Sex and secrecy: How HIV-status disclosure affects safe sex among HIV-positive adolescents

Figures & data

Figure 1. Approach to integrating qualitative and quantitative methods.

Figure 2. Themes and prompts of focus group discussion with adolescent boys.

Figure 3. Levels of disclosure from HIV-positive adolescents to their partners (boyfriend or girlfriend).

Table 1. Socio-demographic and health characteristics of HIV-positive adolescents by knowledge of HIV-status.

Category	Factor	Knows HIV-status (n = 584)^a	Does not know HIV-status (n = 274)^a	Total HIV-positive sample (n = 858)^a
Gender	Female	317 (54.3)*	129 (45.7)*	446 (52.0)
	Male	267 (47.1)*	145 (52.9)*	412 (48.0)
Age	Age in years^a	14.28 (2.66)***	11.95 (2.00)***	13.53 (2.69)
	10–14 years old	328 (56.2)***	241 (88)***	569 (66.3)
	15–19 years old	256 (43.8)***	33 (12)***	289 (33.7)
Residence	Urban	475 (82.5)**	195 (73.6)**	670 (79.7)
	Rural	101 (17.5)**	70 (26.4)**	171 (20.3)
Ethnicity	Xhosa	562 (96.2)	265 (96.7)	827 (96.4)
	Other	22 (3.8)	9 (3.3)	31 (3.6)
Housing type	Informal	96 (16.4)	46 (16.8)	142 (16.6)
	Formal	488 (83.6)	228 (83.2)	716 (83.4)
Poverty	Missing any of the basic eight necessities	400 (68.5)**	168 (61.3)*	568 (66.2)
	Hunger in the last week	91 (15.6)	41 (15.0)	132 (15.4)
Caregiving arrangement	Living with biological parent	240 (41.4)*	139 (50.7)*	379 (44.4)
	Maternal orphan	291 (49.8)***	97 (35.4)***	388 (45.2)
	Paternal orphan	194 (33.2)**	65 (23.7)**	259 (30.2)
	Double orphan	106 (18.2)**	30 (10.9)**	136 (15.9)
Mode of infection	Vertically	420 (71.9)**	164 (28.1)**	584 (68.1)
	Horizontally	224 (81.8)**	50 (18.2)**	274 (31.9)
Treatment-related factors	Years on ART^a	6.45 (4.68)*	5.83 (4.15)*	6.26 (4.53)
	Non adherent in the last week	196 (33.6)	100 (36.5)	296 (34.5)
Access to healthcare services	Hospital	256 (43.8)*	95 (34.7)*	351 (40.9)
	Clinic or community healthcare centre	328 (56.2)*	179 (65.3)*	507 (59.1)
Health	At least 2 STI symptoms	78 (13.4)	40 (14.6)	118 (13.8)
	At least one opportunistic infection	348 (59.6)	172 (62.8)	520 (60.6)

Notes: This table includes the results of a series of chi-square tests with knowing one's status as an outcome and the noted factor as the independent variable. The first two columns display numbers and proportional percentages within groups, the third column displays numbers and shares between groups. Bold typeface indicates determinants that were significant: ***p ≤ .001, **p ≤ .01, *p ≤ .05.

^aAll values displayed are numbers (%) except for age in years, and years on treatment. These display mean (SD).

Figure 4. Rates of safe sex by type of disclosure.

Table 2. Sexual and relationship characteristics of HIV-positive adolescents by knowledge of HIV-status.

Factors	Categories	Knows HIV-status (n = 584) N (%)	Does not know HIV-status (n = 274) N (%)	Total HIV-positive sample (n = 858) N (%)
Relationship status	Has a boyfriend or girlfriend	146 (25)***	32 (11.7)***	178 (20.8)
Sexual Debut	Ever had intercourse (vaginal or anal)	117 (20)***	11 (4.0)***	128 (14.9)
Among sexually active adolescents in a relationship
Factors	Categories	Knows HIV-status (n = 99) N (%)	Does not know HIV-status (n = 8) N (%)	Total HIV-positive sample (n = 107) N (%)
Knowledge of partner status	Unknown	57 (58.2)	5 (62.5)	62 (58.5)
	HIV-negative	28 (28.6)	3 (37.5)	31 (29.2)
	HIV-positive	13 (13.3)	0 (0)	13 (12.3)
Disclosure to partner	Partner knows adolescents is HIV-positive and/or taking ARVs for HIV^b	34 (34.3)	4 (50.0)	38 (35.5)
Among sexually active adolescents
Factors	Categories	Knows HIV-status (n = 117) N (%)	Does not know HIV-status (n = 11) N (%)	Total HIV-positive sample (n = 128) N (%)
First sexual experience	Age in years^a	15.55 (1.86)***	13.27 (5.39)***	15.35 (2.42)
	Abstinent or male condom use	88 (75.2)	7 (63.6)	95 (74.2)
	Unprotected sex	29 (24.8)	4 (36.4)	33 (25.8)
Most recent sexual experience	Abstinent or male condom use	86 (73.5)	5 (45.5)*	91 (71.1)
	Unprotected sex	31 (26.5)*	6 (55.5)*	37 (28.9)
Reasons for safe sex	Prevent pregnancy	73 (65.2)	7 (63.6)	80 (65.0)
	Passing HIV to my partner	70 (62.5)	N/A	70 (54.7)
	Prevent STI infection	52 (46.4)	4 (36.4)	56 (45.5)

