To provide understanding of social and psychological factors that affect disclosure of HIV status among women diagnosed HIV-positive in pregnancy, 438 HIV positive women attending antenatal clinics in Pretoria, South Africa were invited to participate in a longitudinal study. A total of 293 (62%) women were enrolled from June 2003 to December 2004. Questionnaires assessing sociodemographics and psychological measures were administered during pregnancy and at 3 months postdelivery. At enrollment, 59% had disclosed to their partners and 42% to others. This rose to 67% and 59%, respectively, by follow-up. Logistic regression analysis identified being married (adjusted odds Ratio [AOR] 2.32; 95% confidence interval [CI] 1.20–4.47), prior discussion about testing (AOR 4.19; CI 2.34–7.49), having a partner with tertiary education (AOR 2.76; CI 1.29–5.88) and less experience of violence (AOR 0.48; CI 0.24–0.97) as factors associated with having disclosed to partners prior to enrollment. Better housing (AOR 1.26; CI 1.06–1.49), less financial dependence on partners (AOR 0.46; CI 0.25–0.85), and knowing someone with HIV (AOR 2.13; CI 1.20–3.76) were associated with prior disclosure to others. Increased levels of stigma at baseline decreased the likelihood of disclosure to partners postenrollment (AOR 0.91; CI 0.84–0.98) and increased levels of avoidant coping decreased subsequent disclosure to others (AOR 0.84; CI 0.72–0.97). These results provide understanding of disclosure for women diagnosed as HIV positive in pregnancy, and identify variables that could be used to screen for women who require help.
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References
1.
GebrekristosH, Abdool KarimQ, LurieM. Disclosure of HIV status for patients on HAART: Implications for treatment adherence and sexual behaviour [Abstract]South African AIDS Conference: Durban, August3–6, 2003.
2.
OlleyBO, SeedatS, SteinDJ. Self-disclosure of HIV serostatus in recently diagnosed patients with HIV in South Africa. Afr J Reprod Health, 2004; 8:71–76.
3.
DabisF, FransenL, SabaJ, LepageP, LeroyP, CartouxM. Prevention of mother-to-child transmission of HIV in developing countries: Recommendations for practice. The Ghent International Working Group on Mother-to-Child Transmission of HIV. Health Policy Plan, 2000; 15:34–42.
4.
MedleyA, Garcia-MorenoC, McGillS, MamanS. Rates, barriers and outcomes of HIV sero-status disclosure among women in developing countries: Implications for prevention of mother-to-child transmission programmes. Bull WHO, 2004; 82:299–307.
5.
KilewoC, MassaweA, LyamuyaE, SemaliI, KalokolaF, UrassaE. HIV counseling and testing of pregnant women in sub-Saharan Africa. J AIDS, 2001; 28:458–462.
6.
KuhnL, MathewsC, FransmanD, DikweniL, HusseyG. Child feeding practices and attitudes of HIV-seropositive mothers in Cape Town, South Africa. AIDS, 1999; 13:144–145.
7.
SigxasheTA, BaggaleyR, MathewsC. Attitudes to disclosure of HIV status to sexual partners. S Afr Med J, 2001; 91:908–909.
8.
SethosaE, PetlzerK. Evaluation of HIV counselling and testing, self-disclosure, social support and sexual behaviour change among a rural sample of HIV reactive patients in South Africa. Curationis, 2005Feb29–41.
9.
FarquharC, NgachaD, BosireR, NduatiR, KreissJ, JohnG. Partner notification by HIV-1 seropositive pregnant women: association with infant feeding decisions. AIDS, 2001; 15:815–817.
10.
GalliardP, MelisR, MwanyumbaFet al.Vulnerability of women in an African setting: Lessons for mother to child HIV transmission programmes. AIDS, 2002; 16:937–939.
11.
IssiakaS, CartouxM, ZerboOKet al.Living with HIV: Women's experience in Burkina Faso, West Africa. AIDS Care, 2001; 13:123–128.
12.
MamanS, MbwamboJ, HoganNM, KilonzoGP, SweatM. Women's barriers to HIV-1 testing and disclosure: Challenges for HIV-1 voluntary counselling and testing. AIDS Care, 2001; 13:595–603.
13.
GielenAC, O'CampoP, FadenRR, EkeA. Women's disclosure of HIV status: Experiences of mistreatment and violence in an urban setting. Women Health, 1997; 25:19–31.
14.
GielenAC, McDonellKA, BurkeJG, O'CampoP. Women's lives after an HIV-positive diagnosis: Disclosure and violence. Matern Child Health J, 2000; 4:111–119.
15.
