Research Consultant, Abuja, Nigeria.
International Research Center of Excellence, Institute of Human Virology Nigeria, Abuja, Nigeria.
PLoS One. 2020 Apr 30;15(4):e0232423. doi: 10.1371/journal.pone.0232423. eCollection 2020.
Peer support provided by experienced and/or trained "expert" women living with HIV has been adopted by prevention of mother-to-child transmission of HIV (PMTCT) programs across sub-Saharan Africa. While there is ample data on HIV status disclosure among non-expert women, there is little data on disclosure among such expert women, who support other women living with HIV.
This study compared HIV disclosure rates between expert and non-expert mothers living with HIV, and contextualized quantitative findings with qualitative data from expert women.
We compared survey data on HIV disclosure to male partners and family/friends from 37 expert and 100 non-expert mothers living with HIV in rural North-Central Nigeria. Four focus group discussions with expert mothers provided further context on disclosure to male partners, extended family and peers. Chi square and Fisher's exact tests were applied to quantitative data. Qualitative data were manually analyzed using a Grounded Theory approach.
Two-thirds of the 137 participants were 21-30 years old; 89.8% were married, and 52.3% had secondary-level education. Disclosure to male partners was higher among expert (100.0%) versus non-expert mothers (85.0%), p = 0.035. Disclosure to anyone (93.1% vs 80.8%, p = 0.156), and knowledge of male partners' HIV status were similar (75.7% versus 66.7%, p = 0.324) between expert and non-expert mothers, respectively. With respect to male partners, HIV serodiscordance rates were also similar (46.4% vs 55.6%, p = 0.433). Group discussions indicated that expert mothers did not consistently disclose to their mentored clients, with community-level stigma and discrimination stated as major reasons for this non-disclosure.
Expert mothers experience similar disclosure barriers as their non-expert peers, especially regarding disclosure outside of intimate relationships. Thus, attention to expert mothers' coping skills and disclosure status, particularly to mentored clients is important to maximize the impact of peer support in PMTCT.
Clinicaltrials.gov registration number NCT01936753 (retrospective), September 3, 2013.
在撒哈拉以南非洲，经验丰富和/或经过培训的“专家”艾滋病毒感染者提供的同伴支持已被艾滋病毒母婴传播预防（PMTCT）项目所采用。虽然有大量关于非专家妇女艾滋病毒状况披露的数据，但关于支持其他艾滋病毒感染者的此类专家妇女的披露数据却很少。
本研究比较了艾滋病毒感染专家和非专家母亲之间的披露率，并将定量研究结果与专家母亲的定性数据相结合。
我们比较了来自尼日利亚农村中北部地区 37 名艾滋病毒感染专家和 100 名非专家母亲向男性伴侣和家庭/朋友披露艾滋病毒的调查数据。对 4 组专家母亲进行了焦点小组讨论，进一步了解了向男性伴侣、大家庭和同龄人披露艾滋病毒的情况。对定量数据应用了卡方检验和 Fisher 精确检验。定性数据使用扎根理论方法进行了手动分析。
137 名参与者中有三分之二年龄在 21-30 岁之间；89.8%已婚，52.3%接受过中等教育。向男性伴侣披露的专家（100.0%）比非专家母亲（85.0%）高，p = 0.035。向任何人披露（93.1%比 80.8%，p = 0.156）以及男性伴侣的艾滋病毒状况知识（75.7%比 66.7%，p = 0.324）在专家和非专家母亲之间相似。就男性伴侣而言，艾滋病毒血清不一致率也相似（46.4%比 55.6%，p = 0.433）。小组讨论表明，专家母亲并没有一贯向她们指导的客户披露，社区层面的耻辱和歧视被认为是不披露的主要原因。
专家母亲与非专家同行一样面临披露障碍，尤其是在亲密关系之外的披露。因此，关注专家母亲的应对技巧和披露状况，特别是对指导的客户，对于最大限度地提高同伴支持在 PMTCT 中的影响非常重要。
Clinicaltrials.gov 注册号 NCT01936753（回顾性），2013 年 9 月 3 日。
