Research Article: When Do HIV-Infected Women Disclose Their HIV Status to Their Male Partner and Why? A Study in a PMTCT Programme, Abidjan

Date Published: December 1, 2007

Publisher: Public Library of Science

Author(s): Hermann Brou, Gérard Djohan, Renaud Becquet, Gérard Allou, Didier K Ekouevi, Ida Viho, Valériane Leroy, Annabel Desgrées-du-Loû, Lynne Mofenson

Abstract: BackgroundIn Africa, women tested for HIV during antenatal care are counselled to share with their partner their HIV test result and to encourage partners to undertake HIV testing. We investigate, among women tested for HIV within a prevention of mother-to-child transmission of HIV (PMTCT) programme, the key moments for disclosure of their own HIV status to their partner and the impact on partner HIV testing.Methods and FindingsWithin the Ditrame Plus PMTCT project in Abidjan, 546 HIV-positive and 393 HIV-negative women were tested during pregnancy and followed-up for two years after delivery. Circumstances, frequency, and determinants of disclosure to the male partner were estimated according to HIV status. The determinants of partner HIV testing were identified according to women’s HIV status. During the two-year follow-up, disclosure to the partner was reported by 96.7% of the HIV-negative women, compared to 46.2% of HIV-positive women (χ2 = 265.2, degrees of freedom [df] = 1, p < 0.001). Among HIV-infected women, privileged circumstances for disclosure were just before delivery, during early weaning (at 4 mo to prevent HIV postnatal transmission), or upon resumption of sexual activity. Formula feeding by HIV-infected women increased the probability of disclosure (adjusted odds ratio 1.54, 95% confidence interval 1.04–2.27, Wald test = 4.649, df = 1, p = 0.031), whereas household factors such as having a co-spouse or living with family reduced the probability of disclosure. The proportion of male partners tested for HIV was 23.1% among HIV-positive women and 14.8% among HIV-negative women (χ2 = 10.04, df = 1, p = 0.002). Partners of HIV-positive women who were informed of their wife's HIV status were more likely to undertake HIV testing than those not informed (37.7% versus 10.5%, χ2 = 56.36, df = 1, p < 0.001).ConclusionsIn PMTCT programmes, specific psychosocial counselling and support should be provided to women during the key moments of disclosure of HIV status to their partners (end of pregnancy, weaning, and resumption of sexual activity). This support could contribute to improving women's adherence to the advice given to prevent postnatal and sexual HIV transmission.

Partial Text: At the end of 2006, 63% of all people livingwith HIV/AIDS lived in sub-Saharan Africa [1]. Programmatic strategies for the prevention of sexual transmission of HIV need urgent development, assessment, and scale-up [2]. In African countries confronted with an HIV/AIDS pandemic, most cases of sexual transmission of HIV occur within stable relationships. In sub-Saharan Africa, Prevention within the couple is therefore of primary importance. In 2006, 59% of HIV-infected adults were women [1], and most of them had contracted HIV through sexual transmission from their stable partner [3].

In this study, almost all (96.7%) women who had been informed of their HIV-negative status notified their partner. Among HIV-infected women, less than half (46.2%) had disclosed to their partner at the end of the follow-up period. We have also highlighted the existence of three privileged moments for HIV-infected women’s disclosure to their partner: before delivery, upon resumption of sexual activity, and around early weaning for breast-feeding women. For HIV-negative women, we had already described in a previous study that most of them informed their partner of their testing before delivery [7]. Only one in five male partners were tested for HIV. Partners informed of their wife’s HIV status were more likely to undertake HIV testing, in particular when the woman tested HIV-positive.