Academic journal article Bulletin of the World Health Organization

Rates, Barriers and Outcomes of HIV Serostatus Disclosure among Women in Developing Countries: Implications for Prevention of Mother-to-Child Transmission Programmes

Academic journal article Bulletin of the World Health Organization

Rates, Barriers and Outcomes of HIV Serostatus Disclosure among Women in Developing Countries: Implications for Prevention of Mother-to-Child Transmission Programmes

Article excerpt

Introduction

The prevention and control of human immunodeficiency virus (HIV) infection depends on the success of strategies to prevent new infections and to treat currently infected individuals. Voluntary HIV testing and counselling serve both goals. HIV testing and counselling provide essential knowledge and support to individuals at risk for contracting HIV, enabling uninfected individuals to remain uninfected and those infected to plan for the future and prevent HIV transmission to others (1, 2). Knowing their HIV status may also enable HIV-infected individuals to access early and appropriate treatment, care and support programmes. Furthermore, HIV-infected women who know their serostatus are in a better position to make informed choices about their reproductive lives and, if pregnant, to access specific interventions, such as antiretroviral prophylaxis and infant feeding counselling and support, which can significantly reduce the risk of mother-to-child transmission of HIV (3-5). At present, the majority of HIV-infected individuals are unaware o ive the services they need.

Disclosure of HIV status to sexual partners is an important prevention goal emphasized by the WHO (6) and the Centers for Disease Control and Prevention (CDC) (7) in their protocols for HIV testing and counselling. Disclosure offers a number of important benefits to the infected individual and to the general public. Disclosure of HIV test results to sexual partners is associated with less anxiety and increased social support among many women (8). In addition, HIV status disclosure may lead to improved access to HIV prevention and treatment programmes, increased opportunities for risk reduction and increased opportunities to plan for the future. Disclosure of HIV status also expands the awareness of HIV risk to untested partners, which can lead to greater uptake of voluntary HIV testing and counselling and changes in HIV risk behaviours (1, 2, 9). It is clear from the literature that risk behaviours change most dramatically among couples where both partners are aware of their HIV serostatus (1, 2, 9). In addition, disclosure of HIV status to sexual partners enables couples to make informed reproductive health choices that may ultimately lower the number of unintended pregnancies among HIV-positive women (2).

Along with these benefits, however, there are a number of potential risks from disclosure for HIV-infected women, including loss of economic support, blame, abandonment, physical and emotional abuse, discrimination and disruption of family relationships. These risks may lead women to choose not to share their HIV test results with their friends, family and sexual partners. This, in turn, leads to lost opportunities for the prevention of new infections and for the ability of these women to access appropriate treatment, care and support services where they are available.

This paper reviews the current information available on HIV status disclosure among women in developing countries. The implications of non-disclosure are considered in the context of prevention of mother-to-child transmission (pMTCT) programmes. Programmatic and policy strategies that have been used to increase disclosure rates and minimize negative outcomes among women are also discussed.

Methods

We reviewed all published abstracts and journal articles from January 1990 to December 2001 identified through a comprehensive search of four medical and social science electronic databases including: PubMed, the National Library of Medicine's (NLM) Gateway database, Psych INFO, and Sociologic Abstracts. We also searched four HIV-related journals by hand: AIDS Care, AIDS, AIDS and Behavior, and AIDS Education and Prevention. Any article that qualified during these searches was then retrieved from the library and the bibliography searched for any additional references. The terms used during the computer-based searches include HIV counselling and testing and disclosure, HIV voluntary counselling and testing and disclosure, HIV serostatus disclosure and women, and pMTCT and disclosure. …

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