The Disclosure Dilemma: Willingness to Disclose a Positive HIV Status Among Individuals Preparing for HIV Testing During
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ORIGINAL PAPER
The Disclosure Dilemma: Willingness to Disclose a Positive HIV Status Among Individuals Preparing for HIV Testing During Antenatal Care in Tanzania Rimel N. Mwamba1 · Saumya S. Sao1 · Brandon A. Knettel1 · Linda M. Minja2 · Haika Osaki2 · Blandina T. Mmbaga1,2,3,4 · Melissa H. Watt1,5 Accepted: 30 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract HIV status disclosure can reduce transmission risks and improve care engagement. Individuals may have strong feelings about HIV disclosure even prior to diagnosis. We assessed willingness to disclose a positive HIV status among pregnant women and their male partners awaiting routine HIV testing during antenatal care in Tanzania (n = 939). Logistic regression models were used to examine factors associated with willingness to disclose to one’s inner circle (partner/family member) and outer circle (friend/neighbor) in the event of an HIV diagnosis. Almost all (93%) were willing to disclose to at least one person; participants were more willing to disclose to their inner circle (91%) vs outer circle (52%). Individuals with some form of employment, more stigmatizing attitudes of social distancing of PLWH, greater anticipated HIV stigma, more perceived social support, and prior contact with someone living with HIV were more likely to disclose to their inner circles. Individuals who were older, male, and who had higher levels of perceived social support were more willing to disclose to their outer circle. These findings increase the understanding of the intra- and interpersonal factors that influence HIV disclosure decisions. Tailored pre- and post- HIV test counseling are needed to facilitate social support and overcome barriers to disclosure if they test positive for HIV. Keywords Tanzania · HIV · Disclosure · Prevention of mother-to-child transmission of HIV
Introduction Among people living with HIV (PLWH), decisions related to whether, how, and when to disclose one’s positive HIV status can have far-reaching impacts for health and wellbeing. Across multiple studies and settings, serostatus disclosure has been associated with improved HIV care engagement, increased social support in managing the disease, and decreased risk of HIV transmission from unprotected sex * Rimel N. Mwamba [email protected] 1
Duke Global Health Institute, Duke University, 310 Trent Drive, Box 90519, Durham, NC 27710, USA
2
Kilimanjaro Clinical Research Institute, Moshi, Tanzania
3
Kilimanjaro Christian Medical Centre, Moshi, Tanzania
4
Kilimanjaro Christian Medical University College, Moshi, Tanzania
5
University of Utah, Salt Lake City, UT, USA
[1–3]. Conversely, PLWH who have not disclosed their HIV status are more likely to report symptoms of depression and describe their nondisclosure as a considerable source of worry and stress in their lives [4, 5]. Concealing a positive HIV status can lead to challenges in attending HIV clinic appointments, taking antiretroviral medication, and obtaining social support to effe
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