AIDS and Behavior

, Volume 17, Issue 2, pp 488–497 | Cite as

Non-Disclosure of a Pregnant Woman’s HIV Status to Her Partner is Associated with Non-Optimal Prevention of Mother-to-Child Transmission

  • C. Jasseron
  • L. Mandelbrot
  • C. Dollfus
  • N. Trocmé
  • R. Tubiana
  • J. P. Teglas
  • A. Faye
  • C. Rouzioux
  • S. Blanche
  • J. Warszawski
Original Paper


Our objective was to study relations between non-disclosure of HIV to partner, socio demographics and prevention of HIV mother-to-child transmission (PMTCT), among HIV-infected pregnant women enrolled in the French Perinatal Cohort (ANRS-EPF-CO1) from 2005 to 2009 (N = 2,952). Fifteen percent of the women did not disclose their HIV status to their partner. Non-disclosure was more frequent in women diagnosed with HIV infection late in pregnancy, originating from Sub-Saharan Africa or living alone, as well as when the partner was not tested for HIV. Non-disclosure was independently associated with non optimal PMTCT: late initiation of antiretroviral therapy, detectable viral load at delivery and lack of neonatal prophylaxis. Nonetheless, the rate of transmission did not differ according to disclosure status. Factors associated with non-disclosure reflect vulnerability and its association with non optimal PMTCT is a cause for concern although the impact on transmission was limited in this context of universal free access to care.


HIV/AIDS Prevention of mother-to-child transmission Non-disclosure during pregnancy Access to care Public health 


Nuestro objetivo fue estudiar relaciones entre la no revelación del diagnostico de infección por VIH a la pareja y socio-demográficos factores y prevención de la transmisión madre-niño del VIH (PTMN). Todas las mujeres embarazadas seropositivas que forman parte de la encuesta perinatal francesa (ANRS-EPF-CO1) de 2005 a 2009 fueron incluidas (N = 2,952). Quince por ciento no habían revelado su estatus de VIH a su compañero. La no revelación fue más frecuente en mujeres con un diagnóstico en etapas tardías del embarazo, originarias de África subsahariana o viviendo solas y cuando el compañero no había sido estudiado para el VIH. La no revelación fue asociada independamente a PTMN no óptima: iniciación tardía de la terapia anti-retroviral, carga viral detectable en el parto y ausencia de profilaxis neonatal. Sin embargo, la tasa de transmisión no fue diferente según el estatus de revelación. Factores asociados con la no revelación reflejan vulnerabilidad y su asociación con PTMN no óptima es preocupante aunque con un impacto limitado en un contexto con acceso universal y gratuito al tratamiento.


