Disclosure Among People Living with HIV/AIDS
Author(s): Pranita Taraphdar, Aparajita Dasgupta, B Saha
Vol. 32, No. 4 (2007-10 - 2007-12)
ISSN No. 0970-0218
Pranita Taraphdar, Aparajita Dasgupta, B Saha1
The prevention and control of human immunodeficiency
virus (HIV) infections depends on the success of
strategies implemented to prevent new infections and
to treat currently infected individuals. Voluntary HIV
testing and counselling can serve both the goals, by
enabling healthy individuals to remain uninfected and
those infected to plan their future and to prevent HIV
transmission to others.1
Disclosure of the HIV status to ones sexual partner
is an important prevention goal emphasized by the
WHO and CDC in their protocols for HIV counselling
and testing.2 Disclosure offers a number of important
benefits to the infected individual and to the general
public. Disclosure of HIV test results to ones sexual
partner is associated with less anxiety and increased
social support. In addition, it may lead to improved
access to HIV prevention, treatment, opportunities for
risk reduction and planning for the future. Moreover, risk
behaviours change most dramatically among couples
where both partners are aware of their HIV serostatus.
It also enables couples to make informed reproductive
health choices, which may ultimately lower the number
of unintended pregnancies among HIV/AIDS positive
women.3
Among the risks of disclosure of HIV serostatus are
loss of social, economic and emotional support, blame,
abandonment, discrimination and disruption of family
relationships.4 This leads to loss of opportunities for the
prevention of new infections and the ability to access
appropriate care, treatment and support services.
Materials and Methods
This cross-sectional observational study of HIV/AIDS
patients admitted to the School of Tropical Medicine
(STM), Kolkatta, was carried out from May 2004 to
October 2004. The Voluntary Counselling and Testing
Centre started function from 2000 at STM, and from
2001, HIV/AIDS patients were admitted to this hospital
and received treatment. In STM, patients with AIDS
are admitted under four visiting physicians. All patients
admitted under one such consultant and expressed
willingness to participate were included in this study.
Results
Out of the 46 PLWHAs (people living with HIV/AIDS)
studied, 40 were males and 6 were females. All the female
patients had disclosed their serostatus to their sexual
partners, as compared to 26 (65%) in the 40 males. Thus,
the overall disclosure rate was 69.56%. A majority of
patients (28 out of 32, 87.5%) reported positive outcomes
following disclosure, that is kindness, understanding
and acceptance. More importantly, disclosure was
not associated with break-up of marriages. Negative
outcomes included blame, abandonment, violence, anger,
stigma and depression. Only one in six women (16.6%)
reported negative outcomes following disclosure of
serostatus as compared to three in 26 males (11.5%).
From Table 1, it appears that older people were more
likely to disclose than younger people. Only 33.3%
PLWHAs less than 30 years in age disclosed their
serostatus as compared to 75% PLWHAs greater than
30 years (P < 0.005).
There was no statistically significant difference in
disclosure rates among PLWHAs with respect to the
socioeconomic status. The place of residence and type
of family did not appear to be a significant factor affecting
disclosure. Literacy is an important factor affecting
disclosures; as expected, it was observed that 85.7%
of PLWHAs who were literate disclosed their serostatus
to their partners as compared to 44.4% of PLWHAs
who were illiterate (df = 1, χ2 = 8.73, P < 0.005). Similar
results have been found in studies conducted with
women with HIV/AIDS.5
PLWHAs who had been in a relationship for greater
than 5 years had disclosed their serostatus to their
partners as compared to those in a shorter duration of
relationship. None with a relationship less than 1 year
had disclosed their serostatus, mainly because they had
casual sex with commercial sex workers (CSWs) before
marriage. Among married men, 82.3% had disclosed
their serostatus to their sexual partners. Four PLWHAs
are currently separated following the disclosure of their serostatus to their spouses. As expected, none of the
unmarried men had disclosed their serostatus to their
would-be partners, since they had indulged in casual
sex with CSWs.
Table 1: Factors affecting disclosure of serostatus among PLWHAs
Factors affecting
disclosure
Disclosure of serostatus
Total
N = 46
Yes No.
(%) N = 32
No No.
