|Year : 2017 | Volume
| Issue : 1 | Page : 24-28
Serostatus disclosure to sexual partner by human immunodeficiency virus-positive clients receiving antiretroviral therapy in a tertiary health facility in Northwest Nigeria
Sulaiman Saidu Bashir1, Muhammed S Ibrahim1, Matthias O Ekpenukpang2, Samira G Ahmed3
1 Department of Community Medicine, Ahmadu Bello University, Zaria, Nigeria
2 Faculty of Medicine, Ahmadu Bello University, Zaria, Nigeria
3 Department of Family Medicine, Ahmadu Bello University Teaching Hospital, Shika-Zaria, Kaduna State, Nigeria
|Date of Web Publication||13-Sep-2017|
Sulaiman Saidu Bashir
Department of Community Medicine, Ahmadu Bello University, Zaria
Source of Support: None, Conflict of Interest: None
Background: Disclosure of human immunodeficiency virus (HIV)-positive status to sexual partner is crucial and helpful for treatment adherence, HIV transmission reduction, PMTCT interventions, partner testing and acceptance of referrals for HIV-related care, treatment and support. This study assessed the awareness, practices as well as factors associated with serostatus disclosure among HIV positive clients receiving anti-retroviral treatment in a tertiary health facility in northwest Nigeria. Methodology: A cross-sectional study was conducted among 129 HIV positive clients receiving anti-retroviral therapy selected using a systematic random sampling technique. Data were collected using a structured interviewer-administered questionnaire containing open- and close-ended questions, and analyzed using SPSS Statistics version 21.0. Result: The mean age of respondents was 38.0 ± 10.6 years and most (89.9%) of the respondents were on antiretroviral therapy for more than one year. Majority of the respondents have a positive attitude to serostatus disclosure (67.4%) and have disclosed their serostatus to their partner (79.8%), but only 57.3% did so within one month of knowing their serostatus. Their main reason for disclosure were concern for partner's health (74.6%) while partners' reactions were supportive in 35% and understanding in 21.4% of respondents. Disclosure was high among those currently married (odds ratio = 0.075 96% confidence interval: 0.0230-0.237, P = 0.001) but there was no statistically significant association between disclosure and age, gender, religion, educational status and average monthly income. Conclusion: This study found a good partner disclosure rate of HIV serostatus among PLWHA receiving treatment at Nasara Clinic, ABUTH, and client's marital status as currently married was a significant factor that influenced disclosure rate.
Keywords: Disclosure, partner, serostatus
|How to cite this article:|
Bashir SS, Ibrahim MS, Ekpenukpang MO, Ahmed SG. Serostatus disclosure to sexual partner by human immunodeficiency virus-positive clients receiving antiretroviral therapy in a tertiary health facility in Northwest Nigeria. Arch Med Surg 2017;2:24-8
|How to cite this URL:|
Bashir SS, Ibrahim MS, Ekpenukpang MO, Ahmed SG. Serostatus disclosure to sexual partner by human immunodeficiency virus-positive clients receiving antiretroviral therapy in a tertiary health facility in Northwest Nigeria. Arch Med Surg [serial online] 2017 [cited 2019 Mar 23];2:24-8. Available from: http://www.archms.org/text.asp?2017/2/1/24/214556
| Introduction|| |
As at 2013, it was estimated that there were more than 35 million people living with human immunodeficiency virus (HIV). Nigeria represents 9% and 13% of the global and Sub-Saharan Africa burden of the disease, respectively., National prevalence rate was 3.6% in 2013. In the same year, 19% of acquired immunodeficiency syndrome (AIDS)-related death in Sub-Saharan Africa occurred in Nigeria where only two in every ten people living with HIV/AIDS (PLWHA) have access to treatment.
