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Indian Journal of Community Medicine

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 one’s 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 one’s 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

  1. 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.
  2. Counseling and HIV/AIDS. UNAIDS Best Practices Collection. Geneva’ UNAIDS; 1997.
  3. 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.
  4. Bhagat S, Facing the challenge – Household and Community Response to HIV/AIDS in Mumbai, India. HIV/AIDS Research in India, NACO: New Delhi; 1997.
  5. Issiaka S, Cartoux M, Zerbo OK. Living with HIV: Women’s 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

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