Factors Associated with HIV Positive Serostatus Disclosure to Sexual Partners Among Sexually Active Young People on Anti-Retroviral Therapy in Central Uganda

Figures & data

Figure 1 Flow chart of explanatory sequential mixed methods design.

Table 1 Study Variables

Variable	Categories	Description of Variables
Dependent variable
Serostatus disclosure of HIV status to a sexual partner	Yes	HIV serostatus disclosure
	2. No
Independent variable
Age of study participant	1. 15–19 years	Ordinal, Categorical variable
	2. 20–24 years
Sex of study participant	1. Male	Nominal, Categorical variable
	2. Female
Age of sex partner	1. 15–19 years	Ordinal, Categorical variable
	2. 20–24 years
	3. 25–29 years
	4. ≥30 years
Living status	1. Living with a sexual partner	Nominal, Categorical variable
	2. Not living with a sexual partner
Employment status	1. Not employed	Nominal, Categorical variable
	2. Employed
Source of HIV infection	1. Prenatally infected	Nominal, Categorical variable
	2. Postnatally infected
Period on ART	1. 1–4 years	Ordinal, Categorical variable
	2. 5–9 years
	3. ≥10 years
Number of sexual partners	1. One	Ordinal, Categorical variable
	2. More than one
Knowledge on disclosure	1. Low	Ordinal, Categorical variable
	2. High
Attitude towards disclosure	1. Negative	Nominal, Categorical variable
	2. Positive
Belief on disclosure	1. Wrong	Nominal, Categorical variable
	2. Right
Service delivery of SRHR Service	1. Poor	Ordinal, Categorical variable
	2. Good
Human resource factors	1. Insufficient	Ordinal, Categorical variable
	2. Sufficient
Health Education factors	1. Low	Ordinal, Categorical variable
	2. High
Community support factors	1. Unsupportive	Nominal, Categorical variable
	2. Supportive

Figure 2 Multicollinearity check.

Table 2 Socio-Demographic Characteristics of Study Participants

Variable	Categories	Frequency	Percentage
Age group	15–19	85	35.7
	20–24	153	64.3
Sex	Male	41	17.2
	Female	197	82.8
Religion	Christians	198	83.2
	Non-Christians	40	16.8
Education level	None	24	10.1
	Primary	93	39.1
	Secondary	121	50.8
Staying with	Parents	77	32.4
	Relative	42	17.7
	Partner	69	29.0
	Alone	50	21.0
Employment Status	Unemployed	134	56.3
	Employed	104	43.7
Residence	Urban	142	59.7
	Rural	96	40.3
Marital Status	Married	107	45.0
	Unmarried	131	55.0
Time on ART	1–4 years	156	65.6
	5–9 years	40	16.8
	10+ years	42	17.7
Source of infection	Mother	71	29.8
	Partner	138	58.0
	Other	29	12.2
Number of Sexual Partners	1 Partner	189	79.4
	>1 partner	49	20.6
Knowledge on Disclosure	Low	8	3.4
	High	230	96.6
Attitude towards Disclosure	Negative	46	19.3
	Positive	192	80.7
Belief on Disclosure	Wrong	48	20.2
	Right	190	79.8
Service Delivery of SRHR Services	Poor	10	4.2
	Good	228	95.8
Human Resources Factors	Insufficient	17	7.1
	Sufficient	221	92.9
Health Education Factors	Low	70	29.4
	High	168	70.6
Community Support Factors	Unsupportive	66	27.7
	Supportive	172	72.3
Disclosure	None	64	26.9
	One-way	58	24.4
	Two-way	116	48.7

Table 3 Association Between Disclosure and Non-Disclosure with Various Factors (Bivariate Analysis)

