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Try out PMC Labs and tell us what you think. Learn More. Data availability statement. Data from this study are available upon request from the authors. However, there is limited information on the associations between HIV status disclosure in types of sexual partnerships and ensuing sexual practices. Participants completed partner-by-partner sexual behavior interviews and provided permission to extract recurrent STI clinic visits over the subsequent months. There were no associations between HIV status disclosure and demographic characteristics, sexual practices, or recurrent STI clinic visits.
Undisclosed HIV to at least one HIV different-status sex partner was associated with greater alcohol use and less likelihood of receiving ART; participants who were least likely to disclosure their HIV status to partners drank more alcohol and were less likely to be taking antiretroviral therapy. High prevalence of partner non-disclosure and lack of ificant correlates to HIV status disclosure indicate a need for further research with an eye toward identifying disclosure processes and mechanisms that may ultimately lead to effective interventions.
Disclosing HIV status to sex partners potentially reduces HIV transmission risks by negotiating safer sex and sharing in sexual decision-making. Relative to casual sex partners, there is a 6-fold greater likelihood of disclosing HIV status to stable e. In the Eastern Cape of South Africa, for example, women are ificantly more likely to disclose their HIV status to family members than sex partners 78with non-disclosure most common among younger women with poorer retention to HIV care and lower antiretroviral therapy ART adherence 9.
One reason for greater disclosure to family members than sex partners is that individuals derive greater support from family who know their HIV status than from sex partners Furthermore, disclosure to sex partners can entail considerable costs including threats of abandonment, loss of economic support, and potential violence 3. A majority of people living with HIV in South Africa experience high-levels of internalized, anticipated, and enacted stigma and all of these forms of stigma are robust impediments to HIV treatment and HIV disclosure 13 — Overall, non-disclosure of HIV to avoid stigma is a stronger predictor of ART non-adherence than depression and poor social support Hiding medications, removing medication bottle labels and other actions intended to conceal HIV status are associated with poor ART adherence However, we are not aware of research examining HIV status disclosure to sex partners among people living with HIV and being treated for sexually transmitted co-infections in southern Africa, the region of the world with the vast majority of HIV infections.
The purpose of this study is to fill this gap by examining factors associated with HIV status disclosure to sex partners among people living with HIV. We examined participant characteristics e. We hypothesized that people living with HIV who were receiving treatment for an STI would be ificantly more likely to have disclosed their HIV status to main sex partners than to their casual and one-time partners.
We also hypothesized that participants who had disclosed their HIV status to different-status sex partners would engage in lower-rates of condomless intercourse, higher-rates of condom use, and would be more likely to be treated with ART than their counterparts who had not disclosed their HIV status to HIV different-status partners.
We conducted a cross-sectional study with people who self-identified as having tested HIV positive from a larger sample of patients receiving treatment for an STI at a clinic located in an economically impoverished Cape Town community. Participants were enrolled in a behavioral intervention trial to prevent contracting a new STI. This study utilizes data collected at the baseline assessments conducted between June, and August,prior to the intervention exposure.
We invited all individuals 18 years of age and older who were diagnosed with an STI at the clinic to participate. Recruitment occurred in the clinic waiting area on the day of their STI diagnosis. Participants were given the option to participate the day of recruitment, or at most 2 days afterwards. After providing informed consent, participants completed a face-to-face interview that included collecting participant demographic and health characteristics, and sex behaviors elicited partner-by-partner.
Interviews were conducted by two female bachelors-level research assistants with extensive training and weekly supervision provided by the project manager. We used female interviewers because of the generally higher response rates found with female interviewers in sex research Participants had the option to complete interviews in English or isiXhosa. In addition, participants provided consent for the researchers to access their electronic clinical records over the subsequent months in order to code clinic visits and extract new STI visits.
Participants reported their demographic characteristics including age, sex, education, marital status, and whether they had children.
Participants also reported their substance use, HIV testing and treatment history, and history of STI symptoms and diagnoses. To assess alcohol use, participants reported how often and how much they typically drink frequency and quantity using the Alcohol Use Disorders Identification Test consumption scale [AUDIT-C 2526 ]. Participants also reported their use of Older women for casual sex 19930, amphetamines and other drugs e. Responses to these questions were used to identify HIV positive participants for inclusion in this study.