Pivotal to the prevention and control of the HIV/AIDS epidemic is serostatus disclosure. Serostatus disclosure is the process of revealing one's HIV status to those that are important to the patient, i.e., people that are affected by his/her HIV status; sexual partners, children, and other patient's dependents. While the disclosure stands the chance of receiving social support, improved access to necessary medical care, and emotional catharsis among others benefits, a study has reported a desirable relationship between serostatus disclosure and absolute CD4 cell count over time., In the context of society and community, disclosure is thought to be important for public health purposes in terms of preventing the spread of HIV; as early disclosure of HIV-positive status to sexual partner is crucial and helpful for treatment adherence, HIV transmission reduction, prevention of mother-to-child transmission (PMTCT) interventions, partner testing, and acceptance of referrals for HIV-related care, treatment, and support.,
On the other hand, disclosure of HIV status may pose complex lifelong psychosocial challenges to PLWHA, with a negative outcome that includes neglect by partner, divorce/separation from spouse and/or family, stigmatization, physical abuse from partner (especially in the case of a female discloser), and accusations of infidelity.,, This necessitated the WHO and UNAIDS advocacy of “beneficial disclosure” anchored on the need for individuals to have control over if, how, and when to tell others about their HIV-positive status.,
Thus, beneficial disclosure is disclosure that is voluntary; respects the autonomy and dignity of the affected individuals; maintains confidentiality as appropriate; leads to beneficial results for the individual, his/her sexual and drug-injecting partners, and family; leads to greater openness in the community about HIV/AIDS; and meets ethical imperatives so as to maximize good for both the uninfected and the infected., Furthermore, a six-step framework has been developed for the process of disclosure with each step including dilemmas, barriers, and decisions. These steps are adjustment to the diagnosis, evaluation of personal disclosure skills, evaluating the appropriateness of disclosing to a potential recipient, evaluating the circumstances for disclosure, anticipating the reactions of the potential recipients, as well as identifying the motivation for disclosure to each recipient.
As prevention and control of HIV infection hinge on the success of strategies to prevent new infections and to treat currently infected individuals, one way to curb the spread of the virus may be to encourage infected individuals to communicate their disease status to their sexual partners.,,, Potential benefits of HIV serostatus disclosure of an individual include increased opportunities for instrumental and expressive social support, improved access to necessary medical treatment and care, as well as increased opportunities to discuss and implement HIV risk reduction with partners. Other benefits include increased opportunities to plan for the future carefully and thoughtfully, as well as behavioral modification that may improve the management of HIV vis-à-vis better adherence to antiretroviral therapy (ART)., Serostatus disclosure can inform regularity in clinic and care and support group meeting , and participation in programs for PMTCT of the disease.
Some studies have reported factors that influence awareness and disclosure of HIV serostatus to include long-term romantic relationship, fear of divorce, physical abuse, gender,, monogamous setting,, educational and financial status  as well as the need for treatment and counseling by health workers.
Despite the public health benefits of disclosure that include expanded awareness of risk that may lead to decreased sexual risk taking and ultimately decreased transmission of HIV, improvement of access to treatment and motivation of partners for voluntary counseling and testing; there is a paucity of data on this subject both at national as well as state levels. In fact, this information is conspicuously missing from Nigeria Demographic Health Survey. This study assessed the awareness, practices as well as factors associated with serostatus disclosure among PLWHA receiving antiretroviral treatment. Studies like this can provide a proxy appraisal of the recently passed HIV/AIDS Anti-Discrimination Bill of 2014 aimed at boosting confidence and self-esteem of PLWHA in Nigeria.
| Materials and Methods|| |
The study was conducted from October to December 2014 at Nasara Clinic and Treatment Centre of the Ahmadu Bello University Teaching Hospital (ABUTH), Shika-Zaria in Kaduna State, Nigeria. Established in November 2008, the center provides free HIV care and treatment among several other services and has 4446 clients enrolled on ART; 3972 in adult clinic, 125 in PMTCT, and 349 in pediatric clinic.
A cross-sectional descriptive study design was adopted, and an estimated minimum sample size determined using the formula, where n is the desired sample size for large or infinite population, Z = standard normal deviation at 95% confidence interval (CI) (1.96), P = partner disclosure rate of 90.5% (0.905) from a previous study in Nnewi, Nigeria,q = complementary probability, (1 − p), which is 9.5% (0.095) while d = margin of error tolerance for 95% CI taken as 0.05. An allowance for a small or finite population N of patient load of 4446 at Nasara, clinic, using the formula:
A provision was made for an anticipated nonresponse rate of 10%, giving a final estimated sample size of 141. A systematic random sampling technique was used to select respondents over 10 clinic days. With average attendance per clinic day of 50, 13 clients were randomly selected per clinic day. On each clinic day, a number between 1 and 3 (sampling fraction) was randomly picked by balloting, and using the clinic attendance register, with a sampling interval of 3, the third respondent from the randomly selected number (1–3) was automatically selected until a maximum of 13 respondents have been randomly selected on each of ten clinic days; data were collected.
Trained research assistants collected data on ten clinic days (over a period of 4 weeks) using a structured, interviewer-administered questionnaire. Data were checked for completeness and accuracy, and 129 questionnaires have met these criteria. The data were then analyzed using IBM SPSS statistic Version 21.0 by IBM Corp, Armonk, NY, USA. Chi-square test was used to test for statistical significance of association between categorical variables with P = 0.05.