Notes: This table includes the results of a series of chi-square tests with sexual practices or relationship-related factors as an outcome and knowing one's status as the independent variable. Percentages report rates within each sub-group, that is, among adolescents who knew their status and those who did not. Bold typeface indicates determinants that were significant: ***p ≤ .001, **p ≤ .01, *p ≤ .05.

^aAll values displayed are numbers (%) except for age of sexual debut in years^a. These display mean (SD).

^bHIV-positive adolescents who did not know their status were asked if they had told their boyfriend/girlfriend that they were taking medication.

Table 3. Sexual and relationship characteristics of HIV-positive adolescents by sex.

Factors	Categories	Female (n = 446) N (%)	Male (n = 412) N (%)	Total sample (n = 858) N (%)
Relationship status	Has a boyfriend or girlfriend	99 (22.1)	82 (19.9)	181 (21.0)
Sexual Debut	Ever had intercourse (vaginal or anal)	88 (19.2)***	44 (10.7)***	130 (15.1)
Among sexually active adolescents in relationships		Female (n = 70)	Male (n = 37)	Total sample (n = 107)
Disclosure	Knows own status	64 (91.4)	35 (94.6)	99 (92.5)
Knowledge of partner status	Unknown	36 (50.7)	26 (70.3)	62 (57.4)
	HIV-negative	24 (33.8)	9 (27.3)	33 (30.6)
	HIV-positive	11 (15.5)	2 (5.4)	13 (12.0)
Disclosure to partner	Partner knows adolescents is HIV-positive and/or taking ARVs for HIV^a	33 (45.8)***	5 (13.5)***	38 (34.9)
First sexual experience	Age of sexual debut^b	16.19 (1.21)***	14.27 (2.75)***	15.54 (2.08)
	Abstinent or male condom use	55 (76.4)	31 (83.8)	86 (78.9)
	Unprotected sex	17 (23.6)	6 (16.2)	23 (21.1)
Most recent sexual experience	Abstinent or male condom use	49 (68.1)*	32 (86.5)*	81 (74.3)
	Unprotected sex	23 (31.9)*	5 (13.5)*	28 (25.7)

Note: This table includes the results of a series of chi-square tests with sexual practices or relationship-related factors as an outcome and sex (male/female) as the independent variable. The first two columns display numbers and proportional percentages within groups, the third column displays numbers and shares between groups, that is, among girls and boys. Bold typeface indicates determinants that were significant: ***p ≤ .001, **p ≤ .01, *p ≤ .05.

^aHIV-positive adolescents who did not know their status were asked if they had told their boyfriend/girlfriend that they were taking medication.

^bAll values displayed are numbers (%) except for age of sexual debut in years. These display mean (SD).

Table 4. Regression models to test associations between types of disclosure and safe sex.

Factors	Model 1		Model 2		Model 3
	OR	CI	OR	CI	OR	CI
Knowledge of adolescent's own status	4.355	1.085–17.474*	4.335	1.081–17.389*	4.356	1.084–17.500*
Knowledge of partner's status			0.870	0.283–2.669	0.824	0.198–3.426
Disclosure of own status to partner					1.091	0.262–4.536

Notes: All regression models were run with safe sex as the dependent variable, controlling for age, gender, poverty, rural/urban residence, ethnicity, housing type, caregiving arrangements and treatment and health-related covariates. Bold typeface indicates determinants that were significant: ***p ≤ .001, **p ≤ .01, *p ≤ .05.

Figure 5. Thanda's story.