Understanding the determinants and consequences of HIV status disclosure in Manicaland, Zimbabwe: cross-sectional and prospective analyses

ABSTRACT

Few longitudinal studies have measured trends and effects of disclosure over ART scale-up in general-population samples. We investigated levels, determinants and outcomes of disclosure to relatives and partners in a large general-population cohort in Zimbabwe. Trends in disclosure levels from 2003 to 2013 were analysed, and multivariable logistic regression was used to identify determinants. Longitudinal analyses were conducted testing associations between disclosure and prevention/treatment-related outcomes. Disclosure to anyone increased from 79% to 100% in men and from 63% to 98% in women from 2003 to 2008; but declined to 89% in both sexes in 2012–2013. More women than men disclosed to relatives (67.8% versus 44.4%; p < 0.001) but fewer women disclosed to partners (85.3% versus 95.0%; p < 0.001). In 2012–2013,secondary/higher education, being single, and experience of stigma were associated with disclosure to relatives in both sexes. Partner characteristics and HIV-group attendance were associated with disclosure to partners for women. Reactions to disclosure were generally supportive but less so for females than males disclosing to partners (92.0% versus 97.4%). Partner disclosure was weakly associated (p < 0.08) with having had a CD4 count or taken ART at follow-up in females. To conclude, this study shows disclosure is vital to HIV prevention and treatment, and programmes to facilitate disclosure should be re-invigorated.

KEYWORDS:

• Disclosure
• HIV
• Zimbabwe

Acknowledgements

We are grateful to the study participants for providing the data needed for this study and to the Manicaland Centre team for conducting the data collection and processing.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

The Manicaland General-Population Cohort survey was funded by grants from the Wellcome Trust programme [grant number 084401/Z/07/B] and the Bill and Melinda Gates Foundation (OPP1161471). S.G., C.N., and L.M. acknowledge joint MRC Centre for Global Infectious Disease Analysis funding from the UK Medical Research Council and Department for International Development [grant number MR/R015600/1]. The study funders had no influence on the design of the study, on the collection, analysis, and interpretation of data, and on the writing the manuscript.