less than 12 months duration and communicate on the timing of HIV testing for HIV negative families with ongoing risk of acquiring HIV.

Considerations for purposeful HIV status disclosure among women living with HIV in Ghana

AIDS Care ◽  
2016 ◽  
Vol 29 (5) ◽  
pp. 541-544 ◽  
Author(s):  
Rebecca A. Poku ◽  
Adobea Yaa Owusu ◽  
Patricia Dolan Mullen ◽  
Christine Markham ◽  
Sheryl A. McCurdy
Keyword(s):  
Hiv Status ◽  
Women Living With Hiv ◽  
Hiv Status Disclosure ◽  
Living With Hiv ◽  
Status Disclosure

scholarly journals Social concerns related to HIV status disclosure and participation in the prevention of mother-to-child transmission of HIV care among pregnant women in Kenya

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Björn Nordberg ◽  
Erin E. Gabriel ◽  
Edwin Were ◽  
Eunice Kaguiri ◽  
Anna Mia Ekström ◽  
...  
Keyword(s):  
Pregnant Women ◽  
Hiv Disclosure ◽  
Hiv Status ◽  
Lower Odds ◽  
Women Living With Hiv ◽  
Social Concerns ◽  
Hiv Status Disclosure ◽  
Living With Hiv ◽  
Status Disclosure ◽  
Mother To Child

Abstract Background Social concerns about unintentional HIV status disclosure and HIV-related stigma are barriers to pregnant women’s access to prevention of mother-to-child transmission of HIV (PMTCT) care. There is limited quantitative evidence of women’s social and emotional barriers to PMTCT care and HIV disclosure. We aimed to investigate how social concerns related to participation in PMTCT care are associated with HIV status disclosure to partners and relatives among pregnant women living with HIV in western Kenya. Methods A cross-sectional study, including 437 pregnant women living with HIV, was carried out at enrolment in a multicentre mobile phone intervention trial (WelTel PMTCT) in western Kenya. Women diagnosed with HIV on the day of enrolment were excluded. To investigate social concerns and their association with HIV disclosure we used multivariable-adjusted logistic regression, adjusted for sociodemographic and HIV-related characteristics, to estimate odds ratios (OR) and 95% confidence intervals (CI). Results The majority (80%) had disclosed their HIV status to a current partner and 46% to a relative. Older women (35–44 years) had lower odds of disclosure to a partner (OR = 0.15; 95% CI: 0.05–0.44) compared to women 18–24 years. The most common social concern was involuntary HIV status disclosure (reported by 21%). Concern about isolation or lack of support from family or friends was reported by 9%, and was associated with lower odds of disclosure to partners (OR = 0.33; 95% CI: 0.12–0.85) and relatives (OR = 0.37; 95% CI: 0.16–0.85). Concern about separation (reported by 5%; OR = 0.17; 95% CI: 0.05–0.57), and concern about conflict with a partner (reported by 5%; OR = 0.18; 95% CI: 0.05–0.67), was associated with lower odds of disclosure to a partner. Conclusions Compared to previous reports from Kenya, our estimated disclosure rate to a partner is higher, suggesting a possible improvement over time in disclosure. Younger pregnant women appear to be more likely to disclose, suggesting a possible decreased stigma and more openness about HIV among younger couples. Healthcare providers and future interventional studies seeking to increase partner disclosure should consider supporting women regarding their concerns about isolation, lack of support, separation, and conflict with a partner. PMTCT care should be organized to ensure women’s privacy and confidentiality.

scholarly journals HIV serostatus disclosure and associated factors among HIV positive pregnant and lactating women at Nekemte public health facilities, western Ethiopia

PLoS ONE ◽  
2021 ◽  
Vol 16 (3) ◽  
pp. e0248278
Author(s):  
Tadesse Tolossa ◽  
Bizuneh Wakuma ◽  
Merga Besho ◽  
Diriba Mulisa ◽  
Ginenus Fekadu ◽  
...  
Keyword(s):  
Public Health ◽  
Hiv Positive ◽  
Hiv Status ◽  
Child Transmission ◽  
Lactating Women ◽  
Factors Associated ◽  
Hiv Serostatus ◽  
Hiv Status Disclosure ◽  
Status Disclosure ◽  
Mother To Child

Background Disclosure of Human Immune Virus (HIV) serostatus by pregnant and lactating women is crucial for the successful prevention of mother to child transmission of HIV/AIDS. However, little has been studied regarding the prevalence and factors associated with HIV status disclosure among HIV positive pregnant and lactating women in Ethiopia. Methods An institution-based cross-sectional study was conducted in the Nekemte Public Health facilities among 380 pregnant and lactating women enrolled in universal antiretroviral therapy (ART) treatment from January 2015-December, 2019. The data were collected by using a checklist, developed from Prevention of Mother to Child Transmission (PMTCT) logbook, ART intake forms, and medical cards of the patients. Epidata version 3.2 was used for data entry, and then the data were exported to STATA version 14 for further analysis. The binary logistic regression model was employed to determine factors associated with the disclosure status among HIV positive pregnant and lactating women. Adjusted Odds Ratio (AOR) with 95% confidence intervals was computed and statistical significance was declared when it is significant at a 5% level (p-value < 0.05). Results A total of 380 women have participated in the study. Two hundred seventy-six (73.4%) of women had disclosed their HIV status to at least one individual. The study found living in urban (OR = 1.83, 95% CI: 1.04, 3.20), married women (OR = 4.16, 95% CI: 1.87, 9.24), higher educational status (OR = 2.35, 95% CI: 1.31, 5.51), positive HIV status of partner (OR = 2.35, 95%CI: 1.17, 4.70), and being multipara (OR = 4.94, 95% CI: 2.29, 10.66) were independent determinants of HIV status disclosure. Conclusions HIV status disclosure among pregnant and lactating women in the study area was sub-optimal. Empowering women through education, encouraging partners for HIV testing, and enhancing active male involvement in HIV treatment and control programs should get due attention.

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