HIV This Week

King R, Katuntu D, Lifshay J, Packel L, Batamwita R, Nakayiwa S, Abang B, Babirye F, Lindkvist P, Johansson E, Mermin J, Bunnell R. Processes and Outcomes of HIV Serostatus Disclosure to Sexual Partners among People Living with HIV in Uganda. AIDS Behav. 2008;12(2):232-43. Epub 2007 Sep 8.

Disclosure of HIV serostatus to sexual partners supports risk reduction and facilitates access to prevention and care services for people living with HIV. To assess health and social predictors of disclosure as well as to explore and describe the process, experiences and outcomes related to disclosure of men and women living with HIV in Eastern Uganda, King and colleagues conducted a study among clients of The AIDS Support Organization (TASO) in Jinja, Uganda. The authors enrolled TASO clients in a cross-sectional study on transmission risk behaviour. Demographic and behavioural data and CD4 cell count measurements were collected. Among 1,092 participants, 42% were currently sexually active and 69% had disclosed their HIV serostatus to their most recent sexual partner. Multivariate logistic regression analysis showed that disclosure of HIV-status was associated with being married, having attended TASO for more than 2 years, increased condom use, and knowledge of partner’s serostatus. From these clients, 45 men and women were purposefully selected and interviewed in-depth on disclosure issues. Positive outcomes included risk reduction behaviour, partner testing, increased care-seeking behaviour, anxiety relief, increased sexual communication, and motivation to plan for the future.

Editors’ note: Almost half of the participants disclosed indirectly, a culturally appropriate method of conveying personal information in this setting but one that requires more human resources. Given the strong association found between knowledge of serostatus and disclosure, widespread promotion of couples counselling, with the option of mutual disclosure, can link couples to family-focused HIV treatment, care, and prevention opportunities. Both Uganda and Kenya are expanding home-based testing programmes that do exactly that.

Menon and colleagues aimed to examine emotional and behavioural difficulties in Zambian adolescents living with HIV, and to determine the relationship between disclosure of HIV status and mental health. In a cross-sectional survey, 127 adolescents living with HIV aged 11 to 15 years were recruited through clinics in the Lusaka region. Mental health was assessed using the youth report version of the Strengths and Difficulties Questionnaire (SDQ). Caregivers completed the parent SDQ. Sixty-two participants were invited for a semi-structured interview which probed views on attending a peer support group. Compared to a British community sample, participants had increased mental health problems (OR, 2.1), particularly emotional symptoms (OR = 3.6), and peer problems (OR = 7.1). The majority of the study subjects (n = 94) were receiving antiretroviral treatment, but only 48 (37.8%) had their HIV status disclosed to them. Those who had not had their HIV status disclosed to them were younger (P < 0.001) and less likely to be receiving antiretroviral treatment (P < 0.001). Controlling for these factors they were also more likely to score in the abnormal range of the emotional difficulties subscale (OR = 2.63, 95% CI: 1.11 to 6.26). Of 38 interviews transcribed, content analysis showed that only 3 individuals were opposed to participation in a peer-group programme, with the majority (23/38 ) expressing reasoned and positive responses, regardless of disclosure status. In conclusion, high rates of emotional and peer problems were found in this sample but disclosure of HIV status did not have a negative effect on mental health. Interventions to promote disclosure could facilitate access to emotional and peer support.

Editors’ note: Children with HIV are at increased risk of mental health problems but not necessarily as a result of their health status. In this study, Zambian young people aged 11 to 15 years aware of their serostatus were 2.5 times less likely to score in the abnormal range for emotional difficulty, after controlling for age, sex, and medication, than those who did not know. Since this is a cross-sectional study, it is difficult to know whether more psychologically stable children are more likely to learn their serostatus and even, whether families who choose to disclose have higher expressivity levels or tend to have more psychologically stable children. What is clear is that knowledge of serostatus is the door to participation in a peer support group that can provide psychological support.