(%) N = 14
Age*
20-30
2 (33.3)
4 (66.7)
6
31-40
20 (71.4)
8 (28.6)
28
40-50
4 (66.7)
2 (22.3)
6
>50
6 (100)
0
6
Per capita income
<500
10 (62.5)
6 (37.5)
16
500-1000
10 (71.4)
4 (28.6)
14
1000-1500
6 (100)
0 (0)
6
>1500
6 (60)
4 (40)
10
Place of residence
Rural
20 (71.4)
8 (28.5)
28
Urban
12 (66.67)
6 (33.33)
18
Type of family
Nuclear
14 (70)
6 (30)
20
Joint
18 (69.2)
8 (30.8)
26
Literacy*
Illiterate
8 (44.4)
10 (55.6)
18
Literate
24 (85.7)
4 (14.3)
28
Duration of relationship
>1 year
0
6 (100)
6
1-5 years
4 (33.3)
8 (66.7)
12
>5 years
28 (100)
0
28
Current marital status
Unmarried
0
6 (100)
6
Married
28 (82.3)
6 (17.7)
34
Separated/divorced
4 (66.7)
2 (33.3)
6
*
P < 0.005
The study of sexual practice of PLWHAs [Table 2]
showed that, out of 46 subjects, only 32 (69.56%) had
got their sexual partners tested for HIV infection, of
which 17 (53.12%) were HIV positive. The current sexual
practice of PLWHAs showed that 20 out of 46 (43.47%)
were using condoms and an equal number were not
(43.47%), whereas 12.8% practised abstinence. Of the
untested sexual partners, 64.2% were not using condoms
and, although seronegative, are at risk of acquiring HIV
infection. It was encouraging to note that all PLWHAs
were practising safe sex with their partners who were
tested negative.
Discussion
Thus, the overall outcome of serostatus disclosure was
positive. However, more than 30% of PLWHAs had not
disclosed their serostatus. The positive outcomes can be
attributed to the familistic orientation of the Indian society
and, in small measures, to the ignorance of caregivers
about the full implications of the epidemic. This is in
continuation with similar studies conducted in Mumbai,
India.4 Previous studies have shown that responses to
HIV/AIDS are both gendered and contextualized. Male
positives are granted greater acceptance, care and
support by their spouses. The outcome also depended
on the status of the person within the household.4 In our
study, negative outcome following disclosure was seen
in 16.6% women as compared to 11.5% men. Literacy
is an important factor affecting disclosure of serostatus, and disclosure rates were significantly higher in literate
population as compared to illiterate population. The type
of family, socioeconomic status and per capita income
did not appear to be important factors affecting the
disclosure of serostatus. However, the longer duration
of relationship appeared to be an important factor in the
disclosure of serostatus.
Table 2: Distribution of study subjects by serostatus of partner and sexual practice in the last 1 year (n = 46)
Sexual practice
Serostatus of partner No. (%)
Total No. (%)
Positive
Negative
Untested
Using condoms
3 (17.6)
12 (80)
5 (35.1)
20 (43.6)
Not using condoms
11 (64.8)
-
9 (64.2)
20 (43.6)
Abstinence
3 (17.6)
3 (20)
-
6 (12.8)
Total
17 (100)
15 (100)
14 (100)
46 (100)
References
- Allen S, Tice. J, Van de Perre P, Serufilira A, Hudes E,
Nsengumuremyi F, et al. Effect of serotesting with
counseling on condom use and sero conversion among
HIV discordant couples in Africa. BMJ 1992;304:1605-9.
- Counseling and HIV/AIDS. UNAIDS Best Practices
Collection. Geneva UNAIDS; 1997.
- Medley A, Moreno Garcia C, McGill S, Manon S. Rates,
barriers and out comes of HIV serostatus disclosure among
women in developing countries: Implications for prevention
of mother to child transmission programmes. Bull WHO
2004;82:299-304.
- Bhagat S, Facing the challenge – Household and
Community Response to HIV/AIDS in Mumbai, India.
HIV/AIDS Research in India, NACO: New Delhi; 1997.
- Issiaka S, Cartoux M, Zerbo OK. Living with HIV: Womens
experience in Burkina faso, West Africa. AIDS Care
2001;13:123-8.
Department of Preventive and Social Medicine, All India
Institute of Hygiene and Public Health, and 1Department of
Tropical Medicine, School of Tropical Medicine,
Kolkatta – 700 073, India
Correspondence to:
Dr. Aparajita Dasgupta,
Department of Preventive and Social Medicine, All India Institute of
Hygiene and Public Health, 110, C.R. Avenue, Kolkatta – 700 073,
India.