STI symptoms included genital ulcerations, discharge, and pain as well as experiencing genital bleeding during sexual intercourse coital bleeding. In addition, using electronic medical records we identified whether participants returned to the clinic for treatment of a new STI over the subsequent months.
Participants were asked to identify, by first name or nickname, up to five sex partners during the prior 3-months. Names were recorded on a response form by the interviewer along with responses to detailed questions regarding partner characteristics, relationship history, and sexual behaviors. Responses to these partner questions were used to classify partners into. Participants also reported the of times they had vaginal and anal intercourse as well as the of times participants had used alcohol in the context of a sexual encounter with each partner over the 3-months.
This measure was modeled after a validated point rating scale that has become standard in estimating HIV treatment adherence For each partner in the partner-by-partner interview, participants were asked whether they knew if the partner had been tested for HIV, and if they had been tested what their HIV test were. Not knowing whether a partner had been tested was coded as HIV different-status as was knowing that a partner had tested HIV negative.
Likewise, for each partner we asked if participants had disclosed their HIV status to that partner. Using the intersection of partner status and disclosure status, participants were classified into partner-disclosure groups.
Specifically, we formed three groups of participants: a those who only reported having sex partners known to also be HIV positive same-status partners ; b participants who reported at least one HIV different-status partner to whom they had disclosed their HIV status; and c participants who reported at least one HIV different-status partner to whom they had not disclosed their HIV status.
The sero-partnership groups were conceptualized hierarchically, such that the HIV same-status partner group did not have any HIV different-status partners and were therefore not at risk for transmitting HIV to an uninfected partner. For the participants with HIV different-status partners, we formed the other two groups: those who had disclosed their HIV status to all HIV different-status partners, and those who had at least one HIV different-status partner to whom they had not disclosed their HIV status. This classification scheme resulted in 46 participants who only reported HIV same-status partners, 54 participants who reported different-status partners that had been disclosed to, and participants who had at least one HIV different-status partner to whom they had not disclosed their HIV status.
Data analyses were performed at the participant level. We compared the three sero-partnership groups on demographic and health characteristics using contingency table chi-square X 2 tests for categorical variables and one-way analyses of variance ANOVA for continuous variables.
Comparisons between groups for s of sex partners and counts of sexual behaviors were conducted using generalized linear modeling GLM. Specifically, we used Poisson regression to model predictors of counts with robust estimators. We included participant gender and gender X sero-partnership group interactions as controls in all models. In total, these participants reported sex partners in the past 3-months with whom HIV testing was never discussed and to whom their own HIV status was not disclosed.
Table 1 shows the demographic and health characteristics of the three HIV sero-partnership groups. Uni-variable analyses indicated ificant differences between groups. With respect to demographic characteristics, participants who had not disclosed to different-status partners were less likely to be married and less likely to have children than the other two groups, which did not differ from each other.
In terms of substance use, individuals with non-disclosed to different-status partners were ificantly more likely to report alcohol use, including greater quantity and frequency of drinking. More than half of participants were experiencing genital discharge and genital pain associated with their current STI, with more than one in four reporting genital ulcers see Table 1. In addition, more than one in three participants with non-disclosed different-status partners reported coital bleeding in the past 3-months.
Examination of electronic medical records over the subsequent year showed that 26 There were no ificant differences between groups for any of the STI symptoms and no difference for new STI visits.Why Is It Easier For Older Women To Have Casual Sex
Among the participants in the study, there was a total of partners reported in the 3-months; main partners, casual partners, and 75 one-time partners. Furthermore, a total of partners were of a different HIV status e. Participants reported an average of The average frequency of anal intercourse was. Analyses showed no differences between partnership status groups for rates and frequencies of engaging in any sexual behaviors see Table 2. The current Older women for casual sex 19930 contributes to the growing literature on the role of HIV status disclosure to sex partners in the prevention of forward HIV transmission.
In contrast to past studies, however, we did not find ificant differences between men and women in their HIV status disclosure 29 also failed to confirm our hypotheses regarding the association between different disclosure rates across different partner types. We also did not find ificant differences in condomless or condom protected sex across HIV status disclosure groups. However, we did confirm our hypothesis that participants who had not disclosed their HIV status to HIV different status partners were ificantly less likely to be taking ART.
