title: HIV-positive status disclosure and use of essential PMTCT and maternal health services in rural Kenya.
abstract: BACKGROUND
  In sub-Saharan Africa, women's disclosure of HIV-positive status to others may affect their use of services for prevention of mother-to-child transmission of HIV (PMTCT) of HIV and maternal and child health-including antenatal care, antiretroviral drugs (ARVs) for PMTCT, and skilled birth attendance.
  
  
  METHODS
  Using data from the Migori and AIDS Stigma Study conducted in rural Nyanza Province, Kenya, we compared the use of PMTCT and maternal health services for all women by HIV status and disclosure category (n = 390). Among HIV-infected women (n = 145), associations between disclosure of HIV-positive status and the use of services were further examined with bivariate and multivariate logistic regression analyses.
  
  
  RESULTS
  Women living with HIV who had not disclosed to anyone had the lowest levels of maternity and PMTCT service utilization. For example, only 21% of these women gave birth in a health facility, compared with 35% of HIV-negative women and 49% of HIV-positive women who had disclosed (P < 0.001). Among HIV-positive women, the effect of disclosure to anyone on ARV drug use [odds ratio (OR) = 5.8; 95% confidence interval (CI): 1.9 to 17.8] and facility birth (OR = 2.9; 95% CI: 1.4 to 5.7) remained large and significant after adjusting for confounders. Disclosure to a male partner had a particularly strong effect on the use of ARVs for PMTCT (OR = 7.9; 95% CI: 3.7 to 17.1).
  
  
  CONCLUSIONS
  HIV-positive status disclosure seems to be a complex yet critical factor for the use of PMTCT and maternal health services in this setting. The design of interventions to promote such disclosure must recognize the impact of HIV-related stigma on disclosure decisions and protect women's rights, autonomy, and safety.
authors.affiliation: *Nell Hodgson Woodruff School of Nursing and Hubert Department of Global Health (HDGH), Emory University, Atlanta, GA; †Centre for Microbiology Research, Kenya Medical Research Institute (KEMRI), Centre for Microbiology Research, Nairobi, Kenya; ‡Department of Obstetrics, Gynecology, and Reproductive Sciences, University of California, San Francisco (UCSF), San Francisco, CA; and §Department of Health Care Organization and Policy, University of Alabama at Birmingham (UAB), Birmingham, AL.
authors.forename: Sydney A
authors.initials: SA
authors.lastname: Spangler
authors.forename: Maricianah
authors.initials: M
authors.lastname: Onono
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Bukusi
authors.forename: Craig R
authors.initials: CR
authors.lastname: Cohen
authors.forename: Janet M
authors.initials: JM
authors.lastname: Turan
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000523:psychology* / Q000635:transmission*; D006801:Humans; D018445:Infectious Disease Transmission, Vertical / Q000517:prevention & control*; D007630:Kenya; D008137:Longitudinal Studies; D008297:Male; D008427:Maternal Health Services / Q000706:statistics & numerical data*; D008875:Middle Aged; D011247:Pregnancy; D057545:Social Stigma; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents