title: Factors affecting disclosure in South African HIV-positive pregnant women.
abstract: To provide understanding of social and psychological factors that affect disclosure of HIV status among women diagnosed HIV-positive in pregnancy, 438 HIV positive women attending antenatal al clinics in Pretoria, South Africa were invited to participate in a longitudinal study. A total of 293 (62%) women were enrolled from June 2003 to December 2004. Questionnaires assessing sociodemographics and psychological measures were administered during pregnancy and at 3 months postdelivery. At enrollment, 59% had disclosed to their partners and 42% to others. This rose to 67% and 59%, respectively, by follow-up. Logistic regression analysis identified being married (adjusted odds Ratio [AOR] 2.32; 95% confidence interval [CI] 1.20-4.47), prior discussion about testing (AOR 4.19; CI 2.34-7.49), having a partner with tertiary education (AOR 2.76; CI 1.29-5.88) and less experience of violence (AOR 0.48; CI 0.24-0.97) as factors associated with having disclosed to partners prior to enrollment. Better housing (AOR 1.26; CI 1.06-1.49), less financial dependence on partners (AOR 0.46; CI 0.25-0.85), and knowing someone with HIV (AOR 2.13; CI 1.20-3.76) were associated with prior disclosure to others. Increased levels of stigma at baseline decreased the likelihood of disclosure to partners postenrollment (AOR 0.91; CI 0.84-0.98) and increased levels of avoidant coping decreased subsequent disclosure to others (AOR 0.84; CI 0.72-0.97). These results provide understanding of disclosure for women diagnosed as HIV positive in pregnancy, and identify variables that could be used to screen for women who require help.
authors.affiliation: Department of Obstetrics and Gynaecology, University of Pretoria/Medical Research Unit for Maternal and Infant Health Care Strategies, Pretoria, Gauteng, South Africa. jmakin@kalafong.up.ac.za
authors.forename: Jennifer D
authors.initials: JD
authors.lastname: Makin
authors.forename: Brian W C
authors.initials: BW
authors.lastname: Forsyth
authors.forename: Maretha J
authors.initials: MJ
authors.lastname: Visser
authors.forename: Kathleen J
authors.initials: KJ
authors.lastname: Sikkema
authors.forename: Sharon
authors.initials: S
authors.lastname: Neufeld
authors.forename: Bridget
authors.initials: B
authors.lastname: Jeffery
mesh_terms: D015492:AIDS Serodiagnosis; D003710:Demography; D030881:Disclosure; D005260:Female; D006679:HIV Seropositivity / Q000523:psychology*; D006801:Humans; D008137:Longitudinal Studies; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000523:psychology* / Q000821:virology; D011584:Psychology; D012307:Risk Factors; D012747:Sexual Partners; D012959:Socioeconomic Factors; D013019:South Africa; D011795:Surveys and Questionnaires