  1. 1.
    Connor EM, Sperling RS, Gelber R, et al. Reduction of maternal-infant transmission of human immunodeficiency virus type 1 with zidovudine treatment. Pediatric AIDS clinical trials group protocol 076 study group. N Engl J Med. 1994;331(18):1173–80.PubMedCrossRefGoogle Scholar
  2. 2.
    Warszawski J, Tubiana R, Le Chenadec J, et al. Mother-to-child HIV transmission despite antiretroviral therapy in the ANRS French Perinatal Cohort. AIDS. 2008;22(2):289–99.PubMedCrossRefGoogle Scholar
  3. 3.
    Cooper ER, Charurat M, Mofenson L, et al. Combination antiretroviral strategies for the treatment of pregnant HIV-1-infected women and prevention of perinatal HIV-1 transmission. J Acquir Immune Defic Syndr. 2002;29(5):484–94.PubMedGoogle Scholar
  4. 4.
    Mandelbrot L, Landreau-Mascaro A, Rekacewicz C, et al. Lamivudine-zidovudine combination for prevention of maternal-infant transmission of HIV-1. JAMA. 2001;285(16):2083–93.PubMedCrossRefGoogle Scholar
  5. 5.
    European Collaborative Study. Mother-to-child transmission of HIV infection in the era of highly active antiretroviral therapy. Clin Infect Dis. 2005;40:458–65.CrossRefGoogle Scholar
  6. 6.
    Newell ML, Huang S, Fiore S, et al. Characteristics and management of HIV-1-infected pregnant women enrolled in a randomised trial: differences between Europe and the USA. BMC Infect Dis 2007;7:60.Google Scholar
  7. 7.
    Townsend CL, Cortina-Borja M, Peckham CS, de Ruiter A, Lyall H, Tookey PA. Low rates of mother-to-child transmission of HIV following effective pregnancy interventions in the United Kingdom and Ireland, 2000–2006. AIDS. 2008;22(8):973–81.PubMedCrossRefGoogle Scholar
  8. 8.
    Centers for Diseases Control and Prevention. Achievements in public health. Reduction in perinatal transmission of HIV infection–United States, 1985–2005. MMWR Morb Mortal Wkly Rep. 2006;55(21):592–7.Google Scholar
  9. 9.
    Yeni P. Prise en charge médicale des personnes infectées par le VIH. Paris. France: Flammarion Médecine-Sciences; 2008.Google Scholar
  10. 10.
    Aluisio ABR, Jhon-Stewart G, Mbori-Ngacha D, Farquhar C. Male partner HIV-1 testing and antenatal clinic attendance associated with reduced infant HIV-1 acquisition and mortality. Cap Town: IAS; 2009.Google Scholar
  11. 11.
    Medley A, Garcia-Moreno C, McGill S, Maman S. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ. 2004;82(4):299–307.PubMedGoogle Scholar
  12. 12.
    Farquhar C, Kiarie JN, Richardson BA, et al. Antenatal couple counseling increases uptake of interventions to prevent HIV-1 transmission. J Acquir Immune Defic Syndr. 2004;37(5):1620–6.PubMedCrossRefGoogle Scholar
  13. 13.
    Sigxaxhe T, Mathews C. Determinants of disclosure by HIV positive women at khayelitsha mother to child transmission pilot project. Durban: International Conference on AIDS Jul 9–14; 2000 .Google Scholar
  14. 14.
    Antelman G, Smith Fawzi MC, Kaaya S, et al. Predictors of HIV-1 serostatus disclosure: a prospective study among HIV-infected pregnant women in Dar es Salaam, Tanzania. AIDS. 2001;15:1865–74.PubMedCrossRefGoogle Scholar
  15. 15.
    Diagne Gueye NR, Dolfus C, Tabone MD, et al. Psychosocial issues in HIV positive women during the perinatal period. Archives de pédiatrie. 2007;14(5):461–6.PubMedCrossRefGoogle Scholar
  16. 16.
    Theuring S, Mbezi P, Luvanda H, Jordan-Harder B, Kunz A, Harms G. Male involvement in PMTCT services in Mbeya Region, Tanzania. AIDS Behav. 2009;13(1):92–102.PubMedCrossRefGoogle Scholar
  17. 17.
    Makin JD, Forsyth BW, Visser MJ, Sikkema KJ, Neufeld S, Jeffery B. Factors affecting disclosure in South African HIV-positive pregnant women. AIDS Patient Care STDS. 2008;22(11):907–16.PubMedCrossRefGoogle Scholar
  18. 18.
    Brou H, Djohan G, Becquet R, et al. When do HIV-infected women disclose their HIV status to their male partner and why? A study in a PMTCT programme, Abidjan. PLoS Med. 2007;4(12):e342.PubMedCrossRefGoogle Scholar
  19. 19.
    Tubiana R, Matheron S, Le Chenadec J, et al. Extremely low risk of mother-to-child transmission of HIV in women starting HAART before pregnancy in the French perinatal cohort (ANRS EPF CO1/11). Boston: CROI; 2011.Google Scholar
  20. 20.
    SAS Institute. SAS User’s guide: basics, version 9 edition: Cary: SAS Institute Inc.; 2006.Google Scholar
  21. 21.
    Forbes KM, Lomax N, Cunningham L, et al. Partner notification in pregnant women with HIV: findings from three inner-city clinics. HIV Med. 2008;9(6):433–5.PubMedCrossRefGoogle Scholar
  22. 22.
    Peretti-Watel P, Spire B, Pierret J, Lert F, Obadia Y. Management of HIV-related stigma and adherence to HAART: evidence from a large representative sample of outpatients attending French hospitals (ANRS-EN12-VESPA 2003). AIDS Care. 2006;18(3):254–61.PubMedCrossRefGoogle Scholar
  23. 23.
    Jasseron C, Mandelbrot L, Tubiana R, et al. Prevention of mother-to-child HIV transmission: similar access for sub-Sahara African immigrants and for French women? AIDS. 2008;22(12):1503–11.PubMedCrossRefGoogle Scholar
  24. 24.
    Preau M, Marcellin F, Carrieri MP, Lert F, Obadia Y, Spire B. Health-related quality of life in French people living with HIV in 2003: results from the national ANRS-EN12-VESPA Study. AIDS. 2007;21(1):S19–27.PubMedCrossRefGoogle Scholar
  25. 25.
    Sayles JN, Wong MD, Kinsler JJ, Martins D, Cunningham WE. The association of stigma with self-reported access to medical care and antiretroviral therapy adherence in persons living with HIV/AIDS. J Gen Intern Med. 2009;24(10):1101–8.PubMedCrossRefGoogle Scholar
  26. 26.
    Wolitski RJ, Pals SL, Kidder DP, Courtenay-Quirk C, Holtgrave DR. The effects of HIV stigma on health, disclosure of HIV status, and risk behaviour of homeless and unstably housed persons living with HIV. AIDS Behav. 2009;13(6):1222–32.PubMedCrossRefGoogle Scholar
  27. 27.
    Stirratt MJ, Remien RH, Smith A, Copeland OQ, Dolezal C, Krieger D. The role of HIV serostatus disclosure in antiretroviral medication adherence. AIDS Behav. 2006;10(5):483–93.PubMedCrossRefGoogle Scholar
  28. 28.
    Sherr L, Lampe F, Norwood S, et al. Adherence to antiretroviral treatment in patients with HIV in the UK: a study of complexity. AIDS Care. 2008;20(4):442–8.PubMedCrossRefGoogle Scholar
  29. 29.
    Desgrees du Lou A, Brou H, Djohan G, et al. Beneficial effects of offering prenatal HIV counselling and testing on developing a HIV preventive attitude among couples. Abidjan, 2002–2005. AIDS Behav. 2009;13(2):348–55.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC 2011

