Sexual assault history and risks for sexually transmitted infections among women in an African township in Cape Town, South Africa

Sexual violence is associated with women's risks for HIV infection. The current study investigated factors related to risks for sexually transmitted infections (STIs), including HIV, among South African women with a history of sexual assault. An anonymous street intercept survey of women (N = 272) living in an African township in the Western Cape, South Africa assessed demographic characteristics, history of sexual assault, HIV risk behaviours, substance use and non-sexual relationship abuse. Surveys were completed by 90% of women approached. Forty-four per cent (N = 119) of women reported a history of sexual assault. Multiple logistic regressions, controlling for participant age, education, marital status and survey venue, showed that women who had been sexually assaulted were significantly more likely to have shared injection drug equipment, exchanged sex to meet survival needs, and used alcohol compared to women who had not been sexually assaulted. Women with a history of sexual assault were also significantly more likely to have multiple male sex partners, greater rates of unprotected vaginal intercourse, lower rates of condom protected anal intercourse, more sexual contacts involving blood, more STIs and genital ulcers. Finally, women who had been sexually assaulted were more likely to have been non-sexually abused by relationship partners and were more likely to fear asking partners to use condoms. There is a close connection between sexual assault and women's risks for STIs and HIV. Structural and behavioural interventions are needed to simultaneously reduce the prevalence of sexual assault against women and prevent the transmission of HIV.     

Prevalence and determinants of male partner violence against Mexican women: a population-based study

OBJECTIVE: To determine the prevalence of and risk factors for violence against women, inflicted by their male partners, in a representative sample of women residing in the metropolitan area of Cuernavaca Morelos, Mexico. MATERIAL AND METHODS: A population-based study was conducted from June to September 1998, among 1,535 women aged 15 to 49 years. Principal components analysis was used to determine the domains of violence that served as the dependent variable. Polynomial logistic regression models were used to estimate odds ratios (OR), with 95% confidence intervals (CI). RESULTS: Prevalence of low-moderate level violence was 35.8%, while prevalence of severe violence was 9.5%. The lifetime prevalence of reported rape was 5.9%. The main factors associated with violence were socio-economic status (OR=0.57; 95% CI=0.34-0.95); education level, both of the women studied (test for trend p=0.01) and of the male partner (test for trend p=0.002); number of years living with partner (OR=2.63; 95% CI=1.55-4.45), alcohol use (OR=2.56; 95% CI=2.02-3.25), illegal drug use by partner (OR=6.17; 95% CI=2.37-16.03); violence during childhood (OR=3.40; 95% CI=2.23-5.18), and a history of rape (OR=5.89; 95% CI=2.78-12.5). CONCLUSIONS: Study findings confirm that violence against women is a prevalent phenomenon in Mexico. Awareness-raising campaigns about male partner violence should bring this important issue to the front of public discussion. Such efforts will help assure that future generations do not experience partner violence to the extent that contemporary Mexican women do.     

