title: Community Cultural Norms, Stigma and Disclosure to Sexual Partners among Women Living with HIV in Thailand, Brazil and Zambia (HPTN 063).
abstract: Serostatus disclosure may facilitate decreased HIV transmission between serodiscordant partners by raising risk awareness and heightening the need for prevention. For women living with HIV (WLWH), the decision to disclose may be influenced by culturally determined, community-level stigma and norms. Understanding the impact of community HIV stigma and gender norms on disclosure among WLWH in different countries may inform intervention development.
  
  
  
  HPTN063 was a longitudinal, observational study of sexually active HIV-infected individuals, including heterosexual women, in care in Zambia, Thailand and Brazil. At baseline, a questionnaire measuring community HIV stigma and gender norms, anticipated stigma, demographic, partner/relationship characteristics, and intimate partner violence was administered. Longitudinal HIV disclosure to sexual partners was determined via audio-computer assisted self-interview (ACASI) at the baseline and quarterly during the one year following up. Logistic regression was conducted to identify the predictors of disclosure.
  
  
  
  Almost half (45%) of women living with HIV acknowledged perceived community HIV stigma (the belief that in their community HIV infection among women is associated with sex work and multiple sexual partners). Many women (42.9%) also acknowledged perceived community gender norms (the belief that traditional gender norms such as submissiveness to husbands/male sexual partners is necessary and that social status is lost if one does not procreate). HIV disclosure to current sex partners was reported by 67% of women. In multivariate analysis, among all women, those who were older [OR 0.16, 95%CI(0.06,0.48)], reported symptoms of severe depression [OR 0.53, 95%CI(0.31, 0.90)], endorsed anticipated stigma [OR 0.30, 95%CI(0.18, 0.50)], and were unmarried [OR 0.43, 95%CI(0.26,0.71)] were less likely to disclose to current partners. In an analysis stratified by marital status and cohabitation, unmarried [OR 0.41, 95%CI(0.20,0.82)] and non-cohabiting women [OR 0.31, 95%CI(0.13,0.73)] who perceived community HIV stigma were less likely to disclose to their sex partners.
  
  
  
  Perceived community level HIV stigma, along with individual level factors such as anticipated stigma, depressive symptoms, and older age, predict non-disclosure of HIV status to sexual partners among WLWH in diverse geographic settings. Interventions to promote disclosure among women in serodiscordant relationships should incorporate community-level interventions to reduce stigma and promote gender equality.
authors.affiliation: Division of Global Health Equity, Brigham and Women's Hospital, Boston, Massachusetts, United States of America.|Harvard Medical School, Boston, Massachusetts, United States of America.
authors.forename: Bisola O
authors.initials: BO
authors.lastname: Ojikutu
authors.affiliation: Statistical Center for HIV/AIDS Research and Prevention, University of Washington, Seattle, Washington, United States of America.
authors.forename: Subash
authors.initials: S
authors.lastname: Pathak
authors.affiliation: Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.|Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand.
authors.forename: Kriengkrai
authors.initials: K
authors.lastname: Srithanaviboonchai
authors.affiliation: University of Zambia, Lusaka, Zambia.
authors.forename: Mohammed
authors.initials: M
authors.lastname: Limbada
authors.affiliation: University of California Los Angeles, Los Angeles, California, United States of America.
authors.forename: Ruth
authors.initials: R
authors.lastname: Friedman
authors.affiliation: Statistical Center for HIV/AIDS Research and Prevention, University of Washington, Seattle, Washington, United States of America.
authors.forename: Shuying
authors.initials: S
authors.lastname: Li
authors.affiliation: Brown University School of Public Health, Providence, Rhode Island, United States of America.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mimiaga
authors.affiliation: Harvard Medical School, Boston, Massachusetts, United States of America.|The Fenway Institute, Boston, Massachusetts, United States of America.
authors.forename: Kenneth H
authors.initials: KH
authors.lastname: Mayer
authors.affiliation: University of Miami, Miami, Florida, United States of America.
authors.forename: Steven A
authors.initials: SA
authors.lastname: Safren
mesh_terms: D001938:Brazil; D005260:Female; D015658:HIV Infections; D006801:Humans; D012747:Sexual Partners; D013240:Stereotyping; D013785:Thailand; D014342:Truth Disclosure; D015024:Zambia