HIV This Week

Brou H, Djohan G, Becquet R, Allou G, Ekouevi DK, Viho I, Leroy V, Desgrées-du-Loû A; ANRS 1201/1202/1253 Ditrame Plus Study Group. 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 Dec;4(12):e342.

In Africa, women tested for HIV during antenatal care are counselled to share with their partner their HIV test result and to encourage partners to undertake HIV testing. Brou and colleagues investigate, among women tested for HIV within a prevention of mother-to-child transmission of HIV (PMTCT) programme, the key moments for disclosure of their own HIV status to their partner and the impact on partner HIV testing. Within the Ditrame Plus PMTCT project in Abidjan, 546 HIV-positive and 393 HIV-negative women were tested during pregnancy and followed-up for two years after delivery. Circumstances, frequency, and determinants of disclosure to the male partner were estimated according to HIV status. The determinants of partner HIV testing were identified according to women's HIV status. During the two-year follow-up, disclosure to the partner was reported by 96.7% of the HIV-negative women, compared to 46.2% of HIV-positive women (chi(2) = 265.2, degrees of freedom [df] = 1, p < 0.001). Among HIV-infected women, privileged circumstances for disclosure were just before delivery, during early weaning (at 4 mo to prevent HIV postnatal transmission), or upon resumption of sexual activity. Formula feeding by HIV-infected women increased the probability of disclosure (adjusted odds ratio 1.54, 95% confidence interval 1.04-2.27, Wald test = 4.649, df = 1, p = 0.031), whereas household factors such as having a co-spouse or living with family reduced the probability of disclosure. The proportion of male partners tested for HIV was 23.1% among HIV-positive women and 14.8% among HIV-negative women (chi(2) = 10.04, df = 1, p = 0.002). Partners of HIV-positive women who were informed of their wife's HIV status were more likely to undertake HIV testing than those not informed (37.7% versus 10.5%, chi(2) = 56.36, df = 1, p < 0.001). In PMTCT programmes, specific psychosocial counselling and support should be provided to women during the key moments of disclosure of HIV status to their partners (end of pregnancy, weaning, and resumption of sexual activity). This support could contribute to improving women's adherence to the advice given to prevent postnatal and sexual HIV transmission.

Editors’ note: This study emphasises that there are “tellable” moments when HIV-positive women are more likely to disclose their status to their sexual partner – an essential step in obtaining understanding and moral support within the couple. Disclosure contributes to women’s capacity to adhere to advice to prevent postnatal and sexual HIV transmission. Furthermore, men who were informed of their partner’s HIV status, whether positive or negative, were much more likely to undertake HIV testing themselves.

Li L, Sun S, Wu Z, Wu S, Lin C, Yan Z. Disclosure of HIV status is a family matter: field notes from China. J Fam Psychol. 2007 Jun;21(2):307-14.

This study examines the role that family plays in disclosure of HIV in China. In-depth semistructured interviews were conducted with 30 individuals living with HIV infected through different routes. The vast majority of participants were between the ages of 20 and 39 years old (93.4%) and about a third (36.7%) were women. Two primary disclosure processes, involuntary and voluntary, are described. In both processes, family members other than the patient are usually the first to know HIV status. Positive impacts of disclosure include strengthening family relations and help with medical care and counselling, whereas negative impacts include fear, isolation, avoidance, and psychological burden. This study illustrates that family is an intricate part of the disclosure process in China and demonstrates the importance of including families in HIV interventions.

Editors’ note: This is the first systematic and in-depth description of HIV disclosure in China. Both voluntary and involuntary disclosure involve the family. In the former, HIV-positive people weigh the effect that disclosure would have on their families and when they decide to disclose it is often to a family member of the same generation (i.e. spouse or sibling) first. In the latter, parents are often chosen by a health care provider to bear the responsibility of informing the HIV-positive person. China is experiencing rapid social change and the practice of telling family members first may decline with the “Four Free One Care” national campaign. It provides four free services (medical assistance, anonymous HIV tests, education for orphans, and prenatal treatment for pregnant women) and one care service for elderly people who have lost children to AIDS.