To tell or not to tell: South African women's disclosure of HIV status during pregnancy

Abstract

HIV-positive pregnant women often do not disclose their serostatus to their partners, family and friends, creating potential barriers to preventing sexual transmission to partners and mother-to-child transmission through breastfeeding. This research explores recently diagnosed HIV-positive pregnant women's reasons for disclosure and non-disclosure of serostatus to various members of their social networks, as well as the consequences of their disclosure. Data were collected through open-ended questions as part of a semi-structured interview with 293 recently diagnosed HIV-positive pregnant women recruited from antenatal clinics in two townships in Tshwane, South Africa. A content analysis of responses showed that women weighed fear of abandonment and discrimination against their desire to raise risk awareness and their need for support. Partners most often responded to disclosure with disbelief and shock, whereas parents frequently exhibited emotional distress, but were still supportive, as were other relatives and friends. The women subsequently experienced low levels of adverse consequences after disclosure. The results can assist healthcare providers in understanding the complexity of pregnant women's decisions to disclose to various members of their social networks and emphasize the need for continued counselling and support.

Keywords:

• disclosure
• pregnant women
• qualitative research
• HIV+ women in Africa

Acknowledgements

This research was supported by grant R24-HD043558 (awarded to Bridget Jeffery, Serithi project, University of Pretoria under the auspices of the Medical Research Council, Unit for Maternal and Infant Health Care Strategies) from the National Institute for Child Health and Development. We acknowledge the contributions of Prof. B. Jeffery, Ms B. Mdlalose (University of Pretoria) and Prof K. Sikkema (Duke University), the Serithi research team and the women who agreed to participate in the study, despite only recently finding out about their HIV status.

Notes

1. The Serithi project is a longitudinal study in which women diagnosed HIV-positive during pregnancy were enrolled and followed until two years after delivery to examine the role of psychological and nutritional factors on disease progression. Quantitative results of the study are published elsewhere.