Substance use before and during pregnancy: links to intimate partner violence

Although some research has found links between women's experiences of intimate partner violence and their use of substances, little research has examined how this potential relationship changes when women become pregnant. Furthermore, most of the past research examining women's experiences of intimate partner violence and their use of substances has focused on only one type of violence, typically, physical assault. Thus less is known concerning how other important forms of violence, such as psychological aggression and sexual coercion, may be related to women's substance use and substance abuse disorders. This research studies 85 prenatal care patients to describe the women's use of alcohol and illicit drugs, both before and during pregnancy, in relation to their experiences of various types of intimate partner violence before and during pregnancy (including psychological aggression, physical abuse, and sexual coercion). The Conflict Tactics Scales 2 was used to assess the women's experiences of intimate partner violence. The women were asked about their frequency of alcohol use, and alcohol using women were administered a short version of the Michigan Alcohol Screening Test to assess the women for symptoms of alcohol disorder. The women's use of illicit drugs was assessed by asking the women about their frequencies of various types of drug use and drug using women were administered the Drug Abuse Screening Test to assess the women for symptoms of drug disorder. The results showed that before pregnancy, women who were physically assaulted by their partners were somewhat more likely to drink alcohol and use illicit drugs compared with women who did not experience such violence, even though these differences did not reach the traditional level of statistical significance; however, among the substance using women, those who experienced each type of violence were more likely to be frequent users of substances compared with the non-victims, and they evidenced a greater number of substance disorder symptoms compared with the non-victims. After the women became pregnant, the links between women's experiences of intimate partner violence and their use of substances became stronger, with the women who experienced each type of partner violence being more likely to use both alcohol and illicit drugs. Furthermore, among the substance-using women, those who were psychologically and physically abused had somewhat elevated levels of substance disorder symptoms during pregnancy compared with women who did not suffer such victimization. These findings underscore the importance of providing routine screening for various types of violent victimization and substance use within the context of many types of women's health care settings, including substance abuse treatment programs, domestic violence programs, and prenatal care services.     

Substance Use Before and During Pregnancy: Links to Intimate Partner Violence

Although some research has found links between women's experiences of intimate partner violence and their use of substances, little research has examined how this potential relationship changes when women become pregnant. Furthermore, most of the past research examining women's experiences of intimate partner violence and their use of substances has focused on only one type of violence, typically, physical assault. Thus less is known concerning how other important forms of violence, such as psychological aggression and sexual coercion, may be related to women's substance use and substance abuse disorders. This research studies 85 prenatal care patients to describe the women's use of alcohol and illicit drugs, both before and during pregnancy, in relation to their experiences of various types of intimate partner violence before and during pregnancy (including psychological aggression, physical abuse, and sexual coercion). The Conflict Tactics Scales 2 was used to assess the women's experiences of intimate partner violence. The women were asked about their frequency of alcohol use, and alcohol using women were administered a short version of the Michigan Alcohol Screening Test to assess the women for symptoms of alcohol disorder. The women's use of illicit drugs was assessed by asking the women about their frequencies of various types of drug use and drug using women were administered the Drug Abuse Screening Test to assess the women for symptoms of drug disorder. The results showed that before pregnancy, women who were physically assaulted by their partners were somewhat more likely to drink alcohol and use illicit drugs compared with women who did not experience such violence, even though these differences did not reach the traditional level of statistical significance; however, among the substance‐using women, those who experienced each type of violence were more likely to be frequent users of substances compared with the non‐victims, and they evidenced a greater number of substance disorder symptoms compared with the non‐victims. After the women became pregnant, the links between women's experiences of intimate partner violence and their use of substances became stronger, with the women who experienced each type of partner violence being more likely to use both alcohol and illicit drugs. Furthermore, among the substance using women, those who were psychologically and physically abused had somewhat elevated levels of substance disorder symptoms during pregnancy compared with women who did not suffer such victimization. These findings underscore the importance of providing routine screening for various types of violent victimization and substance use within the context of many types of women's health care settings, including substance abuse treatment programs, domestic violence programs, and prenatal care services.     

THE IMPACT OF PERPETRATORS' ALCOHOL AND DRUG USE DURING AND AFTER SEXUAL ASSAULT

Purpose:  This study examines the impact of perpetrators' drug and alcohol use during and after sexual assault.
Methods: The study relies on data provided by a representative sample of women in Texas who responded to a random digit dial survey and reported that they were sexually assaulted at some time in their lives. Questions about sexual assault victimization were drawn largely from the National Violence Against Women Survey. A series of binary logistic regressions was conducted to determine the impact of perpetrator's alcohol and drug use on violence during and after the assault.
Results:  Perpetrators' alcohol or drug use at the time of the sexual assault resulted in a greater likelihood of concurrent violence, including, hitting, slapping, kicking, use of a weapon, threats to harm or kill, and physical injury during the assault, and victims who experienced an alcohol– or drug-related sexual assault lost more time from work, school, home duties, and recreation. These impacts occurred regardless of the relationship of the perpetrator to the victim, location of the sexual assault, or ethnicity of the victim.
Conclusions:  This information can assist educators, advocates, and policy makers in directing efforts to limit alcohol and drug use and preventing situations where sexual violence is likely to emerge.     

