Prevalence and factors associated with disclosure of HIV serostatus to sexual partners among HIV positive breastfeeding women attending eMTCT clinics in Jinja District, Uganda

Abstract

Introduction There is a low proportion of HIV positive individuals who disclose their HIV positive status to their sexual partners globally ranging between 16.7 - 46%. This results into poor adherence and poor appointments keeping, ART treatment failure with subsequent increased morbidity and mortality among HIV positive breastfeeding women and their HIV exposed babies. This would undermine the global goal of zero new HIV infections. This study sought to determine the prevalence and factors associated with disclosure of HIV status to sexual partners among HIV positive breastfeeding women attending eMTCT clinics in Jinja district. Methodology This was a cross sectional mixed method study carried out among HIV positive breastfeeding women attending eMTCT clinics in Jinja district. A total of 426 HIV positive breastfeeding women aged >18 years attending eMTCT clinics were selected using simple random sampling and interviewed using interviewer administered questionnaire. eMTCT registers were used to select participants every clinic day. Filled questionnaires were checked for accuracy, consistency and completeness by PI before they were data entered into Epidata version 2.1b, with data checks and validations to ensure accuracy during entry. Statistical packages STATA version 12 was used to analyse quantitative data while qualitative data analysis was done using NVivo version 10. Results A total of 426 HIV positive breastfeeding women were interviewed. Fifty Five percent of the HIV positive breastfeeding women reported ever disclosing their HIV status to their sexual partners. Being born again (AOR=0.38,95% CI:0.17,0.85, p=0.019), being single (AOR=0.07,95% CI:0.02,0.23,p <0.001) having separated/divorced from the sexual partner (AOR=0.21,95% CI:0.09,0.50,p <0.001) were associated with a less likelihood of disclosure of HIV serostatus to their sexual partners. Having someone in the community disclosing their HIV status to the HIV positive breastfeeding woman (AOR=1.84, 95% CI: 1.06, 3.22, p=0.031), the Prevalence and factors associated with disclosure of HIV serostatus to sexual partners among HIV positive breastfeeding women attending eMTCT clinics in Jinja district xii

participant having disclosed to one of the family members (AOR=2.86, 95% CI: 1.61, 5.07, p=<0.001) and using any family planning method (AOR=1.96, 95% CI: 1.13, 3.39, p=0.016) were associated with high likelihood of disclosure of HIV status to the sexual partners, while having challenges/fears disclosing the HIV status (AOR=0.09, 95% CI: 0.05,0.17,p <0.001)and self-stigma (AOR=0.31,95% CI: 0.14,0.69, p = 0.004) were associated with less likelihood of disclosure of HIV status to the sexual partners. The qualitative research findings showed that fears in their relationships greatly prevented HIV positive breastfeeding women from disclosing their HIV status. Conclusion About a halfof the HIV+ breastfeeding women had ever disclosed their HIV serostatus to their sexual partners. Being born again, single, having separated/divorced from the sexual partner were associated with a less likelihood of disclosure of HIV serostatus to their sexual partners. Results from qualitative research showed that the fears in their relationships prevented the HIV positive breastfeeding women from disclosing their HIV status to the sexual partners. Prior experiences of disclosure of HIV serostatus, family support and being on any family planning increased the likelihood of disclosure of the HIV status to the sexual partner.Qualitative researchfindingsindicated that the need to uplift the welfare of theirchildren encouraged them to disclose their HIV status to their partners. Recommendations: Focused counselling ought to be given to the born again christians, single, separated/divorced and those with any fears and self-stigma to ensure behaviour change among these persons. HIV positive persons in the community should be encouraged to talk freely about their HIV serostatus by inviting them to talk at community gatherings like churches. Health education efforts should be directed towards maintaining a good family support as well as encouraging family planning among HIV positive breastfeeding women.