Are HIV unaware persons the hidden population at high risk of HIV infection or re-infection in Uganda

Abstract

Introduction: There has been a prejudiced view that HIV infection creates a state of desperation and a feeling of revenge that latently drives persons with HIV/AIDS (PHAs) into risky sexual and reproductive behaviors. This study examined child bearing, new sexual partnerships, disclosure of HIV status prior to coitus, and negotiations on condom use among HIV infected, uninfected and unaware persons as the basis for ascertaining the group at high risk of HIV infection/re-infection. Methods: HIV infected (86 females and 58 males), HIV uninfected (25 females and 21 males) and HIV unaware (59 males and 40 females) persons were drawn from one parish of Kampala, Iganga, Soroti,Lira, Masaka, Mbarara and Kabale districts. A pre-tested questionnaire which yielded a content validity index (CVI) of .79 was used to measure child bearing, new sexual partnerships, disclosure of HIV status prior to coitus, negotiations on condom use for the three groups. Focus group discussions were also carried out with each group to establish the etiological basis of these behaviors. Results: HIV infected persons (86%) reported higher levels of child bearing compared to the uninfected (66%) and unaware (57%) persons. Of the HIV infected persons who learned of their HIV status through a test, about 61% went a head to bear children. Also, more HIV infected (44%) and uninfected persons (44%) tend to disclose to partners their HIV status prior to coitus than the HIV unaware persons (35%). However, HIV unaware and uninfected persons reported higher levels of initiation and coitus with new partners during the past year from the time this study was undertaken than the HIV infected persons. Also, HIV unaware (77%) and uninfected persons (77%) reported higher levels of negotiations on the form of coitus (condom use) than the HIV infected (69%). This is especially so because it is easier to declare the HIV status if the test results are negative than positive., Males specifically surfaced as the group more complacent to risky sexual and reproductive behaviors, implying that they are more likely to spread HIV than females. Conclusion: Childbearing and non-negotiation with partners on condom use turned out as the factors that increase HIV re-infection among PHAs. However, initiation of new sexual relationships and despondency about disclosing their HIV status to partners prior to coitus seem to be the critical risk factors for HIV transmission among the HIV unaware persons. HIV unaware persons feel that if they disclosed their sero-status their partners would be scared and possibly stop the relationship on the suspicion that they have HIV/AIDS. False confidence arising out of the cognition and imagination that the problem of HIV/AIDS is not in vicinity motivates HIV unaware persons to think positively about sexual situations that, in effect, increase the risk of HIV infection. While more research merits in this area, broaden advocacy for and the coverage of all HIV/AIDS preventive campaigns to not only target the HIV infected, but also uninfected and unaware persons.