Variable	Categories	Disclosure			Chi Square p-value
		None	One-Way	Two-Way
Age group	15–19	33(38.8)	20(23.5)	32(37.7)	0.006*
	20–24	31(20.3)	38(24.8)	84(54.9)
Sex	Male	10(24.4)	11(26.8)	20(48.8)	0.888
	Female	54(27.4)	47(23.9)	96(48.7)
Religion	Christians	53(26.8)	44(22.2)	101(51.0)	0.175
	Non-Christians	11(27.5)	14(35.0)	15(37.5)
Education level	None	6(25.0)	7(29.2)	11(45.8)	0.001*
	Primary	39(41.9)	20(21.5)	34(36.6)
	Secondary	19(15.7)	31(25.6)	71(58.7)
Staying with	Parents	28(36.4)	19(24.7)	30(39.0)	0.001*
	Relative	14(33.3)	8(19.1)	20(47.6)
	Partner	9(13.0)	12(17.4)	48(69.6)
	Alone	13(26.0)	19(38.0)	18(36.0)
Employment Status	Unemployed	36(26.9)	31(23.1)	67(50.0)	0.864
	Employed	28(26.9)	27(26.0)	49(47.1)
Residence	Urban	40(28.2)	32(22.5)	70(49.3)	0.697
	Rural	24(25.0)	26(27.1)	46(47.9)
Marital Status	Married	22(20.6)	18(16.8)	67(62.6)	0.001*
	Unmarried	42(32.1)	40(30.5)	49(37.4)
Time on ART	1–4 years	41(26.3)	35(22.4)	80(51.3)	0.412
	5–9 years	8(20.0)	12(30.0)	20(50.0)
	10+ years	15(35.7)	11(26.4)	16(38.1)
Source of infection	Mother	32(45.1)	13(18.3)	26(36.6)	0.002*
	Partner	27(19.6)	36(26.1)	75(54.3)
	Other	5(17.2)	9(31.0)	15(51.8)
Number of Sexual Partners	1 Partner	50(26.5)	45(23.8)	94(49.7)	0.831
	>1 partner	14(28.6)	13(26.5)	22(44.9)
Knowledge of Disclosure	Low	2(25.0)	2(25.0)	4(50.0)	0.993
	High	62(27.0)	58(24.3)	112(48.7)
Attitude towards Disclosure	Negative	13(28.3)	11(23.9)	22(47.8)	0.973
	Positive	51(26.6)	47(24.4)	94(49.0)
Belief on Disclosure	Wrong	18(37.5)	9(18.8)	21(43.7)	0.165
	Right	46(24.2)	49(25.8)	95(50.0)
Service Delivery of SRHR Services	Poor	2(20.0)	4(40.0)	4(40.0)	0.498
	Good	62(27.2)	54(23.7)	112(49.1)
Human Resources Factors	Insufficient	5(29.4)	3(17.7)	9(52.9)	0.799
	Sufficient	59(26.7)	55(24.9)	107(48.4)
Health Education Factors	Low	17(24.3)	19(27.1)	34(48.6)	0.754
	High	47(28.0)	39(23.2)	82(48.8)
Community Support Factors	Unsupportive	16(24.2)	24(36.4)	26(39.4)	0.026*
	Supportive	48(27.9)	34(19.8)	90(52.3)

Notes: The bold values with asterisk (*) indicates significant association between the respective variables and disclosure of HIV serostatus at 95% confidence level. “Age group” “education level”, “staying with”, “marital status”, “source of infection”, and “community support factors” are significantly (p<0.05) associated with serostatus disclosure. “Age group” is significantly (p=0.006) associated to serostatus disclosure. Serostatus disclosure is different among the categories “Age group”. “Education level” is significantly (p=0.001) associated to serostatus disclosure. Serostatus disclosure is different among the categories of “Education level”. “Staying with” is significantly (p=0.001) associated to serostatus disclosure. Serostatus disclosure is different among the categories of “Staying with”. “Marital status” is significantly (p=0.001) associated to serostatus disclosure. Serostatus disclosure is different among the categories of “Marital status”. “Source of infection” is significantly (p=0.002) associated to serostatus disclosure. Serostatus disclosure is different among the categories of “Source of infection”. “Community Support factors” is significantly (p=0.026) associated to serostatus disclosure. Serostatus disclosure is different among the categories of “Community support factors”.

Table 4 Multinomial Logistic Regression for Factors Associated with Disclosure and Non-Disclosure of HIV Serostatus to Sexual Partners