This difference occurred within a context of only half of participants being treated with ART, despite the STI clinic in which this study was conducted also serving as an ART dispensary. We anticipated HIV treatment would be lower in participants who had not disclosed their HIV status to partners given that stigma concerns likely underlie both non-disclosure and not being engaged in HIV care.
We also found that participants who had not disclosed their HIV status to HIV different-status partners reported greater alcohol use. The difference occurred with respect to overall alcohol use, whereas the difference in alcohol use in sexual contexts was not ificant. Thus, our study does not support a stress-alcohol association specific to sexual situations, as would be predicted by a cognitive-escape hypothesis of substance use and sexual risks High-rates of alcohol use have been reported among people living with HIV in South Africa, and drinking is commonly associated with contracting STI 33 and not engaging HIV treatment 34characteristics of our sample.
Thus, additional research is needed to understand how alcohol use in general, rather than sexual situation-specific drinking, may be associated with HIV status disclosure. There are limitations that should be considered when interpreting the current study findings. Our sample was one of convenience recruited at a single STI clinic and cannot therefore be taken as representative of people living with HIV and receiving STI treatment.
The relatively small of men in our sample is also a limitation and may have contributed to the lack of observed gender differences. We also relied on self-report measures of sexual behavior, HIV disclosure and other social and behavioral characteristics. Sexual behaviors assessed in interviews may be under reported, even when using state-of-the-science measures and procedures 35 Our study was also limited by not including possible explanatory mechanisms for disclosure and non-disclosure. Our findings highlight the importance of first determining reliable relationships between HIV status disclosure and sexual behaviors in same-status and different-status relationships prior to identifying potential mechanisms of disclosure.
With these limitations in mind, we believe that the current study has implications for addressing HIV status disclosure in interventions for people living with HIV who are diagnosed with co-occurring STI. Communication skills building and HIV disclosure decision-making interventions have been found effective in facilitating safer HIV status disclosure among people living with HIV and can be adapted for use in sub-Saharan Africa 37 Evidence to date suggests that interventions for increasing HIV status disclosure to sex partners in sub-Saharan Africa have had mixed.
A review of 14 studies that had tested interventions to increase HIV status disclosure, all in southern Africa, found that few trials demonstrated effects, with the most rigorously deed trials reporting the least positive outcomes One reason for these disappointing intervention outcomes may be a lack of understanding for the dynamics at play in HIV status disclosure in sub-Saharan Africa.
Findings such as those reported in the current study suggest a need for additional research to identify the processes and mechanisms underlying disclosure of HIV status in this context. We did not assess reasons for disclosure and nondisclosure, and such data are critical for moving interventions forward. Finally, the low-level of ART coverage observed in the current sample points out a ificant need for removing barriers to treatment, perhaps most importantly stigma-related barriers.
Disclosure statement. The authors declare no conflicts of interest. National Center for Biotechnology InformationU. J Acquir Immune Defic Syndr. Author manuscript; available in PMC Mar 1. Author information Copyright and information Disclaimer. Copyright notice.
Conclusions: High prevalence of partner non-disclosure and lack of ificant correlates to HIV status disclosure indicate a need for further research with an eye toward identifying disclosure processes and mechanisms that may ultimately lead to effective interventions.
Introduction Disclosing HIV status to sex partners potentially reduces HIV transmission risks by negotiating safer sex and sharing in sexual decision-making. Methods Procedures We conducted a cross-sectional study with people who self-identified as having tested HIV positive from a larger sample of patients receiving treatment for an STI at a clinic located in an economically impoverished Cape Town community.
Measures Participant characteristics. Sexual relationships and sexual behaviors. Classifying HIV status and disclosure status in sexual partnerships For each partner in the partner-by-partner interview, participants were asked whether they knew if the partner had been tested for HIV, and if they had been tested what their HIV test were.
Statistical analyses Data analyses were performed at the participant level. Demographic characteristics and substance use. Open in a separate window. Sexual health. Sex partners. Sexual behaviors. Discussion The current study contributes to the growing literature on the role of HIV status disclosure to sex partners in the prevention of forward HIV transmission.
Footnotes Disclosure statement. References 1.Why Is It Easier For Older Women To Have Casual Sex
Partner HIV serostatus disclosure and determinants of serodiscordance among prevention of mother to child transmission clients in Nigeria. BMC Public Health. Reducing HIV transmission risk by increasing serostatus disclosure: a mathematical modeling analysis. AIDS Behav.Older women for casual sex 19930
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