, Abuja, Nigeria.
International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
Reprod Health. 2018 Mar 2;15(1):36. doi: 10.1186/s12978-018-0474-y.
HIV status disclosure to male partners is important for optimal outcomes in the prevention of mother-to-child transmission of HIV (PMTCT). Depending on timing of HIV diagnosis or pregnancy status, readiness to disclose and disclosure rates may differ among HIV-positive women. We sought to determine rates, patterns, and experiences of disclosure among Nigerian women along the PMTCT cascade.
HIV-positive women in rural North-Central Nigeria were purposively recruited according to their PMTCT cascade status: pregnant-newly HIV-diagnosed, pregnant-in care, postpartum, and lost-to-follow-up (LTFU). Participants were surveyed to determine rates of disclosure to male partners and others; in-depth interviews evaluated disclosure patterns and experiences. Tests of association were applied to quantitative data. Qualitative data were manually analysed by theme and content using the constant comparative method in a Grounded Theory approach.
We interviewed 100 women; 69% were 21-30 years old, and 86% were married. There were 25, 26, 28 and 21 women in the newly-diagnosed, in-care, postpartum, and LTFU groups, respectively. Approximately 81% of all participants reported disclosing to anyone; however, family members were typically disclosed to first. Ultimately, more women had disclosed to male partners (85%) than to family members (55%). Rates of disclosure to anyone varied between groups: newly-diagnosed and LTFU women had the lowest (56%) and highest (100%) rates, respectively (p = 0.001). However, family (p = 0.402) and male partner (p = 0.218) disclosure rates were similar between cascade groups. Across all cascade groups, fear of divorce and intimate partner violence deterred women from disclosing to male partners. However, participants reported that with assistance from healthcare workers, disclosure and post-disclosure experiences were mostly positive.
In our study cohort, although disclosure to male partners was overall higher, family members appeared more approachable for initial disclosure. Across cascade groups, male partners were ultimately disclosed to at rates > 75%, with no significant inter-group differences. Fear appears to be a major reason for non-disclosure or delayed disclosure by women to male partners. Augmentation of healthcare workers' skills and involvement can mediate gender power differentials, minimize fear and shorten time to male partner disclosure among women living with HIV, regardless of their PMTCT cascade status.
Clinicaltrials.gov registration number NCT 01936753 , September 3, 2013 (retrospectively registered).
艾滋病病毒（HIV）状况向男性伴侣披露对于预防母婴传播 HIV（PMTCT）的最佳结果至关重要。根据 HIV 诊断时间或妊娠状况的不同，HIV 阳性妇女的披露准备和披露率可能会有所不同。我们旨在确定尼日利亚妇女在 PMTCT 级联中的披露率、模式和经验。
根据其 PMTCT 级联状况，按目的在尼日利亚中北部农村地区招募 HIV 阳性妇女：孕妇-新诊断 HIV、孕妇-在护理中、产后和失访（LTFU）。对参与者进行调查以确定向男性伴侣和其他人披露的比率；深入访谈评估了披露模式和经验。对定量数据进行了关联检验。定性数据使用扎根理论方法中的恒定比较法，通过主题和内容进行手动分析。
我们采访了 100 名妇女；69%的年龄在 21-30 岁之间，86%的已婚。新诊断、在护理中、产后和 LTFU 组分别有 25、26、28 和 21 名妇女。大约 81%的参与者报告向任何人披露了信息；然而，通常首先向家庭成员披露。最终，向男性伴侣披露的女性多于向家庭成员披露的女性（85%比 55%）。向任何人披露的比率在组间有所不同：新诊断和 LTFU 女性的比率最低（56%）和最高（100%）（p=0.001）。然而，家庭（p=0.402）和男性伴侣（p=0.218）的披露率在级联组之间相似。在所有级联组中，离婚恐惧和亲密伴侣暴力阻止了妇女向男性伴侣披露。然而，参与者报告说，在医疗保健工作者的帮助下，披露和披露后的经历大多是积极的。
在我们的研究队列中，尽管总体上向男性伴侣的披露率较高，但对男性伴侣的披露而言，家庭成员似乎更易接近。在各级联组中，向男性伴侣披露的比率均超过 75%，组间无显著差异。恐惧似乎是妇女向男性伴侣隐瞒或延迟披露的主要原因。增强医疗保健工作者的技能和参与度可以减轻性别权力差异，减少恐惧，并缩短 HIV 阳性妇女向男性伴侣披露的时间，无论其 PMTCT 级联状况如何。
Clinicaltrials.gov 注册号 NCT 01936753，2013 年 9 月 3 日（回溯注册）。
