Processes and Outcomes of HIV Serostatus Disclosure to Sexual Partners among People Living with HIV in Uganda

Disclosure of HIV serostatus to sexual partners supports risk reduction and facilitates access to prevention and care services for people living with HIV/AIDS. To assess health and social predictors of disclosure as well as to explore and describe the process, experiences and outcomes related to disclosure of HIV-infected men and women in Eastern Uganda, we conducted a study among HIV-infected men and women who were clients of The AIDS Support Organization (TASO) in Jinja, Uganda. We enrolled TASO clients in a cross-sectional study on transmission risk behavior. Demographic and behavioral 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 behavior, partner testing, increased care-seeking behavior, anxiety relief, increased sexual communication, and motivation to plan for the future. The findings and conclusions in this report are those of the author and do not necessarily represent the views of the Centers for Disease Control and Prevention.     

Predictors of Serostatus Disclosure to Partners Among Young People Living with HIV in the Pre- and Post-HAART Eras

Predictors of serostatus disclosure were identified among youth living with HIV pre- and post-introduction of highly active antiretroviral therapy (HAART). Two cohorts of HIV-positive youth, aged 13–24, in 1994–1996 (n = 351) and 1999–2000 (n = 253) in Los Angeles, New York, San Francisco, and Miami were sampled through medical providers and a variety of social service agencies. Data were collected on demographic, social, medical, and behavioral topics. Men who had sex with men were more likely to disclose serostatus to their partners. Moreover, a positive association with length of time since diagnosis and the likelihood of disclosure exists; across time, youth were less likely to disclose serostatus to casual partners or HIV-negative partners. Post-HAART, number of sex acts with a partner was associated with increased likelihood of disclosure. Interventions for HIV-positive youth must improve disclosure to casual and serodiscordant sexual partners.     

Receiving HIV Serostatus Disclosure from Partners Before Sex: Results from an Online Survey of Chinese Men Who Have Sex with Men

HIV serostatus disclosure before sex can facilitate serosorting, condom use and potentially decrease the risk of HIV acquisition. However, few studies have evaluated HIV serostatus disclosure from partners before sex. We examined the rate and correlates of receiving HIV serostatus disclosure from regular and casual male partners before sex among an online sample of men who have sex with men (MSM) in China. An online cross-sectional study was conducted among MSM in eight Chinese cities in July 2016. Participants completed questions covering sociodemographic information, sexual behaviors, HIV testing (including HIV self-testing) history, self-reported HIV status, and post-test violence. In addition, participants were asked whether they received HIV serostatus disclosure from their most recent partners before sex. Overall, 2105 men completed the survey. Among them, 85.9% were never married, and 35.4% had high school or less education. A minority (20.6%, 346/1678; 17.8%, 287/1608) of men received HIV serostatus disclosure from their most recent regular and casual male partners, respectively. Multivariate analysis indicated that participants who ever self-tested for HIV were more likely to have received HIV status disclosure from regular [adjusted OR (aOR) = 1.92, 95% CI 1.50–2.44] and casual (aOR = 2.34, 95% CI 1.80–3.04) male partners compared to never self-tested participants. Compared to participants who had not received HIV status disclosure from regular partners, participants who received disclosure from regular male partners had higher likelihood in experiencing post-test violence (aOR = 5.18, 95% CI 1.53–17.58). Similar results were also found for receiving HIV serostatus disclosure from casual partners. This study showed that HIV serostatus disclosure from partners was uncommon among Chinese MSM. Interventions and further implementation research to facilitate safe disclosure are urgently needed for MSM.     

Determinants of HIV Serostatus Disclosure to Sexual Partner Among HIV-Positive Alcohol Users in Haiti

This study examined the relationship between antiretroviral therapy use, participants’ knowledge of partner’s HIV serostatus, number of sex partners, perceived infectivity and HIV disclosure to a main sexual partner among 258 HIV-positive Haitian alcohol users. Only 38.6 % had disclosed their HIV serostatus to sexual partners. Logistic regression analyses revealed that participants who self-reported having an HIV-negative partner (OR = 0.36, 95 % CI 0.13–0.97) or a partner of unknown HIV status (OR = 0.09, 95 % CI 0.04–0.22) were less likely to disclose their HIV serostatus than participants who self-reported having an HIV-positive partner. Participants who had more than one sexual partner in the past 3 months (OR = 0.41, 95 % CI 0.19–0.90) were also less likely to disclose than participants who had one partner. These findings suggest the need for couples-based programs to assist people living with HIV (PLWH) with the disclosure process, especially among PLWH who have more than one sexual partner and/or are in serodiscordant relationships.     