Intimate Violence and Post-Traumatic Stress Disorder Among Individuals with Cocaine Dependence

Intimate physical assault and post-traumatic stress disorder (PTSD) were assessed in a sample of 91 adults seeking treatment for cocaine dependence. Physical assault included self-report of aggravated assault with a weapon, aggravated assault without a weapon, and simple assault. PTSD was assessed with a structured interview. Overall, 85.7% of the participants reported having been physically assaulted at least once during their lifetime. Slightly less than half of these individuals (46.2%) reported physical assault by an intimate partner. Close to half also met criteria for PTSD at some point in their lives. Women were more likely than men to be physically assaulted by an intimate partner and to report PTSD. Men who experienced physical assault by an intimate were more likely to report PTSD than men assaulted by others. Male victims of intimate violence had higher scores on certain subscales measuring addiction severity than male victims assaulted by others. Findings suggest careful assessment of intimate violence is essential given its high prevalence among cocaine-dependent women and men and its association with PTSD.     

Intimate violence and post-traumatic stress disorder among individuals with cocaine dependence.

Intimate physical assault and post-traumatic stress disorder (PTSD) were assessed in a sample of 91 adults seeking treatment for cocaine dependence. Physical assault included self-report of aggravated assault with a weapon, aggravated assault without a weapon, and simple assault. PTSD was assessed with a structured interview. Overall, 85.7% of the participants reported having been physically assaulted at least once during their lifetime. Slightly less than half of these individuals (46.2%) reported physical assault by an intimate partner. Close to half also met criteria for PTSD at some point in their lives. Women were more likely than men to be physically assaulted by an intimate partner and to report PTSD. Men who experienced physical assault by an intimate were more likely to report PTSD than men assaulted by others. Male victims of intimate violence had higher scores on certain subscales measuring addiction severity than male victims assaulted by others. Findings suggest careful assessment of intimate violence is essential given its high prevalence among cocaine-dependent women and men and its association with PTSD.     

Domestic violence and prevention of mother-to-child transmission of HIV-1

OBJECTIVES: To determine the prevalence of life-time domestic violence by the current partner before HIV-1 testing, its impact on the uptake of prevention of mother-to-child transmission (PMTCT) interventions and frequency after testing. DESIGN: A prospective cohort. METHODS: Antenatally, women and their partners were interviewed regarding physical, financial, and psychological abuse by the male partner before HIV-1 testing and 2 weeks after receiving results. RESULTS: Before testing, 804 of 2836 women (28%) reported previous domestic violence, which tended to be associated with increased odds of HIV-1 infection [univariate odds ratio (OR) 1.7, 95% confidence interval (CI) 1.3-2.2; P < 0.0001, adjusted OR 1.2, 95% CI 0.9-1.6; P = 0.1], decreased odds of coming with partners for counseling (adjusted OR 0.7, 95% CI 0.5-1.0; P = 0.04), and decreased odds of partner notification (adjusted OR 0.7, 95% CI 0.5-1.1; P = 0.09). Previous domestic violence was not associated with a reduced uptake of HIV-1 counseling, HIV-1 testing, or nevirapine. After receiving results, 15 out of 1638 women (0.9%) reported domestic violence. After notifying partners of results, the odds of HIV-1-seropositive women reporting domestic violence were 4.8 times those of HIV-1-seronegative women (95% CI 1.4-16; P = 0.01). Compared with women, men reported similar or more male-perpetrated domestic violence, suggesting a cultural acceptability of violence. CONCLUSION: Domestic violence before testing may limit partner involvement in PMTCT. Although infrequent, immediate post-test domestic violence is more common among HIV-1-infected than uninfected women. Domestic violence prevention programmes need to be integrated into PMTCT, particularly for HIV-1-seropositive women.     

