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HIV-Positive Status Disclosure in Patients in Care in Rural South Africa: Implications for Scaling Up Treatment and Prevention Interventions

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Abstract

A nuanced understanding of HIV-positive status disclosure is urgently needed to inform the implementation of prevention interventions, including TasP and PrEP. To provide such understanding for the high HIV-burden setting of rural KwaZulu-Natal, we conducted a prospective cohort study to characterize determinants and trends in HIV-positive status disclosure. 687 consenting HIV-positive individuals (73.2 % female; 60.3 % ART initiated) were enrolled. Reports of any incidence of disclosure to either a family member or sexual partner at enrollment and follow-up visits (median 4.4 months post-enrolment) were common (91.0 %); however, reports of disclosure specifically to sexual partners were relatively rare (34.1 %), especially in women (29.8 %). Participants not engaged in a stable partnerships, not ART-imitated, and/or who had disclosed to their family were at risk of non-disclosure to sexual partners. These data highlight both an urgent need to empower HIV-positive individuals, and the significant barriers to targeting sero-discordant couples for HIV prevention in this setting.

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Acknowledgments

We pay tribute to the participants in this study; their dedication and commitment made this study possible. We also thank all members of staff of the CAPRISA 060 team for their hard work and contributions to this study. CAPRISA is part of the Comprehensive International Program of Research on AIDS (CIPRA) and is supported by the National Institute of Allergy and infectious Disease (NIAID), National Institutes of Health (NIH) and the US Department of Health and Human Services (DHHS) (grant# 1 U19 AI51794); we are grateful to these contributors for the research infrastructure that made this study possible. We would also like to acknowledge the CAPRISA Fellowship Program, and Columbia University-Southern African Fogarty AIDS International Training and Research Programme Fullbright Clinical Traineeship for direct funding to Rachael Dellar and Benjamin Bearnot, respectively.

Conflict of interest

The authors declare no conflicts of interests.

Funding

The project described was supported by Award Number D43TW000231 from the Fogarty International Center. Rachael Dellar is supported by the CAPRISA Fellowship Training Program. Benjamin Bearnot was recipient of a Fulbright-Fogarty Fellowship in Public Health when he undertook some of this research. The content is solely the responsibility of the authors and does not necessarily represent the official views of the Fogarty International Center or the National Institutes of Health.

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Author notes

  1. Benjamin Bearnot

    Present address: Department of Medicine, Massachusetts General Hospital, Boston, MA, USA

Authors and Affiliations

  1. Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

    Quarraisha Abdool Karim, Rachael C. Dellar & Salim S. Abdool Karim

  2. Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, USA

    Quarraisha Abdool Karim, Lise Werner, Janet A. Frohlich, Ayesha B. M. Kharsany & Salim S. Abdool Karim

  3. New York University School of Medicine, New York, NY, USA

    Benjamin Bearnot

Authors
  1. Quarraisha Abdool Karim
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  2. Rachael C. Dellar
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  3. Benjamin Bearnot
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  4. Lise Werner
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  5. Janet A. Frohlich
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  6. Ayesha B. M. Kharsany
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  7. Salim S. Abdool Karim
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Corresponding author

Correspondence to Quarraisha Abdool Karim.

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On behalf of the CAPRISA 060 Study Team.

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Abdool Karim, Q., Dellar, R.C., Bearnot, B. et al. HIV-Positive Status Disclosure in Patients in Care in Rural South Africa: Implications for Scaling Up Treatment and Prevention Interventions. AIDS Behav 19, 322–329 (2015). https://doi.org/10.1007/s10461-014-0951-4

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  • DOI: https://doi.org/10.1007/s10461-014-0951-4

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