E-mail: aparajitagupta(at)rediffmail.com
Received: 19.04.05
Accepted: 08.01.07
ISSN No. 0970-0218
Pranita Taraphdar, Aparajita Dasgupta, B Saha1
The prevention and control of human immunodeficiency virus (HIV) infections depends on the success of strategies implemented to prevent new infections and to treat currently infected individuals. Voluntary HIV testing and counselling can serve both the goals, by enabling healthy individuals to remain uninfected and those infected to plan their future and to prevent HIV transmission to others.1
Disclosure of the HIV status to ones sexual partner is an important prevention goal emphasized by the WHO and CDC in their protocols for HIV counselling and testing.2 Disclosure offers a number of important benefits to the infected individual and to the general public. Disclosure of HIV test results to ones sexual partner is associated with less anxiety and increased social support. In addition, it may lead to improved access to HIV prevention, treatment, opportunities for risk reduction and planning for the future. Moreover, risk behaviours change most dramatically among couples where both partners are aware of their HIV serostatus. It also enables couples to make informed reproductive health choices, which may ultimately lower the number of unintended pregnancies among HIV/AIDS positive women.3
Among the risks of disclosure of HIV serostatus are loss of social, economic and emotional support, blame, abandonment, discrimination and disruption of family relationships.4 This leads to loss of opportunities for the prevention of new infections and the ability to access appropriate care, treatment and support services.
Materials and Methods
This cross-sectional observational study of HIV/AIDS patients admitted to the School of Tropical Medicine (STM), Kolkatta, was carried out from May 2004 to October 2004. The Voluntary Counselling and Testing Centre started function from 2000 at STM, and from 2001, HIV/AIDS patients were admitted to this hospital and received treatment. In STM, patients with AIDS are admitted under four visiting physicians. All patients admitted under one such consultant and expressed willingness to participate were included in this study.
Results
Out of the 46 PLWHAs (people living with HIV/AIDS) studied, 40 were males and 6 were females. All the female patients had disclosed their serostatus to their sexual partners, as compared to 26 (65%) in the 40 males. Thus, the overall disclosure rate was 69.56%. A majority of patients (28 out of 32, 87.5%) reported positive outcomes following disclosure, that is kindness, understanding and acceptance. More importantly, disclosure was not associated with break-up of marriages. Negative outcomes included blame, abandonment, violence, anger, stigma and depression. Only one in six women (16.6%) reported negative outcomes following disclosure of serostatus as compared to three in 26 males (11.5%). From Table 1, it appears that older people were more likely to disclose than younger people. Only 33.3% PLWHAs less than 30 years in age disclosed their serostatus as compared to 75% PLWHAs greater than 30 years (P < 0.005).
There was no statistically significant difference in disclosure rates among PLWHAs with respect to the socioeconomic status. The place of residence and type of family did not appear to be a significant factor affecting disclosure. Literacy is an important factor affecting disclosures; as expected, it was observed that 85.7% of PLWHAs who were literate disclosed their serostatus to their partners as compared to 44.4% of PLWHAs who were illiterate (df = 1, χ2 = 8.73, P < 0.005). Similar results have been found in studies conducted with women with HIV/AIDS.5
PLWHAs who had been in a relationship for greater than 5 years had disclosed their serostatus to their partners as compared to those in a shorter duration of relationship. None with a relationship less than 1 year had disclosed their serostatus, mainly because they had casual sex with commercial sex workers (CSWs) before marriage. Among married men, 82.3% had disclosed their serostatus to their sexual partners. Four PLWHAs are currently separated following the disclosure of their serostatus to their spouses. As expected, none of the unmarried men had disclosed their serostatus to their would-be partners, since they had indulged in casual sex with CSWs.
