Non-disclosure of HIV Serostatus to Sexual Partners

Prevalence, Risk Factors and Clinical Impact in Patients With HIV

E Morkphrom; W Ratanasuwan; G Sittironnarit; P Rattanaumpawan

Disclosures

HIV Medicine. 2021;22(3):194-200. 

In This Article

Abstract and Introduction

Abstract

Objective: To determine the prevalence, risk factors and impact of non-disclosure of HIV serostatus to sexual partners among HIV-positive patients at Siriraj Hospital, Bangkok.

Methods: We conducted a prospective observational study to enrol HIV-positive adults with one or more regular sexual partners during the past 3 months. We obtained personal information via anonymous questionnaire and clinical data of those receiving antiretroviral therapy (ART) for ≥12 months via chart-review.

Results: A total of 328 HIV-positive participants were enrolled. Approximately half were female and in the symptomatic HIV stage at diagnosis, with an average age 44.08 ± 8.59 years. Approximately one-third of participants (35.7%) reported that they had not disclosed their HIV serostatus to their sexual partners. The non-disclosure group had a higher rate of poor ART adherence owing to fear of revealing their HIV serostatus to their partner (12.0% vs. 1.9%; P < 0.001), as compared with the disclosure group. Rates of immunological and virological failure did not differ between groups. Multivariate analysis [adjusted odds ratio (OR); 95% confidence interval (CI); P-value] revealed having an occupation as a teacher (4.08; 1.40–16.61; P = 0.01) and reporting acquisition of HIV infection through blood transfusion (4.08; 1.31–12.68; P = 0.02) were independent risk factors. Furthermore, a longer duration of the sexual relationship (0.997; 0.994–0.999; P = 0.02), having a seropositive sexual partner (0.57; 0.33–0.99; P = 0.04), living in their partner's house (0.53; 0.31–0.90; P = 0.02) and having a higher mean Pictorial Thai Self-Esteem Scale (PTSS) score (0.62; 0.38–0.99; P = 0.05) were identified as independent protective factors.

Conclusions: We found a high prevalence of HIV serostatus non-disclosure, which was associated with poorer ART adherence. Appropriately focusing interventions on high-risk populations with aforementioned risk factors is important for improved HIV care.

Introduction

Disclosure of HIV serostatus to sexual partners is an important step for the prevention of HIV infection. Knowing the sexual partner's HIV serostatus can prevent HIV transmission between a serodiscordant couple with condom use and pre/post-exposure prophylaxis. Such disclosure can stimulate the sexual partner to seek HIV testing and early treatment. Additionally, past studies have shown that serostatus disclosure is related to good antiretroviral therapy (ART) adherence, which is of direct benefit to individuals who disclose their serostatus.[1]

The prevalence of HIV serostatus disclosure has been studied among various populations across the world and ranges from 20% to 50%.[2–7] In Thailand, the prevalence of HIV serostatus disclosure to sexual partners varies from 95% among HIV-positive pregnant women[8] to only 26% among HIV-positive men who have sex with men (MSM).[9] Furthermore, regional variation in the prevalence of HIV disclosure was documented in a recent study in northern and north-eastern Thailand.[10]

HIV stigma and fear of social discrimination are considered major obstacles to HIV serostatus disclosure. A recent qualitative study conducted among HIV-positive people in Thailand revealed that significant barriers to HIV serostatus disclosure were perceived stigma, shame and fear of rejection.[11] The negative impact of HIV stigma and social discrimination on HIV prevention and care has been confirmed in many previous studies.[12–14]

Until now, few studies have thoroughly explored this issue in Thailand. Given these considerations, we aimed to determine the prevalence, associated factors and impact of HIV serostatus non-disclosure among HIV-positive patients receiving HIV care at a Thai university hospital. The study results will help us to understand patients' attitudes better and can guide development of appropriate interventions to encourage patients to disclose their HIV serostatus.

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