Mulawa Marta I, Hung Frances, Phillips Nicole J, Austin Mark F, Barfield Richard, Lee Hui-Jie, Zar Heather J, Stein Dan J, Hoare Jacqueline
School of Nursing, Duke University, Durham, NC, United States.
Duke Global Health Institute, Duke University, Durham, NC, United States.
Front Reprod Health. 2025 May 21;7:1545039. doi: 10.3389/frph.2025.1545039. eCollection 2025.
Little is known about HIV status disclosure within the social networks of adolescents with perinatally-acquired HIV (APHIV) in sub-Saharan Africa, where HIV prevalence is high and stigma surrounding HIV is pervasive. This study employed egocentric network analysis to characterize HIV disclosure in the social networks of APHIV in Cape Town South Africa. Associations between HIV disclosure and characteristics of APHIV (egos), their relationship to network members (alters), and features of the social network, including ego's network size and alter's centrality within the network, were also examined.
Network data were collected from 58 APHIV (mean age 14.3 years; 52% female) using a customized touchscreen-based assessment, providing data on 349 ego-alter relationships. Associations with HIV disclosure within the ego-alter pairs were evaluated by adjusted odds ratios (AOR) from multivariable logistic regression with generalized estimating equations, clustering by ego.
Among all ego-alter pairs identified, 36.4% (127/349) were disclosed to by egos. Odds of disclosure did not differ based on the ego's gender or viral suppression. Odds of disclosure were significantly higher when alters were presumed by the ego to have HIV [AOR 6.26; 95% confidence interval (CI): 2.36-16.58, < 0.001], were more trusted by the ego (AOR 2.84; 95% CI: 1.14-7.06, = 0.03), or were older than the ego (1-year difference AOR 1.04; 95% CI: 1.02-1.07, < 0.001). Increasing alter's centrality by 0.01 was associated with an increased odds of disclosure (AOR 1.02; 95% CI: 1.002-1.03, = 0.03), though overall network size was not associated with increased odds of disclosure. The effect of the ego's emotional support network size on disclosure, however, depended on the type of ego-alter relationship.
HIV status disclosure was low in the social networks of APHIV. Our study found that disclosure was not influenced by network size, gender, or viral suppression but rather by factors related to interpersonal trust and shared experience, such as perceived HIV status of alters, network-level centrality and emotional support network size. The study further highlights the benefits and future potential of using social network data collection and analysis methods to better understand HIV disclosure among adolescents.
在撒哈拉以南非洲地区，围产期感染艾滋病毒（APHIV）的青少年社交网络中的艾滋病毒感染状况披露情况鲜为人知，该地区艾滋病毒感染率很高，对艾滋病毒的污名化现象普遍存在。本研究采用自我中心网络分析来描述南非开普敦APHIV青少年社交网络中的艾滋病毒披露情况。还研究了艾滋病毒披露与APHIV（自我）特征、他们与网络成员（他我）的关系以及社交网络特征（包括自我的网络规模和他我在网络中的中心性）之间的关联。
使用定制的基于触摸屏的评估方法，从58名APHIV青少年（平均年龄14.3岁；52%为女性）收集网络数据，提供了349对自我-他我关系的数据。通过广义估计方程进行多变量逻辑回归调整后的优势比（AOR），按自我进行聚类，评估自我-他我对中与艾滋病毒披露的关联。
在所有确定的自我-他我对中，有36.4%（127/349）的他我被告知。披露的几率不因自我的性别或病毒抑制情况而有所不同。当自我认为他我感染了艾滋病毒时，披露的几率显著更高[AOR 6.26；95%置信区间（CI）：2.36 - 16.58，P < 0.001]，自我更信任的他我（AOR 2.84；95% CI：1.14 - 7.06，P = 0.03），或年龄比自我大的他我（相差1岁时AOR 1.04；95% CI：1.02 - 1.07，P < 0.001）。他我的中心性每增加0.01，披露的几率就会增加（AOR 1.02；95% CI：1.002 - 1.03，P = 0.03），不过总体网络规模与披露几率的增加无关。然而，自我的情感支持网络规模对披露的影响取决于自我-他我关系的类型。
APHIV青少年社交网络中的艾滋病毒感染状况披露率较低。我们的研究发现，披露情况不受网络规模、性别或病毒抑制的影响，而是受与人际信任和共同经历相关的因素影响，例如他我的感知艾滋病毒状况、网络层面的中心性和情感支持网络规模。该研究进一步凸显了使用社交网络数据收集和分析方法来更好地了解青少年艾滋病毒披露情况的益处和未来潜力。
