Hunter-Adams Jo, Zerbe Allison, Philips Tamsin, Rini Zanele, Myer Landon, Petro Greg, Abrams Elaine
a Health Economics Unit, Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa.
b Centre for Infectious Diseases Epidemiology & Research, Public Health and Family Medicine , University of Cape Town , Cape Town , South Africa.
Afr J AIDS Res. 2017 Jul;16(2):101-107. doi: 10.2989/16085906.2017.1311932. Epub 2017 May 31.
Disclosure of HIV status to sexual partners and others has been presented as positive health behaviour and is widely encouraged by antiretroviral treatment (ART) programmes, providers and policies. However, disclosure is also highly contextual and its positive effects are not universal. We explore the dimensions of disclosure amongst post-partum women who initiated ART during pregnancy in Cape Town, South Africa. Forty-seven semi-structured interviews with post-partum women were conducted as part of the Maternal Child Health-Antiretroviral Therapy (MCH-ART) study. Primary elements of disclosure were coded and interpreted according to dominant themes and subthemes. Disclosure was commonplace in the sample, ranging from widely disclosing status (rare); to disclosing to some family, friends and partners; to tacit disclosure, where participants took medication in front of others without explicitly discussing their status. Women described reasons for non-disclosure in terms of not being ready, fear of negative reactions (including violence and loss of financial support), and fear of their status being widely known. Self-reported adherence was uniformly high throughout the range of disclosure. Even those who made special efforts to avoid disclosure, such as attending clinics distant from their homes, reported good adherence. Those who disclosed experienced a range of responses to their disclosure, from support to shunning. Despite access to ART, stigma remained a persistent feature in descriptions of disclosure, particularly in relation to partner disclosure. Our findings suggest that disclosure is not always positive and adherence can be maintained within a wide range of disclosure behaviours. It is important that clinic settings allow women to retain control over their disclosure process.
向性伴侣及其他人披露艾滋病毒感染状况被视为一种积极的健康行为，并且受到抗逆转录病毒治疗（ART）项目、提供者及政策的广泛鼓励。然而，披露情况也高度依赖具体情境，其积极效果并非普遍存在。我们探究了南非开普敦在孕期开始接受抗逆转录病毒治疗的产后女性的披露情况。作为母婴健康 - 抗逆转录病毒治疗（MCH - ART）研究的一部分，我们对47名产后女性进行了半结构化访谈。根据主要主题和子主题对披露的主要内容进行编码和解读。在样本中，披露情况很常见，范围从广泛披露感染状况（罕见）到向一些家人、朋友和伴侣披露，再到默示披露，即参与者在他人面前服药但未明确讨论自己的感染状况。女性描述了不披露的原因，包括尚未做好准备、担心负面反应（包括暴力和失去经济支持）以及担心自己的感染状况被广泛知晓。在整个披露范围内，自我报告的依从性普遍较高。即使是那些特别努力避免披露的人，比如去离家很远的诊所看病，也报告有良好的依从性。披露的人对自己的披露经历了一系列反应，从支持到回避。尽管能够获得抗逆转录病毒治疗，但在披露情况的描述中，耻辱感仍然是一个持续存在的特征，特别是在向伴侣披露方面。我们的研究结果表明，披露并不总是积极的，并且在广泛的披露行为范围内都可以维持依从性。重要的是，诊所环境应允许女性对自己的披露过程保持掌控。
