title: Antiretroviral Therapy Availability and HIV Disclosure to Spouse in Rakai, Uganda: A Longitudinal Population-Based Study.
abstract: BACKGROUND
  A decade after the rollout of antiretroviral therapy (ART) in sub-Saharan Africa, the effects of this structural change on social aspects of HIV, such as rates of HIV disclosure to partners, remain largely unmeasured. We evaluated whether the introduction of ART was associated with disclosure of HIV diagnosis to spouses in Rakai, Uganda, using longitudinal, population-based data.
  
  
  METHODS
  We identified individuals in marital/cohabitating unions who were newly diagnosed with HIV in Rakai Community Cohort Study surveys between 2000 and 2008, where ART was introduced in mid-2004. Using discrete-time survival analysis, we assessed the hazard of self-reported HIV disclosure to spouse after diagnosis pre-ART and post-ART rollout, adjusting for individual and union characteristics. Disclosure in the ART period was further stratified by ART initiation.
  
  
  RESULTS
  The analysis included 557 married adults, 264 of whom were diagnosed with HIV before ART was available (2000-2004), and 293 diagnosed after ART was introduced (2005-2008). The cumulative incidence of self-reported disclosure was 75.2% in the post-ART period, compared with 58.3% before ART availability [P < 0.001, adjusted hazard ratio: 1.46 (95% confidence interval: 1.16 to 1.83)]. In the post-ART period, observed disclosure rates were 39% (72 of 184) among those not in HIV care, 65% (82 of 126) among those in pre-ART care, and 85% (64 of 75) among persons on ART (P < 0.001).
  
  
  CONCLUSIONS
  Treatment availability and use, especially ART initiation, was associated with increased self-disclosure of HIV diagnosis to partners. ART access may facilitate the prevention of transmission to uninfected partners and linkage to treatment for infected couples.
authors.affiliation: *Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; †Rakai Health Sciences Program, Entebbe, Uganda; and ‡Department of Population, Family, and Reproductive Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
authors.forename: Sabina A
authors.initials: SA
authors.lastname: Haberlen
authors.forename: Gertrude
authors.initials: G
authors.lastname: Nakigozi
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: Heena
authors.initials: H
authors.lastname: Brahmbhatt
authors.forename: Joseph
authors.initials: J
authors.lastname: Ssekasanvu
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Joseph
authors.initials: J
authors.lastname: Kagaayi
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active / Q000706:statistics & numerical data*; D003625:Data Collection; D018562:Disease Transmission, Infectious / Q000517:prevention & control; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000517:prevention & control / Q000523:psychology*; D006297:Health Services Accessibility; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D012650:Self Disclosure; D018454:Spouses; D014454:Uganda
chemical_list: D044966:Anti-Retroviral Agents