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Double Disclosure Bind: Complexities of Communicating an HIV Diagnosis in the Context of Unintended Pregnancy in Durban, South Africa

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Abstract

Disclosure of HIV status is widely promoted in the prevention of mother-to-child transmission (PMTCT), but a number of context-specific factors may mediate disclosure outcomes. To better understand HIV-disclosure dynamics, we conducted in-depth interviews among 62 HIV-positive pregnant women accessing PMTCT services in Durban, South Africa. Transcripts were coded for emergent themes and categories. Thirty-nine women (63 %) had been recently diagnosed with HIV; most (n = 37; 95 %) were diagnosed following routine antenatal HIV testing. Forty-two women (68 %) reported unplanned pregnancies. Overall, 37 women (60 %) reported an unintended pregnancy and recent HIV diagnosis. For them, 2 life-changing diagnoses had resulted in a double-disclosure bind. The timing and stigma surrounding these events strongly influenced disclosure of pregnancy and/or HIV. PMTCT-related counseling must be responsive to the complex personal implications of contemporaneous, life-changing events, especially their effect on HIV-disclosure dynamics and, ultimately, on achieving better maternal mental-health outcomes.

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Notes

  1. Due to data-quality issues with the fertility section of the 2003 SADHS, the 1998 survey figures are reported. However, the 2003 SADHS reported unintended pregnancy trends similar to those of the 1998 SADHS.

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Acknowledgments

This study and the lead author (TLC) received support through the Centre of HIV/AIDS Networking (HIVAN), University of KwaZulu-Natal from the National Institute of Child Health and Human Development (NICHD), Partnership for HIV/AIDS Research in South Africa (R24 HD43554) and Atlantic Philanthropies. The lead author (TLC) also received support from the University of California, San Francisco from the following Grants from the U.S. National Institutes of Health (NIH): National Institute of Mental Health (NIMH), Center for AIDS Prevention Studies (P30 MH062246), International Traineeships in AIDS Prevention Studies (ITAPS, R25MH064712), and the Fogarty International Center (FIC) AIDS International Training and Research Program (AITRP, D43TW000003). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH, NICHD, NIMH, FIC or Atlantic Philanthropies. We would like to thank Sbongile Maimane from the Centre for HIV/AIDS Networking (HIVAN) for conducting the interviews and Lynae Darbes and Angelica Espinosa Barbosa Miranda for their review of this paper and their thoughtful comments. We are especially grateful to all the women who participated in the study and who so generously gave of their time and perspectives.

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Authors and Affiliations

  1. Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa

    Tamaryn L. Crankshaw & Anna Voce

  2. McCord Hospital, PO Box 37587, Overport, Durban, 4067, KwaZulu-Natal, South Africa

    Tamaryn L. Crankshaw & Janet Giddy

  3. Global Health Sciences, University of California, San Francisco, San Francisco, CA, USA

    Rachel L. King & Lisa M. Butler

  4. Division of International Health, Department of Public Health, Karolinska Institute, Stockholm, Sweden

    Rachel L. King

  5. Center for AIDS Prevention Studies, University of California, San Francisco, San Francisco, CA, USA

    Nicolas M. Sheon

  6. Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA

    Lisa M. Butler

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  1. Tamaryn L. Crankshaw
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Correspondence to Tamaryn L. Crankshaw.

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Crankshaw, T.L., Voce, A., King, R.L. et al. Double Disclosure Bind: Complexities of Communicating an HIV Diagnosis in the Context of Unintended Pregnancy in Durban, South Africa. AIDS Behav 18 (Suppl 1), 53–59 (2014). https://doi.org/10.1007/s10461-013-0521-1

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  • DOI: https://doi.org/10.1007/s10461-013-0521-1

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