title: HIV-positive status disclosure in patients in care in rural South Africa: implications for scaling up treatment and prevention interventions.
abstract: A nuanced understanding of HIV-positive status disclosure is urgently needed to inform the implementation of prevention interventions, including TasP and PrEP. To provide such understanding for the high HIV-burden setting of rural KwaZulu-Natal, we conducted a prospective cohort study to characterize determinants and trends in HIV-positive status disclosure. 687 consenting HIV-positive individuals (73.2 % female; 60.3 % ART initiated) were enrolled. Reports of any incidence of disclosure to either a family member or sexual partner at enrollment and follow-up visits (median 4.4 months post-enrolment) were common (91.0 %); however, reports of disclosure specifically to sexual partners were relatively rare (34.1 %), especially in women (29.8 %). Participants not engaged in a stable partnerships, not ART-imitated, and/or who had disclosed to their family were at risk of non-disclosure to sexual partners. These data highlight both an urgent need to empower HIV-positive individuals, and the significant barriers to targeting sero-discordant couples for HIV prevention in this setting.
authors: Centre for the AIDS Programme of Research in South Africa (CAPRISA), Doris Duke Medical Research Institute, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa, quarraisha.abdoolkarim@caprisa.org.
authors: Quarraisha
authors: Q
authors: Abdool Karim
authors: Rachael C
authors: RC
authors: Dellar
authors: Benjamin
authors: B
authors: Bearnot
authors: Lise
authors: L
authors: Werner
authors: Janet A
authors: JA
authors: Frohlich
authors: Ayesha B M
authors: AB
authors: Kharsany
authors: Salim S
authors: SS
authors: Abdool Karim
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control; D006679:HIV Seropositivity / Q000188:drug therapy* / Q000523:psychology; D006801:Humans; D015994:Incidence; D008297:Male; D011446:Prospective Studies; D012424:Rural Population / Q000706:statistics & numerical data*; D012959:Socioeconomic Factors; D013019:South Africa / Q000453:epidemiology; D014342:Truth Disclosure
chemical_list: D044966:Anti-Retroviral Agents