Facilitators and barriers of self-disclosure of HIV status among adolescents aged 10-19 years in Makerere University Joint Aids Program

Abstract

Introduction: By the end of 2018 there were about 37.9 million people living with HIV globally. Adolescents account for about 5 per cent of these people and about 10 per cent of new adult HIV infections. In Uganda, 1.4 million people are living with HIV with a prevalence 5.7% among 15-49-year olds. Despite efforts and regulation for mandatory disclosure, non-disclosure of HIV sero-status to others remains high, which contributes to the high rates of new infections, poor adherence to treatment and low retention in care. There are few studies reporting the magnitude, facilitators, and barriers of self-disclosure of HIV status among adolescents in Uganda especially in the era of „Test and Treat.‟ The study aimed at exploring the facilitators, barriers, and consequences of self-disclosure among adolescents attending Makerere University Joint AIDS Program (MJAP) clinic. Methods: This was a mixed methods study conducted at Makerere University Joint AIDS Program‟s ISS Clinic, Mulago. The clinic takes care of over 280 adolescents. Respondents were 161 adolescents 10-19 years who knew their HIV status, and 7 health care workers that had worked at the adolescents‟ clinic for at least 3 months. For the quantitative component of the study, data was collected from the 161 adolescents on basic demographics, the person who disclosed HIV sero-status to the adolescents and whether the adolescents had disclosed their status to someone else. The qualitative component of the study, 20 adolescent In-depth interviews and 7 Key Informant interviews were conducted using semi-structured interview guides to obtain information about the facilitators, barriers, and consequences of self-disclosure. Quantitative data was analyzed using STATA version 14.0. Descriptive statistic was used and factors associated with self-disclosure calculated using logistic regression. Qualitative data was analyzed using content thematic approach. Results: The average age of the adolescents was 16 years (IQR 12-18); 54% were females, 68% were in school, and 21.1% total orphans, 42.9% were disclosed to by parents. Overall 46% of the 161 adolescents had disclosed their sero-status to someone else including friends, relatives, and sexual partners. From quantitative methods, more self-disclosure was observed among older adolescents [COR-2.69 (1.19, 6.09), p 0.017, orphans [AOR-4.24 (1.79, 10.04), p 0.001], those not in school [COR-2.73 (1.37, 5.41), p 0.004]. Less self-disclosure was observed among those with stigma [COR-2.7 (1.37, 5.31), p 0.004] and mother alive [COR- 2.51 (1.29, 4.89), p 0.007]. Facilitators to self-disclosure included; need for support, knowledge about HIV, built trust, continued counselling and peer-to-peer interactions. Barriers to self-disclosure included; stigma, lack of knowledge of how to start, parental influence, and desire for HIV negative partner, others found no need to disclose. Among those who disclosed, positive consequences included; support, viral suppression, happiness and sensitization of others. Negative consequences included; domestic violence, rejection by friends and/or relatives, job loss, and depression among others. Conclusion: The rate of self-disclosure in this study was relatively low, with stigma as a major barrier and need for support as a major facilitator. Recommendation: There is a need for key stakeholders like clinicians and peer counsellors to develop strategies to overcome the barriers and improve self-disclosure among adolescents as a strategy to increase ART adherence, retention in care and reduction of HIV transmission.