HIV disclosure patterns, predictors, and psychosocial correlates among HIV positive women in Zimbabwe

Abstract

Disclosure of positive HIV status in Sub-Saharan Africa has been associated with safer sexual practices and better antiretroviral therapy (ART) adherence, but associations with psychosocial function are unclear. We examined patterns and psychosocial correlates of disclosure in a Zimbabwean community. Two hundred HIV positive women at different stages of initiating ART participated in a cross-sectional study examining actual disclosures, disclosure beliefs, perceived stigma, self-esteem, depression, and quality of life. Ninety-seven percent of the women disclosed to at least one person, 78% disclosed to their current husband/partner, with an average disclosure of four persons per woman. The majority (85–98%) of disclosures occurred in a positive manner and 72–95% of the individuals reacted positively. Factors significantly correlated with HIV disclosure to partners included being married, later age at menses, longer duration of HIV since diagnosis, being on ART, being more symptomatic at baseline, ever having used condoms, and greater number of partners in the last year. In multivariate analysis, being married and age at menses predicted disclosure to partners. Positive disclosure beliefs, but not the total number of disclosures, significantly correlated with lower perceived stigma (ρ = 0.44 for personalized subscale and ρ = 0.51 for public subscale, both p<0.0001), higher self-esteem (ρ = 0.15, p=0.04), and fewer depressive symptoms (ρ = –0.14, p=0.05). In conclusion, disclosure of positive HIV status among Zimbabwean women is common and is frequently met with positive reactions. Moreover, positive disclosure beliefs correlate significantly with psychosocial measures, including lower perceived stigma, higher self-esteem, and lower depression.

Keywords:

• HIV disclosure
• stigma
• depression
• antiretroviral therapy
• Zimbabwe
• Sub-Saharan Africa

Acknowledgements

We acknowledge foremost the Zimbabwean women's participation in this project. Thank you to the staff at Zimbabwean AIDS Prevention Project (ZAPP) for providing support during study implementation. Thank you to Dr Mark Vosvick for providing guidance on the psychosocial measures, Dr Albert Wu on the MOS-HIV QOL analysis, and Dr Alex McMillian on statistical analysis. This study was supported by Medical Scholars Fellowship at Stanford University School of Medicine, National Institutes of Health (NIAID R01 AI060399), and the Fogarty International Center (ICOHRTA U2R TW006878).