Reduced Sexual Risk Behaviors Among People Living with HIV: Results from the Healthy Relationships Outcome Monitoring Project

In 2006, the Centers for Disease Control and Prevention funded seven community-based organizations (CBOs) to conduct outcome monitoring of Healthy Relationships. Healthy Relationships is an evidence-based behavioral intervention for people living with HIV. Demographic and sexual risk behaviors recalled by participants with a time referent of the past 90 days were collected over a 17-month project period using a repeated measures design. Data were collected at baseline, and at 3 and 6 months after the intervention. Generalized estimating equations were used to assess the changes in sexual risk behaviors after participation in Healthy Relationships. Our findings show that participants (n = 474) in the outcome monitoring project reported decreased sexual risk behaviors over time, such as fewer number of partners (RR = 0.55; 95% CI 0.41–0.73, P < 0.001) and any unprotected sex events (OR = 0.44; 95% CI 0.36–0.54, P < 0.001) at 6 months after the intervention. Additionally, this project demonstrates that CBOs can successfully collect and report longitudinal outcome monitoring data.     

Disclosure of HIV Status to Sex Partners Among HIV-Infected Men and Women in Cape Town, South Africa

This study examines factors influencing HIV sero-status disclosure to sex partners among a sample of 630 HIV-infected men and women with recent sexual contact attending anti-retroviral therapy (ART) clinics in Cape Town, South Africa, with a focus on sex partner type, HIV-related stigma, and ART as potential correlates. About 20% of the sample had not disclosed their HIV status to their most recent sex partners. HIV disclosure to sex partner was more likely among participants who had a steady sex partner [Adjusted odds ratio (AOR) = 2.7; 95% CI: 1.6–4.6], had a partner with known-HIV status [AOR = 7.8; 95% CI: 3.2–18.7]; perceived less stigma [AOR = 1.9; 95% CI: 1.2–2.9]; and were on ART [AOR = 1.6; 95% CI: 1.1–2.3]. Stratified analyses by the type of sex partner further reveals that stigma and ART were significantly associated with HIV disclosure within steady relationships but were not significant correlates of HIV disclosure with casual sex partners. The findings support a positive prevention strategy that emphasizes increased access to ART, and behavioral interventions to reduce casual sex partnerships for persons who are HIV-positive. Mitigating the influence of HIV stigma on HIV status disclosure particularly within steady sex partnerships is also important and may be accomplished through individual and couple counseling.     

Association Between ART Adherence and Mental Health: Results from a National HIV Sero-Behavioural Survey in South Africa

AIDS and Behavior - This paper assesses the levels of antiretroviral treatment (ART) adherence and mental health distress among study participants in a national behavioural HIV-sero prevalence...     

New insights into HIV epidemic in South Africa: key findings from the National HIV Prevalence,Incidence and Behaviour Survey, 2012

This article presents key findings from the 2012 HIV prevalence, incidence and behaviour survey conducted in South Africa and explores trends in the HIV epidemic. A representative household based survey collected behavioural and biomedical data among people of all ages. Chi-squared test for association and formal trend tests (2002, 2005, 2008 and 2012) were used to test for associations and trends in the HIV epidemic across the four surveys. In 2012 a total of 38 431 respondents were interviewed from 11 079 households; 28 997 (67.5%) of 42 950 eligible individuals provided blood specimens. HIV prevalence was 12.2% [95% CI: 11.4–13.1] in 2012 with prevalence higher among females 14.4% than males 9.9%. Adults aged 25–49 years were most affected, 25.2% [95% CI: 23.2–27.3]. HIV prevalence increased from 10.6% [95%CI: 9.8–11.6] in 2008 to 12.2% [95% CI: 11.4–13.1] in 2012 (p < 0.001). Antiretroviral treatment (ART) exposure doubled from 16.6% in 2008 to 31.2% in 2012 (p < 0.001). HIV incidence in 2012 among persons 2 years and older was 1.07% [95% CI: 0.87–1.27], with the highest incidence among Black African females aged 20–34 years at 4.5%. Sexual debut before 15 years was reported by 10.7% of respondents aged 15–24 years, and was significantly higher among male youth than female (16.7% vs. 5.0% respectively, p < 0.001). Reporting of multiple sexual partners in the previous 12 months increased from 11.5% in 2002 to 18.3% in 2012 (p < 0.001). Condom use at last sex dropped from 45.1% in 2008 to 36.2% in 2012 (p < 0.001). Levels of accurate HIV knowledge about transmission and prevention were low and had decreased between 2008 and 2012 from 31.5% to 26.8%. South Africa is on the right track with scaling up ART. However, there have been worrying increases in most HIV-related risk behaviours. These findings suggest that there is a need to scale up prevention methods that integrate biomedical, behavioural, social and structural prevention interventions to reverse the tide in the fight against HIV.     

