GF-PMTCT Study, Makerere University School of Public Health, Kampala, Uganda.
Department of Epidemiology and Biostatistics, Makerere University School of Public Health, Kampala, Uganda.
Reprod Health. 2017 Aug 30;14(1):107. doi: 10.1186/s12978-017-0367-5.
Disclosure of HIV positive status to sexual partners is promoted by HIV prevention programs including those targeting the prevention of mother-to-child transmission. Among other benefits, disclosure may enhance spousal support and reduce stigma, violence and discrimination. HIV status disclosure and associated outcomes were assessed among a cohort of women, newly initiating lifelong antiretroviral therapy in Uganda between October 2013 and May 2014.
This was a mixed method study, drawing data from a prospective cohort study of 507 HIV positive pregnant women on lifelong antiretroviral therapy, who were followed for four months to determine disclosure and its outcomes. Women were recruited from three facilities for the cohort study; in addition, fifty-seven women were recruited to participate in qualitative interviews from six facilities. Factors associated with spousal support and negative outcomes were determined using random-effects logistic regression in two separate models, with prevalence ratio as measure of association. In-depth interviews were used to document experiences with disclosure of HIV status.
Overall HIV status disclosure to at least one person was high [(375/507), 83.7%]. Nearly three-quarters [(285/389), 73.3%], had disclosed to their spouse by the fourth month of follow up post-enrolment. Among married women, spousal support was high at the first 330/407 (81.1%) and second follow-up 320/389 (82.2%). The majority of women who reported spousal support for either antenatal care or HIV-related care services had disclosed their HIV status to their spouses (adj.PR = 1.17; 95% CI: 1.02-1.34). However, no significant differences were observed in the proportion of self-reported negative outcomes by HIV status disclosure (adj.PR = 0.89; 95% CI: 0.56-1.42). Qualitative findings highlighted stigma and fear of negative outcomes as the major barriers to disclosure.
HIV status disclosure to partners by pregnant women on lifelong antiretroviral therapy was associated with increased spousal support, but was impeded by fear of adverse outcomes such as stigma, discrimination and violence. Interventions to reduce negative outcomes could enhance HIV status disclosure.
艾滋病毒预防规划（包括预防母婴传播的规划）提倡艾滋病毒阳性者向性伴侣透露其艾滋病毒状况。除其他好处外，透露艾滋病毒状况可增强配偶支持，并减少耻辱、暴力和歧视。本研究评估了乌干达于 2013 年 10 月至 2014 年 5 月期间新开始终身抗逆转录病毒治疗的一批妇女的艾滋病毒状况透露情况及其相关结局。
这是一项混合方法研究，从一项针对 507 名正在接受终身抗逆转录病毒治疗的艾滋病毒阳性孕妇的前瞻性队列研究中提取数据，这些妇女在四个月的时间里接受了随访，以确定透露状况及其结局。这些妇女是从三个机构招募到队列研究中的；此外，还从六个机构招募了 57 名妇女参加定性访谈。使用两个单独的随机效应逻辑回归模型确定配偶支持和负面结局的相关因素，以比值比作为关联的衡量指标。使用深入访谈记录透露艾滋病毒状况的经历。
总体而言，至少向一人透露艾滋病毒状况的比例很高[(375/507)，83.7%]。近四分之三[(285/389)，73.3%]在入组后第四个月的随访中向配偶透露了艾滋病毒状况。在已婚妇女中，配偶支持率在第一次[330/407(81.1%)]和第二次[320/389(82.2%)]随访时很高。大多数报告配偶支持产前保健或艾滋病毒相关保健服务的妇女都向配偶透露了艾滋病毒状况（调整后的比值比[PR]为 1.17；95%置信区间：1.02-1.34）。然而，按艾滋病毒状况透露情况划分，报告的负面结局比例没有显著差异（调整后的 PR 为 0.89；95%置信区间：0.56-1.42）。定性研究结果突出了耻辱感和对负面结局的恐惧是透露状况的主要障碍。
正在接受终身抗逆转录病毒治疗的孕妇向伴侣透露艾滋病毒状况与配偶支持增加有关，但因担心耻辱、歧视和暴力等不良后果而受到阻碍。减少负面结局的干预措施可促进艾滋病毒状况的透露。
