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"How can I tell?" Consequences of HIV status disclosure among couples in eastern African communities in the context of an ongoing HIV "test-and-treat" trial.
AIDS Care. 2016; 28 Suppl 3:59-66.AC

Abstract

People living with HIV/AIDS anticipate HIV-related stigma and fear disclosure to intimate partners. Yet, disclosure is critical to reducing HIV transmission and improving care engagement. This qualitative study characterized HIV disclosure experiences and normative beliefs among couples in communities participating in an HIV test-and-treat trial in Kenya and Uganda (Sustainable East Africa Research in Community Health, NCT#01864603). In-depth interviews were conducted with care providers (n = 50), leaders (n = 32) and members (n = 112) of eight communities. Data were analyzed using grounded theoretical approaches and Atlas.ti software. Findings confirmed gender differences in barriers to disclosure: while both men and women feared blame and accusation, women also feared violence and abandonment ("I did not tell my husband because [what if] I tell him and he abandons me at the last moment when I am in labor?"). Positive consequences included partner support for increased care-seeking and adherence ("My husband keeps on reminding me 'have you taken those drugs?'") Yet negative consequences included partnership dissolution, blame, and reports of violence ("some men beat their wives just because of that [bringing HIV medications home]"). Among HIV-infected individuals in discordant relationships, men more often reported supportive spouses ("we normally share [HIV-risk-reduction strategies] since I have been infected and she is HIV negative"), than did women ("my husband refused to use condoms and even threatened to marry another wife"). Care providers lent support for HIV-positive women who wanted to engage partners in testing but feared negative consequences: "They engaged the two of us in a session and asked him if we could all test." Findings demonstrate differing experiences and support needs of women and men living with HIV in eastern Africa, with HIV-positive women in discordant couples particularly vulnerable to negative consequences of disclosure. Efforts to strengthen capacity in health systems for gender-sensitive clinician- or counselor-assisted disclosure should be accelerated within test-and-treat efforts.

Authors+Show Affiliations

a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya.b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA.b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA.c Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA.d Infectious Diseases Research Collaboration , Kampala , Uganda.d Infectious Diseases Research Collaboration , Kampala , Uganda.d Infectious Diseases Research Collaboration , Kampala , Uganda.a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya.e Makerere University Joint AIDS Program , Kampala , Uganda.d Infectious Diseases Research Collaboration , Kampala , Uganda.a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya.d Infectious Diseases Research Collaboration , Kampala , Uganda.f Department of HIV, Infectious Disease and Global Medicine , University of California , San Francisco , CA , USA.g Divisions of Biostatistics and Epidemiology, School of Public Health , University of California , Berkeley , CA , USA.b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA.a Centre for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya.d Infectious Diseases Research Collaboration , Kampala , Uganda. h School of Medicine, Makerere University College of Health Sciences , Kampala , Uganda.f Department of HIV, Infectious Disease and Global Medicine , University of California , San Francisco , CA , USA.b Bixby Center for Global Reproductive Health, Department of Obstetrics, Gynecology & Reproductive Sciences , University of California , San Francisco , CA , USA. c Center for AIDS Prevention Studies , University of California , San Francisco , CA , USA.No affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27421052