Alcohol Use, Intimate Partner Violence, Sexual Coercion and HIV among Women Aged 15–24 in Rakai, Uganda

Disinhibition due to alcohol may induce intimate partner violence and sexual coercion and increased risk of HIV infection. In a sample of 3,422 women aged 15–24 from the Rakai cohort, Uganda, we examined the association between self-reported alcohol use before sex, physical violence/sexual coercion in the past and prevalent HIV, using adjusted odds ratios (Adj OR) and 95% confidence intervals (95% CI). During the previous year, physical violence (26.9%) and sexual coercion (13.4%) were common, and alcohol use before sex was associated with a higher risk of physical violence/sexual coercion. HIV prevalence was significantly higher with alcohol consumption before sex (Adj OR = 1.45, 95% CI: 1.06–1.98) and especially when women reported both prior sexual coercion and alcohol use before sex (Adj OR = 1.79, 95% CI: 1.25–2.56). Alcohol use before sex was associated with physical violence and sexual coercion, and both are jointly associated with HIV infection risk in young women.     

Domestic violence in a genitourinary medicine setting--an anonymous prevalence study in women

Domestic violence (DV) affects around one in four women in the UK. This study aimed to determine the prevalence of DV and the associations with sociodemographic and sexual behaviour variables in female attendees of an inner-city genitourinary (GU) medicine clinic. In this cross-sectional survey, 177 of 380 women (46.6%) disclosed a history of abuse and 17.4% reported DV in the preceding 12 months. Women with a history of a sexually transmitted infection (STI) were more likely to have experienced DV at some point in their lives (odds ratio [OR]=2.39; 95% confidence interval [CI]: 1.58-3.63). Logistic regression analysis revealed that being black compared with white, (OR=1.7; 95% CI: 2.4-12.5) current cohabitation with a partner (OR=2.24; 95% CI: 1.06-4.75), increasing number of sexual partners in the last year (OR=1.24; 95% CI: 1.01-1.5) and consumption of illicit drugs (OR=2.05; 95% CI: 1.02-4.11) were significantly associated with DV in the last 12 months but age, current occupation, history of STIs, age of coitarche and condom use were not. DV was common in this GU medicine clinic population and associated with STIs. We recommend that health practitioners undergo training to increase awareness of the links between partner violence and sexual health problems.     

The Role of Sexual Assault and Sexual Dysfunction in Alcohol/Other Drug Use Disorders

Many women with sexual assault histories receive care in alcohol/other drug (AOD) treatment programs. Affected women frequently suffer from sexual dysfunction, leading investigators to suggest self-medication may be one path to AOD use disorders and relapse. This preliminary study examined sexual dysfunction and sexual assault in 71 women receiving treatment for addiction. Women with prior sexual assault scored higher than nonassaulted women on sexual dysfunction overall, a discrepancy accounted for by higher scores among assaulted women on sexual inhibition subscales. Sexual inhibition and sexual assault each predicted the use of alcohol or other drugs to increase sexual desire. These preliminary findings suggest sexually abused women may follow a different course into AOD-related problems than nonabused women, possibly including self-medication to relieve sexual inhibition.     

Abused women report greater male partner risk and gender-based risk for HIV: findings from a community-based study with Hispanic women

