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Patterns and Predictors of HIV-Status Disclosure Among Pregnant Women in South Africa: Dimensions of Disclosure and Influence of Social and Economic Circumstances

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Abstract

HIV-status disclosure may improve psychosocial health and adherence to antiretroviral therapy (ART), but existing insights suffer from methodological limitations. We explored disclosure over time during pregnancy and postpartum among 1347 HIV-positive women in Cape Town. Among 995 women diagnosed HIV-positive before the pregnancy and entering antenatal care (median age 30 years), 95% had disclosed to ≥ 1 individual. In Mokken scale analysis, we observed two separate dimensions of disclosure: disclosure to a male partner, and disclosure to family/community members. Among 352 women diagnosed during the pregnancy and initiating ART (median age 27 years), 61% disclosed to a male partner and 71% to a family/community member by 12 months after diagnosis. Relationship status modified the impact of pregnancy intentions and poverty on disclosure to a male partner. These unique data provide important insights into dimensions of disclosure during pregnancy and postpartum, and suggest that women’s social and economic circumstances are central determinants of disclosure.

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Acknowledgements

The authors would like to thank the women who participated in this study, as well as the study staff for their support of this research.

Funding

This research was supported by the President’s Emergency Plan for AIDS Relief (PEPFAR) through the National Institute of Child Health and Human Development (NICHD), grant number 1R01HD074558. Additional funding comes from the Elizabeth Glaser Pediatric AIDS Foundation. Ms. Brittain is supported by the South African Medical Research Council under the National Health Scholars Programme. Drs. Mellins and Remien are supported by a grant from NIMH to the HIV Center for Clinical and Behavioral Studies (P30-MH45320).

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Authors and Affiliations

  1. Division of Epidemiology and Biostatistics, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

    Kirsty Brittain, Tamsin Phillips & Landon Myer

  2. Centre for Infectious Disease Epidemiology and Research, School of Public Health and Family Medicine, University of Cape Town, Cape Town, South Africa

    Kirsty Brittain, Tamsin Phillips & Landon Myer

  3. HIV Center for Clinical and Behavioral Studies, New York State Psychiatric Institute, Columbia University, New York, NY, USA

    Claude A. Mellins & Robert H. Remien

  4. Mailman School of Public Health, ICAP, Columbia University, New York, NY, USA

    Allison Zerbe & Elaine J. Abrams

  5. College of Physicians and Surgeons, Columbia University, New York, NY, USA

    Elaine J. Abrams

Authors
  1. Kirsty Brittain
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  2. Claude A. Mellins
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  3. Robert H. Remien
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  4. Tamsin Phillips
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  5. Allison Zerbe
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  6. Elaine J. Abrams
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  7. Landon Myer
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Corresponding author

Correspondence to Kirsty Brittain.

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Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was conducted in accordance with the ethical standards of the 1964 Helsinki declaration and its later amendments, and was approved by and conducted in accordance with the standards of the Faculty of Health Sciences Human Research Ethics Committee of the University of Cape Town as well as the Institutional Review Board of the Columbia University Medical Centre.

Informed Consent

Written informed consent was obtained from all individual participants included in the study.

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Brittain, K., Mellins, C.A., Remien, R.H. et al. Patterns and Predictors of HIV-Status Disclosure Among Pregnant Women in South Africa: Dimensions of Disclosure and Influence of Social and Economic Circumstances. AIDS Behav 22, 3933–3944 (2018). https://doi.org/10.1007/s10461-018-2263-6

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  • DOI: https://doi.org/10.1007/s10461-018-2263-6

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