Adeniyi Oladele Vincent, Ajayi Anthony Idowu, Selanto-Chairman Nonkosi, Goon Daniel Ter, Boon Gerry, Fuentes Yusimi Ordaz, Hofmeyr George Justus, Avramovic Gordana, Carty Craig, Lambert John
Department of Family Medicine and Rural Health, Walter Sisulu University, Cecilia Makiwane Hospital/East London Hospital Complex, East London, South Africa.
Department of Sociology, University of Fort Hare, East London, South Africa.
PLoS One. 2017 Aug 24;12(8):e0181730. doi: 10.1371/journal.pone.0181730. eCollection 2017.
Drawing from a baseline sample of a cohort study, the study examines the extent and correlates of serostatus non-disclosure to sex partners and family members, and reasons for non-disclosure among HIV-infected pregnant women in the Eastern Cape Province, South Africa.
This longitudinal cohort study recruited 1709 pregnant women living with HIV who attended three of the largest maternity centres in the Eastern Cape, South Africa, for delivery between September 2015 and May 2016. Relevant items on demographics, serostatus awareness, disclosure to sex partners and family members, and lifestyle behaviours were obtained using structured interviews. Age-stratified binary logistic regression models were used to determine the significant correlates of non-disclosure among the participants.
A higher rate of HIV serostatus non-disclosure to sex partners (25.6%) in comparison to family members (20%) was reported by the participants. Younger age, not living with partners and alcohol use were significantly associated with non-disclosure of HIV serostatus to sex partners. Non-disclosure of HIV serostatus to sex partners was significantly (p<0.05) associated with poor adherence to the highly active anti-retroviral therapy (HAART), failure to keep clinic appointments and high viral load at the delivery of the baby. Perceived fear of intimate partner violence, fear of rejection, guilt of not disclosing at the onset of the relationship, sex partner's non-disclosure of HIV serostatus, and guilt of unfaithfulness were some of the reasons for non-disclosure of HIV serostatus to sex partners.
Non-disclosure of HIV serostatus is a public health concern with serious implications for both mother-to-child transmission, as well as horizontal transmission, in our setting. Strategic efforts toward ending the epidemic of HIV and AIDS in South Africa should address the sociocultural and behavioural determinants of non-disclosure.
本研究以一项队列研究的基线样本为基础，调查南非东开普省感染艾滋病毒的孕妇向性伴侣和家庭成员隐瞒血清学状态的程度及其相关因素，以及隐瞒的原因。
这项纵向队列研究招募了1709名感染艾滋病毒的孕妇，她们于2015年9月至2016年5月期间在南非东开普省最大的三家产科中心之一分娩。通过结构化访谈获取了有关人口统计学、血清学状态知晓情况、向性伴侣和家庭成员披露情况以及生活方式行为的相关信息。采用年龄分层的二元逻辑回归模型来确定参与者中隐瞒行为的显著相关因素。
参与者报告称，向性伴侣隐瞒艾滋病毒血清学状态的比例（25.6%）高于向家庭成员隐瞒的比例（20%）。年龄较小、未与伴侣同住以及饮酒与向性伴侣隐瞒艾滋病毒血清学状态显著相关。向性伴侣隐瞒艾滋病毒血清学状态与高效抗逆转录病毒疗法（HAART）依从性差、未能按时就诊以及分娩时病毒载量高显著相关（p<0.05）。担心亲密伴侣暴力、害怕被拒绝、在关系开始时未披露而感到内疚、性伴侣未披露艾滋病毒血清学状态以及不忠的内疚感是向性伴侣隐瞒艾滋病毒血清学状态的一些原因。
在我们的研究环境中，隐瞒艾滋病毒血清学状态是一个公共卫生问题，对母婴传播以及水平传播都有严重影响。南非为终结艾滋病毒和艾滋病流行所做的战略努力应解决隐瞒行为的社会文化和行为决定因素。