Depressive Symptoms,Gender, Disclosure,and HIV Care Stage Among People Living with HIV in Cameroon

AIDS and Behavior - Depression is associated with suboptimal HIV care outcomes. Little is known about the extent to which the prevalence of depressive symptoms varies across the HIV care continuum....     

High Levels of Risk Behavior Among People Living with HIV Initiating and Waiting to Start Antiretroviral Therapy in Cape Town South Africa

Baseline data were collected in Cape Town during 2006 to study if patients on combination antiretroviral therapy (ART) experience decreased inhibition to avoid risky sexual behavior. A total of 924 HIV-positive individuals were recruited; 520 who initiated ART within 3 months and 404 waiting for ART. Nearly half of men (40.1%) and women (46.3%) reported having unprotected sex their last time. Men and women who did not disclose their HIV status to their partner [Odds ration (OR)=2.57 (95% CI: 1.22-5.50) and 2.84 (95% CI: 1.84-4.39), respectively], and those with ambivalent perception about the relationship between ART and HIV transmission [OR=2.08 (95% CI: 1.00-4.30) and 2.39 (95% CI: 1.50-3.84), respectively], were twice as likely to have had unprotected sex their last time. Results suggest an urgent need to strengthen prevention interventions among HIV-positive individuals on and about to start ART in this setting.     

Exploring Treatment Needs and Expectations for People Living with HIV in South Africa: A Qualitative Study

The UNAIDS 90-90-90 treatment targets aim to dramatically increase the number of people who initiate antiretroviral therapy (ART) by 2020. Greater understanding of barriers to ART initiation in high prevalence countries like South Africa is critical. Qualitative semi-structured interviews were conducted with 30 participants in Gugulethu Township, South Africa, including 10 healthcare providers and 20 people living with HIV (PLWH) who did not initiate ART. Interviews explored barriers to ART initiation and acceptability of theory-based intervention strategies to optimize ART initiation. An inductive content analytic approach was applied to the data. Consistent with the Theory of Triadic Influence, barriers to ART initiation were identified at the individual, social, and structural levels. Results suggested high acceptability for intervention strategies involving trained HIV-positive peers among South African PLWH and healthcare providers. Research is needed to evaluate their feasibility and efficacy in high HIV prevalence countries.     

TB/HIV risk factors identified from a General Household Survey of South Africa in 2006

Abstract

The level of human immunodeficiency virus (HIV), tuberculosis (TB) as well as the co-infection TB/HIV in South Africa is among the highest in the world. TB is curable while HIV is not, yet the combination of both is a growing feature in the world. This study examined TB and HIV affecting people living in South Africa. Analyses have been undertaken based on data from the General Household Survey of South Africa in 2006. The study focused on respondents aged 15–49 years, corresponding to a total of 55,384 people composed of 25,859 males and 29,525 females. Among this population, 5935 people suffered from illness/injury, including 2469 (41.6%) males and 3466 (58.4%) females. Weighted multivariate logistic regression is performed on TB and/or HIV in association with the province, background characteristics of the target population, and selected socioeconomic and demographic variables included in the survey. In this study we focus on variables of health status and whether subjects suffered from TB and/or HIV. Findings of this investigation show that TB is the second most common cause of illness in the provinces of KwaZulu-Natal (KN) (9.1%), North West (5.4%) and Limpopo (4.2%). People who are married have a 50% lower risk compared to those currently not married to suffer from TB and/or HIV. Those with living spouses have a 5% lower risk to suffer from TB and/or HIV than those whose partners are not alive. This study concluded that rapid action is needed to curb the spread of TB and/or HIV to produce a healthy population. Therefore, follow-up care and special preventative measures are urgently needed in provinces with higher reported rates of TB and/or HIV such as KN.     

