title: Double disclosure bind: complexities of communicating an HIV diagnosis in the context of unintended pregnancy in Durban, South Africa.
abstract: Disclosure of HIV status is widely promoted in the prevention of mother-to-child transmission (PMTCT), but a number of context-specific factors may mediate disclosure outcomes. To better understand HIV-disclosure dynamics, we conducted in-depth interviews among 62 HIV-positive pregnant women accessing PMTCT services in Durban, South Africa. Transcripts were coded for emergent themes and categories. Thirty-nine women (63 %) had been recently diagnosed with HIV; most (n = 37; 95 %) were diagnosed following routine antenatal HIV testing. Forty-two women (68 %) reported unplanned pregnancies. Overall, 37 women (60 %) reported an unintended pregnancy and recent HIV diagnosis. For them, 2 life-changing diagnoses had resulted in a double-disclosure bind. The timing and stigma surrounding these events strongly influenced disclosure of pregnancy and/or HIV. PMTCT-related counseling must be responsive to the complex personal implications of contemporaneous, life-changing events, especially their effect on HIV-disclosure dynamics and, ultimately, on achieving better maternal mental-health outcomes.
authors.affiliation: Department of Public Health Medicine, University of KwaZulu-Natal, Durban, South Africa, tlcrankshaw@gmail.com.
authors.forename: Tamaryn L
authors.initials: TL
authors.lastname: Crankshaw
authors.forename: Anna
authors.initials: A
authors.lastname: Voce
authors.forename: Rachel L
authors.initials: RL
authors.lastname: King
authors.forename: Janet
authors.initials: J
authors.lastname: Giddy
authors.forename: Nicolas M
authors.initials: NM
authors.lastname: Sheon
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Butler
mesh_terms: D000328:Adult; D003376:Counseling; D005260:Female; D015658:HIV Infections / Q000175:diagnosis* / Q000523:psychology; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control; D007407:Interviews as Topic; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000517:prevention & control / Q000523:psychology*; D049168:Pregnancy, Unplanned / Q000523:psychology*; D036301:Qualitative Research; D057545:Social Stigma; D012944:Social Support; D013019:South Africa; D014342:Truth Disclosure; D014505:Urban Population; D055815:Young Adult