Citation

Maeri, Irene, et al. ""How Can I Tell?" Consequences of HIV Status Disclosure Among Couples in Eastern African Communities in the Context of an Ongoing HIV "test-and-treat" Trial." AIDS Care, vol. 28 Suppl 3, 2016, pp. 59-66.
Maeri I, El Ayadi A, Getahun M, et al. "How can I tell?" Consequences of HIV status disclosure among couples in eastern African communities in the context of an ongoing HIV "test-and-treat" trial. AIDS Care. 2016;28 Suppl 3:59-66.
Maeri, I., El Ayadi, A., Getahun, M., Charlebois, E., Akatukwasa, C., Tumwebaze, D., Itiakorit, H., Owino, L., Kwarisiima, D., Ssemmondo, E., Sang, N., Kabami, J., Clark, T. D., Petersen, M., Cohen, C. R., Bukusi, E. A., Kamya, M., Havlir, D., & Camlin, C. S. (2016). "How can I tell?" Consequences of HIV status disclosure among couples in eastern African communities in the context of an ongoing HIV "test-and-treat" trial. AIDS Care, 28 Suppl 3, 59-66. https://doi.org/10.1080/09540121.2016.1168917
Maeri I, et al. "How Can I Tell?" Consequences of HIV Status Disclosure Among Couples in Eastern African Communities in the Context of an Ongoing HIV "test-and-treat" Trial. AIDS Care. 2016;28 Suppl 3:59-66. PubMed PMID: 27421052.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "How can I tell?" Consequences of HIV status disclosure among couples in eastern African communities in the context of an ongoing HIV "test-and-treat" trial. AU - Maeri,Irene, AU - El Ayadi,Alison, AU - Getahun,Monica, AU - Charlebois,Edwin, AU - Akatukwasa,Cecilia, AU - Tumwebaze,Dennis, AU - Itiakorit,Harriet, AU - Owino,Lawrence, AU - Kwarisiima,Dalsone, AU - Ssemmondo,Emmanuel, AU - Sang,Norton, AU - Kabami,Jane, AU - Clark,Tamara D, AU - Petersen,Maya, AU - Cohen,Craig R, AU - Bukusi,Elizabeth A, AU - Kamya,Moses, AU - Havlir,Diane, AU - Camlin,Carol S, AU - ,, PY - 2016/7/16/entrez PY - 2016/7/16/pubmed PY - 2017/7/18/medline KW - HIV sero-discordant couples KW - HIV-related stigma KW - sub-Saharan Africa SP - 59 EP - 66 JF - AIDS care JO - AIDS Care VL - 28 Suppl 3 N2 - People living with HIV/AIDS anticipate HIV-related stigma and fear disclosure to intimate partners. Yet, disclosure is critical to reducing HIV transmission and improving care engagement. This qualitative study characterized HIV disclosure experiences and normative beliefs among couples in communities participating in an HIV test-and-treat trial in Kenya and Uganda (Sustainable East Africa Research in Community Health, NCT#01864603). In-depth interviews were conducted with care providers (n = 50), leaders (n = 32) and members (n = 112) of eight communities. Data were analyzed using grounded theoretical approaches and Atlas.ti software. Findings confirmed gender differences in barriers to disclosure: while both men and women feared blame and accusation, women also feared violence and abandonment ("I did not tell my husband because [what if] I tell him and he abandons me at the last moment when I am in labor?"). Positive consequences included partner support for increased care-seeking and adherence ("My husband keeps on reminding me 'have you taken those drugs?'") Yet negative consequences included partnership dissolution, blame, and reports of violence ("some men beat their wives just because of that [bringing HIV medications home]"). Among HIV-infected individuals in discordant relationships, men more often reported supportive spouses ("we normally share [HIV-risk-reduction strategies] since I have been infected and she is HIV negative"), than did women ("my husband refused to use condoms and even threatened to marry another wife"). Care providers lent support for HIV-positive women who wanted to engage partners in testing but feared negative consequences: "They engaged the two of us in a session and asked him if we could all test." Findings demonstrate differing experiences and support needs of women and men living with HIV in eastern Africa, with HIV-positive women in discordant couples particularly vulnerable to negative consequences of disclosure. Efforts to strengthen capacity in health systems for gender-sensitive clinician- or counselor-assisted disclosure should be accelerated within test-and-treat efforts. SN - 1360-0451 UR - https://www.unboundmedicine.com/medline/citation/27421052/"How_can_I_tell"_Consequences_of_HIV_status_disclosure_among_couples_in_eastern_African_communities_in_the_context_of_an_ongoing_HIV_"test_and_treat"_trial_ L2 - https://www.tandfonline.com/doi/full/10.1080/09540121.2016.1168917 DB - PRIME DP - Unbound Medicine ER -