Bhatia Divya S, Harrison Abigail D, Kubeka Muriel, Milford Cecilia, Kaida Angela, Bajunirwe Francis, Wilson Ira B, Psaros Christina, Safren Steven A, Bangsberg David R, Smit Jennifer A, Matthews Lynn T
Department of Behavioral and Social Sciences, Brown University School of Public Health, Providence, RI, United States.
Maternal Adolescent and Child Health Research Unit, Faculty of Health Sciences, Department of Obstetrics and Gynaecology, University of the Witwatersrand, Durban, South Africa.
Front Public Health. 2017 Jul 31;5:188. doi: 10.3389/fpubh.2017.00188. eCollection 2017.
This qualitative study investigated gender power inequalities as they contribute to relationship dynamics and HIV-serostatus disclosure among men and women living with HIV in Durban, South Africa. HIV serodiscordance among men and women within stable partnerships contributes to high HIV incidence in southern Africa, yet disclosure rates remain low. Given the emphasis on prevention for HIV-serodiscordant couples, this research supports the urgent need to explore how best to support couples to recognize that they are part of this priority population and to access appropriate prevention and treatment.
Thirty-five in-depth individual interviews were conducted with 15 HIV-positive men and 20 HIV-positive women (not couples) receiving care at public-sector clinics near Durban. A structured coding scheme was developed to investigate men's and women's attitudes toward HIV-serostatus disclosure and behaviors of sharing (or not sharing) HIV serostatus with a partner. Narratives were analyzed for barriers and facilitators of disclosure through the lens of sociocultural gender inequality, focusing on reasons for non-disclosure.
Among 35 participants: median age was 33 years (men) and 30 years (women); average years since HIV diagnosis was 1 (men) and 1.5 (women). Four themes related to gender inequality and HIV-serostatus disclosure emerged: (1) Men and women fear disclosing to partners due to concerns about stigma and relationship dissolution, (2) suspicions and mistrust between partners underlies decisions for non-disclosure, (3) unequal, gendered power in relationships causes differential likelihood and safety of disclosure among men and women, and (4) incomplete or implicit disclosure are strategies to navigate disclosure challenges. Findings illustrate HIV-serostatus disclosure as a complex process evolving over time, rather than a one-time event.
Partner communication about HIV serostatus is infrequent and complicated, with gender inequalities contributing to fear, mistrust, and partial or implicit disclosure. Relationship dynamics and gender roles shape the environment within which men and women can engage successfully in the HIV-serostatus disclosure process. Integrated interventions to reduce barriers to trustful and effective communication are needed for HIV-affected men and women in partnerships in which seeking couples-based HIV counseling and testing (CHCT) is challenging or unlikely. These data offer insights to support HIV-serostatus disclosure strategies within relationships over time.
这项定性研究调查了性别权力不平等问题，因为这种不平等影响了南非德班感染艾滋病毒的男性和女性的关系动态以及艾滋病毒血清学状态的披露情况。稳定伴侣关系中的男女艾滋病毒血清学不一致导致了南部非洲艾滋病毒的高发病率，但披露率仍然很低。鉴于对艾滋病毒血清学不一致夫妇预防工作的重视，本研究支持迫切需要探索如何最好地帮助夫妇认识到他们是这一重点人群的一部分，并获得适当的预防和治疗。
对在德班附近的公共部门诊所接受治疗的15名艾滋病毒阳性男性和20名艾滋病毒阳性女性（非夫妇）进行了35次深入的个人访谈。制定了一个结构化编码方案，以调查男性和女性对艾滋病毒血清学状态披露的态度以及与伴侣分享（或不分享）艾滋病毒血清学状态的行为。通过社会文化性别不平等的视角，分析了叙述中披露的障碍和促进因素，重点关注不披露的原因。
在35名参与者中：男性的年龄中位数为33岁，女性为30岁；自艾滋病毒诊断以来的平均年数，男性为1年，女性为1.5年。出现了与性别不平等和艾滋病毒血清学状态披露相关的四个主题：（1）男性和女性因担心耻辱和关系破裂而害怕向伴侣披露；（2）伴侣之间的怀疑和不信任是不披露决定的基础；（3）关系中不平等的性别权力导致男性和女性披露的可能性和安全性存在差异；（4）不完整或隐含的披露是应对披露挑战的策略。研究结果表明，艾滋病毒血清学状态的披露是一个随着时间推移而演变的复杂过程，而不是一次性事件。
关于艾滋病毒血清学状态的伴侣沟通很少且复杂，性别不平等导致恐惧、不信任以及部分或隐含的披露。关系动态和性别角色塑造了男性和女性能够成功参与艾滋病毒血清学状态披露过程的环境。对于那些寻求基于夫妇的艾滋病毒咨询和检测（CHCT）具有挑战性或不太可能的伴侣关系中的艾滋病毒感染男性和女性，需要采取综合干预措施来减少建立信任和有效沟通的障碍。这些数据为长期支持关系中的艾滋病毒血清学状态披露策略提供了见解。