Authors and Affiliations

  • C. Jasseron
    • 1
    • 2
  • L. Mandelbrot
    • 1
    • 3
    • 4
  • C. Dollfus
    • 8
  • N. Trocmé
    • 8
  • R. Tubiana
    • 5
    • 6
  • J. P. Teglas
    • 1
  • A. Faye
    • 3
    • 7
  • C. Rouzioux
    • 9
    • 10
  • S. Blanche
    • 10
    • 11
  • J. Warszawski
    • 1
    • 2
    • 12
  1. 1.INSERM, UMRS 1018, CESP-HIV/IST EpidemiologyLe Kremlin-BicêtreFrance
  2. 2.Department of EpidemiologyAP-HP, Hospital BicêtreLe Kremlin-BicêtreFrance
  3. 3.Université Paris VII DiderotParisFrance
  4. 4.Department of Gynecology and ObstetricsAP-HP, Hospital Louis MourierColombesFrance
  5. 5.Department of Infectious DiseasesAP-HP, Hospital Pitié SalpêtrièreParisFrance
  6. 6.INSERM, U943ParisFrance
  7. 7.Departement of PediatricsAP-HP, Hospital Robert DebréParisFrance
  8. 8.Department of Pediatric Oncology-HematologyAP-HP, Hospital TrousseauParisFrance
  9. 9.Virology LaboratoryAP-HP, Hospital NeckerParisFrance
  10. 10.Université Paris V DescartesParisFrance
  11. 11.Department of Pediatric Immuno-HematologyAP-HP, Hospital NeckerParisFrance
  12. 12.Université Paris-Sud, UMRS 1018Le Kremlin-BicêtreFrance

Personalised recommendations