Table 1: Factors affecting disclosure of serostatus among PLWHAs
Factors affecting disclosure |
Disclosure of serostatus | Total N = 46 |
|
---|---|---|---|
Yes No. (%) N = 32 |
No No. (%) N = 14 |
||
Age* |
|||
20-30 | 2 (33.3) | 4 (66.7) | 6 |
31-40 | 20 (71.4) | 8 (28.6) | 28 |
40-50 | 4 (66.7) | 2 (22.3) | 6 |
>50 | 6 (100) | 0 | 6 |
Per capita income | |||
<500 | 10 (62.5) | 6 (37.5) | 16 |
500-1000 | 10 (71.4) | 4 (28.6) | 14 |
1000-1500 | 6 (100) | 0 (0) | 6 |
>1500 | 6 (60) | 4 (40) | 10 |
Place of residence | |||
Rural | 20 (71.4) | 8 (28.5) | 28 |
Urban | 12 (66.67) | 6 (33.33) | 18 |
Type of family | |||
Nuclear | 14 (70) | 6 (30) | 20 |
Joint | 18 (69.2) | 8 (30.8) | 26 |
Literacy* |
|||
Illiterate | 8 (44.4) | 10 (55.6) | 18 |
Literate | 24 (85.7) | 4 (14.3) | 28 |
Duration of relationship | |||
>1 year | 0 | 6 (100) | 6 |
1-5 years | 4 (33.3) | 8 (66.7) | 12 |
>5 years | 28 (100) | 0 | 28 |
Current marital status | |||
Unmarried | 0 | 6 (100) | 6 |
Married | 28 (82.3) | 6 (17.7) | 34 |
Separated/divorced | 4 (66.7) | 2 (33.3) | 6 |
*
P < 0.005
The study of sexual practice of PLWHAs [Table 2] showed that, out of 46 subjects, only 32 (69.56%) had got their sexual partners tested for HIV infection, of which 17 (53.12%) were HIV positive. The current sexual practice of PLWHAs showed that 20 out of 46 (43.47%) were using condoms and an equal number were not (43.47%), whereas 12.8% practised abstinence. Of the untested sexual partners, 64.2% were not using condoms and, although seronegative, are at risk of acquiring HIV infection. It was encouraging to note that all PLWHAs were practising safe sex with their partners who were tested negative.
Discussion
Thus, the overall outcome of serostatus disclosure was positive. However, more than 30% of PLWHAs had not disclosed their serostatus. The positive outcomes can be attributed to the familistic orientation of the Indian society and, in small measures, to the ignorance of caregivers about the full implications of the epidemic. This is in continuation with similar studies conducted in Mumbai, India.4 Previous studies have shown that responses to HIV/AIDS are both gendered and contextualized. Male positives are granted greater acceptance, care and support by their spouses. The outcome also depended on the status of the person within the household.4 In our study, negative outcome following disclosure was seen in 16.6% women as compared to 11.5% men. Literacy is an important factor affecting disclosure of serostatus, and disclosure rates were significantly higher in literate population as compared to illiterate population. The type of family, socioeconomic status and per capita income did not appear to be important factors affecting the disclosure of serostatus. However, the longer duration of relationship appeared to be an important factor in the disclosure of serostatus.
Table 2: Distribution of study subjects by serostatus of partner and sexual practice in the last 1 year (n = 46)
Sexual practice | Serostatus of partner No. (%) | Total No. (%) | ||
---|---|---|---|---|
Positive | Negative | Untested | ||
Using condoms | 3 (17.6) | 12 (80) | 5 (35.1) | 20 (43.6) |
Not using condoms | 11 (64.8) | - | 9 (64.2) | 20 (43.6) |
Abstinence | 3 (17.6) | 3 (20) | - | 6 (12.8) |
Total | 17 (100) | 15 (100) | 14 (100) | 46 (100) |
References
- Allen S, Tice. J, Van de Perre P, Serufilira A, Hudes E, Nsengumuremyi F, et al. Effect of serotesting with counseling on condom use and sero conversion among HIV discordant couples in Africa. BMJ 1992;304:1605-9.
- Counseling and HIV/AIDS. UNAIDS Best Practices Collection. Geneva UNAIDS; 1997.
- Medley A, Moreno Garcia C, McGill S, Manon S. Rates, barriers and out comes of HIV serostatus disclosure among women in developing countries: Implications for prevention of mother to child transmission programmes. Bull WHO 2004;82:299-304.
- Bhagat S, Facing the challenge – Household and Community Response to HIV/AIDS in Mumbai, India. HIV/AIDS Research in India, NACO: New Delhi; 1997.
- Issiaka S, Cartoux M, Zerbo OK. Living with HIV: Womens experience in Burkina faso, West Africa. AIDS Care 2001;13:123-8.
Department of Preventive and Social Medicine, All India Institute of Hygiene and Public Health, and 1Department of Tropical Medicine, School of Tropical Medicine, Kolkatta – 700 073, India
Correspondence to:
Dr. Aparajita Dasgupta,
Department of Preventive and Social Medicine, All India Institute of
Hygiene and Public Health, 110, C.R. Avenue, Kolkatta – 700 073,
India.
E-mail: aparajitagupta(at)rediffmail.com
Received: 19.04.05
Accepted: 08.01.07