Adherence to Antiretroviral Therapy Among Children Living with HIV in South India

Adherence to ART, fundamental to treatment success, has been poorly studied in India. Caregivers of children attending HIV clinics in southern India were interviewed using structured questionnaires. Adherence was assessed using a visual analogue scale representing past-month adherence and treatment interruptions >48 h during the past 3 months. Clinical features, correlates of adherence and HIV-1 viral-load were documented. Based on caregiver reports, 90.9 % of the children were optimally adherent. In multivariable analysis, experiencing ART-related adverse effects was significantly associated with suboptimal adherence (p = 0.01). The proportion of children who experienced virological failure was 16.5 %. Virological failure was not linked to suboptimal adherence. Factors influencing virological failure included running out of medications (p = 0.002) and the child refusing to take medications (p = 0.01). Inclusion of drugs with better safety profiles and improved access to care could further enhance outcomes.     

Attitudes Toward Payment for Research Participation: Results from a U.S. Survey of People Living with HIV

AIDS and Behavior - Little is known about how payment affects individuals' decisions to participate in HIV research. Using data from a U.S. survey of people living with HIV...     

HIV Knowledge and Sexual Risk Behavior Among Pregnant Couples in South Africa: The PartnerPlus Project

In sub-Saharan Africa, 60 % of people living with HIV are women and most are of childbearing age. Alarmingly, seroconversion rates during pregnancy are high and increase as pregnancy progresses, highlighting the importance of increasing HIV-knowledge among pregnant women and their partners. This study compared sexual risk behavior, HIV knowledge and condom use pre- to post-partum among South African couples (n = 239 couples) randomly assigned to an intervention or an enhanced standard of care with the PMTCT protocol at rural community health antenatal clinics. Consistent condom use and HIV-related knowledge increased baseline to post-intervention and was maintained at long term follow up post-partum among participants in the intervention condition. HIV knowledge mediated the relationship between the intervention and consistent condom use. Results from this pilot study provide support for the integration of HIV risk reduction interventions for both women and men into existing PMTCT services during and following pregnancy.     

Alcohol as a Correlate of Unprotected Sexual Behavior Among People Living with HIV/AIDS: Review and Meta-Analysis

The present investigation attempted to quantify the relationship between alcohol consumption and unprotected sexual behavior among people living with HIV/AIDS (PLWHA). A comprehensive search of the literature was performed to identify key studies on alcohol and sexual risk behavior among PLWHA, and three separate meta-analyses were conducted to examine associations between unprotected sex and (1) any alcohol consumption, (2) problematic drinking, and (3) alcohol use in sexual contexts. Based on 27 relevant studies, meta-analyses demonstrated that any alcohol consumption (OR = 1.63, CI = 1.39–1.91), problematic drinking (OR = 1.69, CI = 1.45–1.97), and alcohol use in sexual contexts (OR = 1.98, CI = 1.63–2.39) were all found to be significantly associated with unprotected sex among PLWHA. Taken together, these results suggest that there is a significant link between PLWHA’s use of alcohol and their engagement in high-risk sexual behavior. These findings have implications for the development of interventions to reduce HIV transmission risk behavior in this population.     

Personality as a Predictor of Unprotected Sexual Behavior Among People Living with HIV/AIDS: A Systematic Review

The present investigation involved a systematic literature review to (1) identify associations between personality constructs and unprotected sex among people living with HIV/AIDS (PLWH); (2) assess patterns of direct versus indirect personality-risky sex associations; and (3) explore possible differences in personality-risky sex associations among PLWH versus non-infected populations. Among the 26 studies yielded through the systematic search, sensation seeking and sexual compulsivity were the constructs most frequently examined, with fewer studies investigating traditional personality typologies. Personality constructs that were more conceptually proximal to the sexual act, such as sexual compulsivity and sex-related sub-components of sensation seeking, showed relatively direct associations with unprotected sex, whereas more conceptually distal constructs such as generalized impulsivity demonstrated only weak or indirect associations. Associations were also frequently mediated by other risk factors, including perceived responsibility and substance use. These findings have implications for the development of interventions to reduce high risk sexual behavior among PLWH.     

Incidence and Persistence of Depression Among Women Living with and Without HIV in South Africa: A Longitudinal Study

Depression and trauma are common among women living with HIV. This is the first study to track the longitudinal course of depression and examine the relationship between depression and trauma over time among women in South Africa. HIV-infected and uninfected women (N = 148) were assessed at baseline and one year later. Results of a path analysis show the multi-directional and entwined influence of early life stress, other life-threatening traumas across the lifespan, depression and PTSD over the course of HIV. We also observed higher rates of depressive symptomatology and more persistent cases among infected women compared to uninfected women, as well as a more consistent and enduring relationship between childhood trauma and depression among women living with HIV. The present study is unique in documenting the course of untreated depression and PTSD in women with and without HIV infection with a high prevalence of early childhood trauma.