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Association of experienced and internalized stigma with self-disclosure of HIV status by youth living with HIV

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Abstract

We examined patterns of disclosure among youth living with HIV (YLHIV) in Kenya, and the association between self-disclosure and antiretroviral therapy adherence, stigma, depression, resilience, and social support. Of 96 YLHIV, 78% were female, 33% were ages 14–18, and 40% acquired HIV perinatally. Sixty-three (66%) YLHIV had self-disclosed their HIV status; 67% to family and 43% to non-family members. Older YLHIV were 75% more likely to have self-disclosed than those 14–18 years. Of the 68 either married or ever sexually active, 45 (66%) did not disclose to their partners. Those who had self-disclosed were more likely to report internalized stigma (50% vs. 21%, prevalence ratio [PR] 2.3, 1.1–4.6), experienced stigma (26% vs. 3%, PR 11.0, 1.4–86), and elevated depressive symptoms (57% vs. 30%, PR 1.8, 1.0–3.1). The association with stigma was stronger with self-disclosure to family than non-family. Support should be provided to YLHIV during self-disclosure to mitigate psychosocial harms.

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Acknowledgements

We wish to thank the Vijana-SMART participants from Kayole in Nairobi, the staff of Kayole II sub-County Hospital and the study staff, Caroline Akinyi, Helen Moraa, Margaret Nduati, and Alex Muriithi for their participation and hard work. This project was funded by University of Washington’s Center for AIDS Research New Investigator Award (AI027757). We also acknowledge the International AIDS Research Training Program (IARTP), supported by the Fogarty International Center, National Institute on Drug Abuse, and National Institute of Mental Health (NIH grant D43 TW009580); and the Global Center for Integrated Health of Women, Adolescents, and Children (Global WACh) for supporting authors during the preparation of this paper.

Funding

National Institutes of health (AI027757 University of Washington Center for AIDS research New Investigator Award). During manuscript development, C.M. was a scholar in the International AIDS Research and Training Program, supported by the Fogarty International Center, National Institute on Drug Abuse, and National Institute of Mental Health (NIH grant D43 TW009580).

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Authors and Affiliations

  1. Department of Research and Programs, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya

    Cyrus Mugo & David Seeh

  2. Department of Pediatrics, Kenyatta National Hospital, P.O. Box 20723-00202, Nairobi, Kenya

    Irene Inwani

  3. Department of Global Health, University of Washington, Seattle, WA, 98104, USA

    Brandon Guthrie, Grace John-Stewart & Keshet Ronen

  4. Department of Epidemiology, University of Washington, Seattle, WA, 98104, USA

    Cyrus Mugo, Brandon Guthrie & Grace John-Stewart

  5. Department of Pediatrics, University of Washington, Seattle, WA, 98104, USA

    Grace John-Stewart

  6. Department of Medicine, University of Washington, Seattle, WA, 98104, USA

    Grace John-Stewart

  7. Department of Psychiatry, University of Nairobi, P.O. Box 19676-00202, Nairobi, Kenya

    Manasi Kumar

  8. School of Medicine and Public Health, University of Wisconsin, Madison, WI, 53705, USA

    Megan Moreno

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  1. Cyrus Mugo
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Contributions

Conceptualization and methodology: Cyrus Mugo and Keshet Ronen; Primary analysis and preparation of original draft: Cyrus Mugo; Writing review, editing and approval of final manuscript: Cyrus Mugo, David Seeh, Brandon Guthrie, Megan Moreno, Manasi Kumar, Grace John-Stewart, Irene Inwani, Keshet Ronen; Funding acquisition: Keshet Ronen.

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Correspondence to Cyrus Mugo.

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Conflict of interest

The authors declare that they have no conflicts of interest.

Ethical approval

This study was performed in line with the principles of the Declaration of Helsinki. Vijana-SMART study was approved by the Kenyatta National Hospital ethics review committee (P296/06/2017, Date: September 13, 2017), and the University of Washington institutional review board (STUDY000002554, Date: June 30, 2017).

Consent to participate

Young adults age ≥ 18 years provided independent written consent. In accordance with Kenyan regulations, adolescents below 18 years who were married, pregnant or had children were emancipated and provided independent written consent. Additionally, adolescents below 18 who were attending care without their caregiver provided independent written consent. Adolescents not emancipated by marriage or parenthood and whose caregiver was attending care with them provided assent and their caregiver provided written consent for study participation. The consenting procedures were approved by the ethics bodies.

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Mugo, C., Seeh, D., Guthrie, B. et al. Association of experienced and internalized stigma with self-disclosure of HIV status by youth living with HIV. AIDS Behav 25, 2084–2093 (2021). https://doi.org/10.1007/s10461-020-03137-0

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