In the analysis, using a measurement scale developed by the author(s), a client was considered to have had a positive attitude if at least 8 out of the 15 questions asked are correctly answered. A client was considered to have disclosed HIV serostatus to partner if the answer to the questions, “Have you disclosed to your partner that you are HIV positive?” was Yes. While appropriate disclosure was assumed to have occurred if a client serostatus was disclosed to clients' partner within 4 weeks of knowing HIV serostatus or starting a relationship.
Ethical clearance was obtained from the Ethical and Scientific Committee of the ABUTH, Shika-Zaria (ABUTH/HREC/TRG/36). Participation in this study was voluntary, and before enrollment, each participant gave informed consent and was assured of the privacy and confidentiality of the responses to be provided.
| Results|| |
A total of 129 out of 141 respondents were successfully interviewed, giving a response rate of 91.5%. The mean age of respondents was 38.0 ± 10.6 years, and most (89.9%) of the respondents have been on ART for >1 year and a male:female ratio of 1:2 [Table 1].
While most respondents were aware of serostatus disclosure 110 (85.3%), with their main source of information being the clinic 65 (59.1%), attitude was positive in 87 (67.4%) respondents. Overall, most of the respondents 103 (79.8%) have disclosed their serostatus to their sexual partner [Table 2]. The main reasons for the serostatus disclosure include concern for the health of the partners by 77 (74.6%) as well as the need for the partner to know by 67 (65.0%) respondents [Table 3].
|Table 2: Awareness attitude and human immunodeficiency virus serostatus disclosure practices of respondents (n=129)|
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|Table 3: Self-reported reason for disclosure of human immunodeficiency virus serostatus by respondents (n=103)|
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Partners' reaction to disclosure was supportive in 36 (35.0%) and understanding in 22 (21.4%) respondents [Table 4]. Although age, gender, religion, marital status, place of residence, and level of education showed some relationships with status disclosure, only marital status showed a statistically significant association [Table 5].
|Table 5: Factors associated with human immunodeficiency virus serostatus disclosure|
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| Discussion|| |
Despite stigmatization being a source of concern among PLWHA, the high prevalence of positive attitude toward status disclosure among the clients studied could have occurred as a result of concern for the health of the partner and the need for the partner to know and perhaps the several antidiscriminatory measures in place as well as awareness campaigns.
The prevalence rate of HIV status disclosure to sexual partners in this study was found to be 79.8%. While this finding is much higher than those reported from Kwara (39.5%) and Ogun (50.9%),, it falls within the range of 77%–97.5% observed in various parts of the country ,,, and continent.,, Furthermore, the finding that concern for partner's health was the main reason for status disclosure to sexual partner and provides a unique opportunity in keeping with the ultimate goal of prevention of new HIV infection.
Despite the fact that most PLWHA had disclosed to their partners in this study, there was still the worrisome challenge of inappropriate disclosure practice in a little more than a half of the respondents, which is higher than the 42.5% inappropriate disclosure reported in a study in Ilorin. This delayed disclosure may be almost as bad as nondisclosure because it often precludes negotiation for safe sex. However, it is lower than the appropriate disclosure practice in 78% of respondents, as reported from a study among pregnant women in Tanzania.
While perceived lack of communication skill was a common reason for nondisclosure in Kenya  and Ethiopia, the finding from this study that the clinic, being the main source of awareness on status disclosure, underscores the role of health-care professionals in facilitating HIV status disclosure to sexual partners as well as the need to optimize the quality of posttest counseling and counselor-facilitated disclosure approach.
However, low level of support and understanding from partners following serostatus disclosure by respondents corroborate similar finding from studies across Africa.,, Although economic dependency has been reported as a factor that delays disclosure, this study found a higher disclosure rate among respondents with lesser estimated monthly income.
On the other hand, this study found that serostatus disclosure to partners was irrespective of the client's age which is in contrast to findings of a study conducted in Ogun State that reported a statistically significant relationship between disclosure and client's age. Although disclosure was higher among females and the relatively more educated respondents, the associations were not statistically significant. However, the finding that the currently married are more likely to disclose their HIV serostatus to their sexual partner is similar to findings that have been previously documented in South Africa and Nigeria., This corroborates earlier reported reasons for partner disclosure by respondents of this study.
| Conclusion and Recommendation|| |
This study found a good HIV serostatus partner disclosure rate among PLWHA receiving treatment at Nasara Clinic and ABUTH, and clients' marital status as currently married was a significant factor that influenced disclosure rate. Consequently, the study recommends that HIV program managers are to engage other relevant stakeholders, in addition to the clinics, to promote status disclosure to partners as well as solicit for the appropriate reactions and support for the PLWHA. In addition, health-care providers should, during their clinic interaction with PLWHA, identify those who may require disclosure facilitation, especially among clients who are not currently married.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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[Table 1], [Table 2], [Table 3], [Table 4], [Table 5]