The purpose of this study was to assess the relationship between intimate partner violence (IPV) and sexual risk in terms of safer sex behaviour and intent, individual and gender-based HIV risk factors, and male partner HIV risk, among a lower-income community-based sample of Hispanic women reporting a current male sexual partner. Baseline survey data on HIV-related behaviours and risk factors gathered from participants (N=170) of an HIV intervention evaluation study for Hispanic women were used for current analyses. Participants were age 18-36 years, predominantly born outside of the continental US (88.8%) and not English fluent (68.2%). Adjusted logistic regression analyses and 95% confidence intervals were conducted to assess the relationships between male-perpetrated IPV in the past three months and sexual risk variables. One-fifth (21.2%) of the sample reported male-perpetrated IPV in the past three months. Abused women were significantly more likely than those not abused in the past three months to report high STD/HIV risk perceptions (OR=3.02, 95% CI=1.33-6.88), gender-based risk including sexual control by male partners (OR=3.09, 95% CI=1.41-6.76) and male partner risk including male infidelity (OR=4.58, 95% CI=1.57-13.32). Results support the need for emphasis on IPV prevention within HIV prevention programmes and demonstrate the need for HIV prevention efforts directed at men with a history of IPV perpetration.     

Lifetime sexual assault prevalence rates and reporting practices in an emergency department population

STUDY OBJECTIVE: Studies suggest significant rates of female sexual assault (SA); the majority of SAs remain unreported, and few victims receive medical care. The purpose of this study was to determine lifetime prevalence rates of SA in an emergency department population and to assess reporting patterns to police, physicians, and social service agencies. METHODS: A verbally administered survey was given to all female patients during 4-hour randomized periods in an urban Level I trauma center. All English-speaking, noncritically ill women who presented during the study period were eligible. RESULTS: Four hundred forty-two women were eligible; 360 (81%) women agreed to participate. The lifetime prevalence rate of SA was 39% (n=139). Ninety-seven women (70%) were older than 15 years at the time of SA. Of these 97 SAs occurring in adulthood, 49 (52%) reported assault by an acquaintance, family member, or friend; 28 (30%) by a stranger; and 17 (18%) by a partner. Forty-five (46%) women reported the crime to the police, 42 (43%) sought medical care, and 23 (25%) contacted a social service agency. Reporting patterns for victims assaulted by a stranger versus those assaulted by a partner were: reported to police 79% (95% confidence interval [CI] 62 to 95) versus 18% (95% CI 0 to 38); P <.001), received medical care 70% (95% CI 46 to 95) versus 29% (95% CI 11 to 48; P<.01), contacted a social service agency 30% (95% CI 5 to 47) versus 24% (95% CI 1 to 46; P=.63). CONCLUSION: Lifetime female SA rates in ED populations are significant. Fewer than half of SA victims report the assault to the police or seek medical care. Women assaulted by a partner are significantly less likely to report the SA to police or seek medical care.     

Reported Physical and Sexual Abuse in Childhood and Adult HIV Risk Behaviour in Three African Countries: Findings from Project Accept (HPTN-043)

Childhood sexual and physical abuse have been linked to adolescent and adult risky sexual behaviors, including early sexual debut, an increased number of sexual partners, unprotected sex, alcohol and drug use during sex and sexual violence. This paper explores these relationships among both men and women who report histories of childhood abuse from representative samples of communities in three countries in southern and eastern Africa (South Africa, Zimbabwe and Tanzania). Data were collected as part of a 3-year randomized community trial to rapidly increase knowledge of HIV status and to promote community responses through mobilisation, mobile testing, provision of same-day HIV test results and post-test support for HIV. The results indicate that reported childhood sexual and physical abuse is high in all three settings, also among men, and shows strong relationships with a range of sexual risk behaviors, including age at first sex (OR ?0.6 (CI: ?0.9, ?0.4, p < 0.003)—among men, OR ?0.7 (CI: ?0.9, ?0.5, p < 0.001)—among women), alcohol (OR 1.43 (CI: 1.22, 1.68, p < 0.001)—men, OR 1.83 (CI: 1.50, 2.24, p < 0.001)—women) and drug use (OR 1.65 (CI: 1.38, 1.97, p < 0.001)—men, OR 3.14 (CI: 1.95, 5.05, p < 0.001)—women) and two forms of partner violence—recent forced sex (OR 2.22 (CI: 1.66, 2.95, p < 0.001)—men, OR 2.76 (CI: 2.09, 3.64, p < 0.001)—women) and ever being hurt by a partner (OR 3.88 (CI: 2.84, 5.29, p < 0.001)—men, OR 3.06 (CI: 2.48, 3.76, p < 0.001)—women). Individuals abused in childhood comprise between 6 and 29 % of young adult men and women living in these African settings and constitute a population at high risk of HIV infection.     

