Brou Hermann, Djohan Gérard, Becquet Renaud, Allou Gérard, Ekouevi Didier K, Viho Ida, Leroy Valériane, Desgrées-du-Loû Annabel
Laboratoire Population Environnement Développement, Institut de recherche pour le développement, Nogent-sur-Marne, France.
PLoS Med. 2007 Dec;4(12):e342. doi: 10.1371/journal.pmed.0040342.
In Africa, women tested for HIV during antenatal care are counselled to share with their partner their HIV test result and to encourage partners to undertake HIV testing. We investigate, among women tested for HIV within a prevention of mother-to-child transmission of HIV (PMTCT) programme, the key moments for disclosure of their own HIV status to their partner and the impact on partner HIV testing.
Within the Ditrame Plus PMTCT project in Abidjan, 546 HIV-positive and 393 HIV-negative women were tested during pregnancy and followed-up for two years after delivery. Circumstances, frequency, and determinants of disclosure to the male partner were estimated according to HIV status. The determinants of partner HIV testing were identified according to women's HIV status. During the two-year follow-up, disclosure to the partner was reported by 96.7% of the HIV-negative women, compared to 46.2% of HIV-positive women (chi(2) = 265.2, degrees of freedom [df] = 1, p < 0.001). Among HIV-infected women, privileged circumstances for disclosure were just before delivery, during early weaning (at 4 mo to prevent HIV postnatal transmission), or upon resumption of sexual activity. Formula feeding by HIV-infected women increased the probability of disclosure (adjusted odds ratio 1.54, 95% confidence interval 1.04-2.27, Wald test = 4.649, df = 1, p = 0.031), whereas household factors such as having a co-spouse or living with family reduced the probability of disclosure. The proportion of male partners tested for HIV was 23.1% among HIV-positive women and 14.8% among HIV-negative women (chi(2) = 10.04, df = 1, p = 0.002). Partners of HIV-positive women who were informed of their wife's HIV status were more likely to undertake HIV testing than those not informed (37.7% versus 10.5%, chi(2) = 56.36, df = 1, p < 0.001).
In PMTCT programmes, specific psychosocial counselling and support should be provided to women during the key moments of disclosure of HIV status to their partners (end of pregnancy, weaning, and resumption of sexual activity). This support could contribute to improving women's adherence to the advice given to prevent postnatal and sexual HIV transmission.
在非洲，接受产前护理时进行HIV检测的女性会得到咨询，建议她们与伴侣分享自己的HIV检测结果，并鼓励伴侣进行HIV检测。我们调查了在预防母婴传播HIV（PMTCT）项目中接受HIV检测的女性向伴侣披露自身HIV状况的关键时机，以及对伴侣HIV检测的影响。
在阿比让的Ditrame Plus PMTCT项目中，546名HIV阳性和393名HIV阴性女性在孕期接受检测，并在产后进行了两年的随访。根据HIV状况估计向男性伴侣披露情况的环境、频率和决定因素。根据女性的HIV状况确定伴侣HIV检测的决定因素。在两年的随访中，96.7%的HIV阴性女性报告向伴侣披露了情况，而HIV阳性女性的这一比例为46.2%（χ² = 265.2，自由度[df]=1，p<0.0０1）。在HIV感染女性中，披露的有利时机是在分娩前、早期断奶期间（4个月时以预防产后HIV传播）或恢复性活动时。HIV感染女性采用配方奶喂养增加了披露的可能性（调整后的优势比为1.54，95%置信区间为1.04-2.27，Wald检验=4.649，df = 1，p = 0.031），而诸如拥有共同配偶或与家人同住等家庭因素则降低了披露的可能性。HIV阳性女性中其男性伴侣接受HIV检测的比例为23.1%，HIV阴性女性中这一比例为14.8%（χ² = 10.04，df = 1，p = 0.002）。被告知妻子HIV状况的HIV阳性女性的伴侣比未被告知的伴侣更有可能接受HIV检测（37.7%对10.5%，χ² = 56.36，df = 1，p<0.0０1）。
在PMTCT项目中，应在向伴侣披露HIV状况的关键时机（妊娠末期、断奶和恢复性活动）为女性提供特定的心理社会咨询和支持。这种支持有助于提高女性对预防产后和性传播HIV所给予建议的依从性。
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