AntelmanG, Smith-FawziMC, KaayaSet al.Predictors of HIV-1 serostatus disclosure: A prospective study among HIV-infected pregnant women in Dar-es-Salaam, Tanzania. AIDS, 2001; 15:1865–1874.
16.
SteinMD, SametJH. Disclosure of HIV status. AIDS Patient Care STDs, 1999; 13:265–267.
17.
ChandraPS, DeepthivarmaS, ManjulaV. Disclosure of HIV infection in South India: patterns, reasons and reactions. AIDS Care, 2003; 15:207–215.
18.
LieG, BiswaloP. Perceptions of the appropriate HIV/AIDS counselor in Arusha and Kilimanjaro regions of Tanzania: Implications for hospital counseling. AIDS Care, 1994; 6:139–151.
19.
KaplanMS, MarksG, MertensSB. Distress and coping among women with HIV infection: preliminary findings from a multiethnic sample. Am J Orthopsychiatry, 1997; 67:80–91.
20.
SerovichJM, KimberleyJA, MosackKE, LewisTL. The role of family and friend social support in reducing emotional distress among HIV-positive women. AIDS Care, 2001; 13:335–341.
21.
SilverEJ, BaumanL, CamachoS, HudisJ. Factors associated with psychological distress in urban mothers with late-stage HIV/AIDS. AIDS Behav, 2003; 7:421–431.
22.
KalichmanSC, DiMarcoM, AustinJ, LukeW, DiFonzoK. Stress, social support and HIV-status disclosure to family and friends among HIV-positive men and women. J Behav Med, 2003; 4:15–332.
23.
Turner-CobbJM, Gore-FeltonC, MarouFet al.Coping, social support and attachment style as psychosocial correlates of adjustment in men and women with HIV/AIDS. J Behav Med, 2002; 25:337–353.
24.
BaumanLJ, CamachoS, WestbrookLE, Forbes-JonesE. Correlates of personal stigma and social stigma among mothers with HIV/AIDS. Presented at the National Conference on Women and HIV, Pasadena, CA, May1997.
25.
BaumanLJ, SilverEJ, CamachoS. Stigma among mothers with HIV/AIDS. Presented at the XIII International AIDS Conference, Durban, South Africa, July2000.
26.
KimberlyJA, SerovichJM. Perceived social support among people living with HIV/AIDS. Am J Family Ther, 1996; 24:41–53.
27.
LevyA, LaskaF, AbelhauseAet al.Disclosure of HIV seropositivity. J Clin Psychol, 1999; 55:1041–1049.
28.
WestbrookLE, BaumanLJ. Perceived Stigma of HIV/AIDS Scale. Bronx, NY: Albert Einstein College of Medicine, 1996.
29.
BaumanLJ, WeissE. Multidimensional Social Support Inventory: Revised. Bronx, NY: Albert Einstein College of Medicine, 1995.
30.
RosenbergM. Society and the Adolescent Self Image. Princeton, NJ: Princeton University Press, 1965.
31.
RadloffLS. The CES-D scale: A self-report depression scale for research in the general population. Appl Psychol Meas, 1977; 1:385–401.
32.
KalichmanSC, RompaD, CageM. Distinguishing between overlapping somatic symptoms of depression and HIV disease in people living with HIV-AIDS. J Nerv Ment Dis, 2000; 188:662–670.
33.
CarverCS. You want to measure coping but your protocol's too long: Consider the Brief COPE. Int J Behav Med, 1997; 4:92–100.
34.
DunkleKL, JewkesRK, BrownHCet al.Prevalence and patterns of gender-based violence and revictimisation among women attending antenatal clinics in Soweto, South Africa. Am J Epidemiol, 2004; 160:230–239.
35.
TheronGB. Antenatal prevention of mother to child transmission of HIV. SA Fam Pract, 2007; 49:50–54.
36.
MyerL, MorroniC, RebeK. Prevalence and determinants of fertility intentions of HIV-infected women and men receiving antiretroviral therapy in South Africa. AIDS Patient Care STDs, 2007; 21:278–285.
37.
AdamsenL. “From victim to agent”: The clinical and social significance of self-help group participation for people with life threatening diseases. Scand J Caring Sci, 2002; 16:224–231.
38.
CrockerJ, MajorB, SteeleC. Social Stigma: The Handbook of Social Psychology, 2. Boston: McGraw Hill, 1998; 504–553.
39.
RothML, NelsonMS. HIV diagnosis rituals and identity narratives. AIDS Care, 1997; 9:161–179.
40.
BesserMJ. Mothers 2 Mothers 2 Be: Education, Emotional support, Economic Opportunity & Empowerment for Pregnant Women and Mothers living with HIV. Presented at the 23rd Conference on Priorities in Perinatal Care in Southern Africa, Warmbaths, South Africa, March2004.