Safe sexual behaviour among female partners of HIV-infected men in Rio de Janeiro, Brazil

A cross-sectional study was designed to assess safe sexual behaviour among heterosexual couples after the woman learned of her partner's infection with HIV. Female partners who had known their partners' serostatus for at least 4 weeks were eligible for participation. Couples were interviewed separately and independent predictors of safe sexual behaviour were identified using multiple logistic regression. Safe sexual behaviour was defined as no unprotected vaginal, oral, or anal intercourse. Of 328 women, 197 (60%) reported safe sexual behaviour since learning of their partners' infection. Significant independent predictors of safe sexual behaviour included older women (>30 years old) (odds ratio [OR]=1.89; 95% confidence intervals [CI]=1.01-3.51), current negative HIV serostatus (OR=2.72; 95% CI=1.50-4.94), advanced clinical stage of the index case (OR=1.96; 95% CI=1.07-3.59), longer duration of relationship (10+ years) (OR= 2.35; 95% CI=1.15-4.82), fewer sex contacts (<100) (OR=2.01; 95% CI=1.14-3.56), only one lifetime partner (OR=2.29; 95% CI=1.26-4.17), non-smoking (OR=2.67; 95% CI=1.43-4.99), not practising oral sex (OR=3.35; 95% CI=1.82-6.19) and previous HIV testing (OR=2.11; 95% CI=1.09-4.07). In addition, women who had known their partner's infection for longer were less likely to report safe sexual behaviour (P < 0.001). Our results indicate that among female partners of HIV-positive Brazilian men, learning of their partner's infection does not uniformly result in safe sexual behaviour. Counselling must emphasize disclosure of serostatus to female partners and target couples with short-term relationships, as well as those where the woman has known about her male partner's infection for a long time, because these are the least likely to maintain safe sexual behaviour.     

Health consequences of intimate partner violence

Intimate partner violence, which describes physical or sexual assault, or both, of a spouse or sexual intimate, is a common health-care issue. In this article, I have reviewed research on the mental and physical health sequelae of such violence. Increased health problems such as injury, chronic pain, gastrointestinal, and gynaecological signs including sexually-transmitted diseases, depression, and post-traumatic stress disorder are well documented by controlled research in abused women in various settings. Intimate partner violence has been noted in 3-13% of pregnancies in many studies from around the world, and is associated with detrimental outcomes to mothers and infants. I recommend increased assessment and interventions for intimate partner violence in health-care settings.     

Fear and violence: raising the HIV stakes.

Through focus group methodology, the study examines three contexts that delineate the co-occurrence of intimate partner violence and sexual risk behaviors among 68 women on methadone. First, it explores the ways in which the presence of physical abuse in an intimate relationship prevents women from asking their partners to use a condom. Second, it describes the ways in which the couple's drug involvement increases the risk of physical and sexual violence, and concomitant sexual HIV risks. Third, it discusses the context in which sexual assault and rape occur in these established intimate relationships and how these abusive events increase women's risks of becoming infected with HIV. The research is guided by feminist theory, which affords powerful insight into the contexts in which women are put at risk for HIV and partner violence. The study provides a discussion on the implications of the findings to HIV prevention for women who are risk for both HIV and partner violence.     