Variable	Categories	Disclosure			Relative Risk Ratio [95% CI]	p-value
		None	One-Way	Two-Way
One-way Disclosure	No disclosure (base)
Age group	15–19	33(38.8)	20(23.5)	32(37.7)	1	1
	20–24	31(20.3)	38(24.8)	84(54.9)	1.134[0.477–2.695]	0.776
Education level	None	6(25.0)	7(29.2)	11(45.8)	1	1
	Primary	39(41.9)	20(21.5)	34(36.6)	0.307[0.083–1.141]	0.078
	Secondary	19(15.7)	31(25.6)	71(58.7)	0.913[0.241–3.462]	0.894
Staying with	Parents	28(36.4)	19(24.7)	30(39.0)	1	1
	Relative	14(33.3)	8(19.1)	20(47.6)	0.675[0.220–2.075]	0.493
	Partner	9(13.0)	12(17.4)	48(69.6)	2.540[0.576–11.202]	0.218
	Alone	13(26.0)	19(38.0)	18(36.0)	2.051[0.748–5.624]	0.163
Marital Status	Married	22(20.6)	18(16.8)	67(62.6)	1	1.000
	Unmarried	42(32.1)	40(30.5)	49(37.4)	1.770[0.577–5.427]	0.318
Source of infection	Mother	32(45.1)	13(18.3)	26(36.6)	1	1.000
	Partner	27(19.6)	36(26.1)	75(54.3)	2.752[1.100–6.888]	0.031*
	Other	5(17.2)	9(31.0)	15(51.8)	2.726[0.695–10.693]	0.150
Community Support Factors	Unsupportive	16(24.2)	24(36.4)	26(39.4)	1	1.000
	Supportive	48(27.9)	34(19.8)	90(52.3)	0.541[0.233–1.252]	0.151
Two-way Disclosure	No disclosure (base)
Age group	15–19	33(38.8)	20(23.5)	32(37.7)	1	1
	20–24	31(20.3)	38(24.8)	84(54.9)	1.347[0.619–2.933]	0.453
Education level	None	6(25.0)	7(29.2)	11(45.8)	1	1
	Primary	39(41.9)	20(21.5)	34(36.6)	0.316[0.096–1.036]	0.057
	Secondary	19(15.7)	31(25.6)	71(58.7)	1.502[0.449–5.023]	0.509
Staying with	Parents	28(36.4)	19(24.7)	30(39.0)	1	1
	Relative	14(33.3)	8(19.1)	20(47.6)	1.017[0.391–2.643]	0.972
	Partner	9(13.0)	12(17.4)	48(69.6)	3.869[1.146–13.060]	0.029*
	Alone	13(26.0)	19(38.0)	18(36.0)	1.246[0.464–3.346]	0.663
Marital Status	Married	22(20.6)	18(16.8)	67(62.6)	1	1
	Unmarried	42(32.1)	40(30.5)	49(37.4)	0.676[0.276–1.657]	0.392
Source of infection	Mother	32(45.1)	13(18.3)	26(36.6)	1	1
	Partner	27(19.6)	36(26.1)	75(54.3)	2.357[1.065–5.214]	0.034*
	Other	5(17.2)	9(31.0)	15(51.8)	2.114[0.595–7.512]	0.247
Community Support Factors	Unsupportive	16(24.2)	24(36.4)	26(39.4)	1	1
	Supportive	48(27.9)	34(19.8)	90(52.3)	1.746[0.773–3.943]	0.180

Notes: The bold values with asterisk (*) indicates the significant association of respective variables to be associated with HIV serostatus disclosure at 95% confidence level. Study participants who had contracted HIV from their partners were significantly (p=0.031) associated with one-way serostatus disclosure compared to non-disclosure. Study participants staying with their partners were significantly (p=0.029) associated with two-way disclosure compared to non-disclosure. Study participants who were perinatally infected were significantly (p=0.034) associated with two-way disclosure compared to non-disclosure.

Table 5 Socio-Demographic Characteristics of Participants Interviewed

Case No.	Sex	Age: 15–19 Years; 20–24 Years	Disclosed: 0=No; 1=Yes	Number of Sexual Partners	Type of Sexual Relationship: 1=Commitment to One Sexual Partner 2=Casual	Staying with: 1=Partner; 2=Parents; 3=Alone
1	Male	19	0	1	1	1
2	Male	20	0	4	2	3
3	Male	21	1	1	1	1
4	Female	17	1	1	1	1
5	Female	22	0	1	1	1
6	Female	21	1	1	1	1
7	Female	18	0	1	2	2
8	Female	19	0	1	2	2
9	Female	20	0	1	2	2
10	Male	20	1	1	2	2
11	Female	21	1	1	2	2
12	Male	23	0	5	2	3
13	Male	19	0	1	2	2
14	Female	20	1	1	1	1
15	Female	24	1	1	2	2
16	Male	21	1	1	1	1
17	Male	18	1	1	1	1
18	Male	22	1	1	2	2

Table 6 Codes and Theme Allocation for Reasons for HIV Serostatus Disclosure

Codes	Frequency (n=10)	Themes
Tired of being secretive.	7	Theme 1: Got tired of pretending and being secretive.
Cannot sustain a lie forever.	6
I love my partner.	3
Wanted peace.	5
Felt guilty always.	4
Got tired of pretending.	5
Storing medicine was a challenge.	2	Theme 2: Desire to adhere to Anti-retroviral medicine
Got tired of missing hospital appointments.	7
Not taking medicines as scheduled.	3
Health workers needed my partner to be tested too since I was pregnant.	2

Table 7 Codes and Theme Allocation for Reasons for Non-Disclosure of HIV Serostatus

Codes	Frequency (n=8)	Themes
Fear to be dropped.	5	Theme 1: Fear of stigma and discrimination
Fear to be abandoned.	4
Partners can disclose this to other people.	3
Partner, not my future husband.	3
Fear to be blamed.	3
Partner is my provider.	3	Theme 2: Desire to continue accessing basic needs (poverty)
He takes care of me.	1
Partners can get traumatized.	1	Theme 3: Prevent causing trauma to a sexual partner
Cannot break the bad news.	1