DISCLOSURE OF HIV STATUS AMONG SOUTH AFRICAN WOMEN: factors that impede disclosure and subsequent re

1
DISCLOSURE OF HIV STATUS AMONG SOUTH
AFRICAN WOMEN factors that impede disclosure
and subsequent repercussionsB. Forsyth, M.
Visser, J. Makin, A. De Villiers, K. Sikkema, B.
Jefferyfor the Serithi Project
Yale University School of Medicine
2
Background

• Difficulties around disclosure are well
  recognized
• Consequences of non-disclosure
• for individual
• public health HIV management
• Pregnant women have short time to come to terms
  with diagnosis

3
Goal

• Understand factors related to HIV disclosure
• to partners and to others (family members and
  friends)
• early and late disclosure
• Repercussions of disclosure

4
Methods

• Interviews conducted with 293 HIV pregnant women
  from low socio-economic urban areas
• Recruited from 4 antenatal clinics in Tshwane
  (South Africa)
• Interviewed
• During pregnancy
• 3 months after birth

5
(No Transcript)
6
Data Collection

• Socio-demographic data
• Extent of disclosure to partners and others
• Know someone with HIV
• Prior discussion of testing with partner
• Past experience of violence

7
Data Collection

• Psychological Measures
• Internalized stigma (12 items adapted from
  Westbrook Bauman)
• Social support (Bauman Weiss)
• Self-esteem (Rosenberg)
• Depression (Beck)
• Coping (COPE, Carver)

8
Socio-demographic Characteristics

• Age in years, mean (SD) 26.5 (5.07)
• Marital Status Single, with partner 68.3
• Married 20.5
• No partner 11.3 
• Housing Total housing score (range 0
  4) 2.93
• Made of brick or
  concrete 30.4 Electricity
  80.0
• Running water indoors 30.4
• Flushing toilet 67.2
• Income Woman has regular income 24.2
• Partner has regular income 77.7
• Partner provides money 82.3 

9
Socio-demographic Characteristics

• Womans education level None/Primary 10.9
• Secondary 75.4
  Tertiary 13.7 
• Partners education level None/Primary 10.5
• Secondary 71.3
• Tertiary 18.1
• Discussed testing with partner 30.7
• Know someone who is HIV 36.0
• Experience more than one type of violence 20.5

10
Disclosure

• Early
• (by baseline
  By
• interview)
  3 months
• (N 293)
  (N 198)
• Disclosure 59 81
• To partner 42 69
• To others 30 59

11
Late disclosure

• Disclosed between baseline and 3-month interview
• Total 64 women
• 31 disclosed to partners
• 51 disclosed to others

12
Factors related to disclosure to partner
Bivariate analysis
13
Logistic regression analysis disclosure to partner
14
Factors related to disclosure to others
Bivariate analysis
15
Logistic regression analysis disclosure to others
 
1.26 (1.06, 1.49)
0.46 (0.25, 0.85)
0.01
2.13 (1.20, 3.76)
16
Summary of factors related to disclosure

• Disclosure to partner Early Late
• Relationship factors
• Married X X
• Partner tertiary education X
• Discussed test with partner X
• Past experience of violence X
• Internalized stigma x
• Disclosure to others
• Socio-economic factors
• Housing score X
• Partner do not provide money X
• Know someone with HIV X
• Less avoidant coping X

17
Repercussions of disclosure

• Felt hurt by others reaction 19
• People do not touch me 15
• Verbal abuse 13
• People keep children away 11
• Have lost friends 10
• Partner left 9
• Physical abuse 5
• Threatened with death 4

18
Conclusions

• High levels of disclosure, though selective
• Disclosure to partners
• Factors relating to relationships affect decision
  on early disclosure
• Feeling less stigmatized affects later disclosure
• Disclosure to others
• Socio-economic factors and knowing someone with
  HIV contribute to early disclosure
• Coping contributes to later disclosure
• While there were repercussions of disclosure,
  severe repercussions were infrequent

19
Recommendations

• Screen women when diagnosed
• Relationship with partner and whether discussed
  prior to testing
• Depend on others for income
• Experience of violence
• Know someone else who is HIV
• Internalized stigma and coping
• Provide special support services to help those
  who are likely to have difficulty with disclosure

20

• Thank you to Tshwane Metro and the people of
  Mamelodi and Atteridgeville
• This study was supported by funding from the US
  National Institute of Child Health and Human
  Development, Grant R24 HD43558