Pregnancy loss in the Philippines

In this cross-sectional study, 8,481 women aged 15-49 who had at least one pregnancy outcome were considered. This study aimed to examine the characteristics of Filipino women having had a pregnancy loss, and to test the association between domestic violence and pregnancy loss. To control for the confounding effect of the number of pregnancies, the sample was divided into seven groups classified by the number of pregnancies. The risk factors considered were demographic characters (age and partner's age, marital status, and place of residence), socioeconomic status (education and partner's education, having a paid helper at home, having a say in how income was spent), domestic violence (physical abuse and forced sex), sexual behavior of partner, whether the pregnancy was wanted, and disease history (tuberculosis, diabetes, hypertension, malaria, hepatitis, kidney disease, heart disease, anemia, goiter and other medical problems). The major risk factors were found to be physical abuse, region, faithfulness of partners, hypertension, hepatitis, kidney disease, anemia, and the other medical problems, respectively. The risk of pregnancy loss for the women suffering domestic violence was 1.59 (95% CI 1.28-1.97) times higher than for the women who did not. Women aged 15-19 years had a much higher risk of pregnancy loss than the other age groups (OR = 1.49, 95% CI 1.22-1.82). There were similar risk for women aged 20-24 years (OR = 1.08, 95% CI 0.94-1.25) and 35-39 years (OR = 1.05, 95% CI 0.92-1.19). No association emerged with marital status, socioeconomic status, forced sex, the number of partners, unwanted pregnancy, tuberculosis, diabetes, malaria, heart disease, and goiter. Although women's age, partner's age, residence, women's education, partner's education, and paid helper at home were significantly associated with pregnancy loss, they were likely to be confounders rather than risk factors.     

The association between caffeinated alcoholic beverages and the perpetration of intimate partner violence

Background: Problematic alcohol use is a recognized risk factor for intimate partner violence (IPV) perpetration.Objective: The use of caffeinated alcoholic beverages (CAB) appears to be associated with high-risk drinking behavior but the relationship between CAB use and IPV has yet to be explored.Methods: Sixty male and 40 female married or dating participants responded to an online survey including measures of past-year alcohol use and partner violence.Results: Logistic regression analyses revealed that CAB users were significantly more likely to perpetrate physical assault and partner injury after controlling for age, sex, ethnicity, income, and heavy alcohol use. The relationship between CAB use and perpetration of sexual coercion was better accounted for by heavy alcohol use.Conclusion: Results from the current study suggest that there exists an independent link between CAB use and partner violence perpetration.     

Factors associated with non-disclosure of HIV infection status of new mothers in Bangkok

The objective of this study was to estimate HIV disclosure rates and identify factors that predict non-disclosure in Thai women who tested HIV positive during pregnancy or at delivery. This was a cohort study evaluating the implementation of prevention of mother-to-child HIV transmission programs at two Bangkok hospitals in 1999-2003. All HIV-infected women who delivered during the study period were enrollment eligible. Thai-language questionnaires were used to collect baseline data before discharge from the hospital. At the 1 and 4 month follow-up visits, women were asked if they had disclosed their HIV status. Of the 799 women who enrolled, 647 (81.0%) completed follow-up at 1 and 4 months. Four hundred fifty-three (70.0%) women disclosed their status by 1 month. Of the 194 women who had not disclosed by 1 month, 48 (24.7%) had disclosed their status by 4 months. An independent increased odds of non-disclosure by 1 month was associated with not having a partner tested for HIV (OR=5.83, 95% CI=3.19-9.08) or not knowing if the partner was ever tested for HIV (OR=1 3.02, 95% Cl=5.26-32.28), first learning of HIV positive status during delivery (OR=6.84, 95% CI=2.36-19.81) or after delivery (OR=3.14, 95% CI=1.57-6.26) and having >2 lifetime sexual partners (OR=1.71, 95% CI=1.04-2.82). Not living with a partner every day was associated with non-disclosure by 4 months in those women who had not disclosed by 1 month (OR=2.28, 95% CI=1.43-3.64). Despite high rates of disclosure by 1 month, 22.6% of women still had not disclosed their HIV status to their partners by 4 months. The benefits of disclosure warrant effective interventions targeted at women at risk for non-disclosure.