Abstract #200  -  Disclosure of serostatus following HIV testing in Zimbabwe
Authors:   Presenting Author:   Ms Ide Cremin - Imperial College
Additional Authors:  Ms Phyllis  Mushati, Mr Paradzai  Mushore, Dr Simon Cauchemez, Prof Geoff Garnett, Prof Simon Gregson,
Aim: Knowing and disclosing one’s status are encouraged as HIV prevention measures (1, 2). Disclosure allows an infected individual to obtain support and potentially enables them to adopt behaviours to prevent further transmission. However, there are a number of potential negative outcomes, such as separation from one’s spouse, which may deter an infected individual from disclosing their status (3).
Method / Issue: We analysed data from the third survey (2003 – 2005) of the Manicaland HIV/STI Prevention Project, a population-based open-cohort study and data from the most recent Demographic and Health Survey (DHS) in Zimbabwe (2005 – 2006). Information on voluntary counselling and testing in both the Manicaland cohort and the DHS were collected during face-to-face interviews. Consenting participants of both the Manicaland cohort and the DHS provided blood spots for anonymous HIV testing. Results from the DHS survey are weighted to account for the clustered survey design. Chi squared tests were used to compare proportions. All analyses consider the non-virgin population.
Results / Comments: Zimbabwe DHS survey In the 2005-06 DHS survey, 7175 men and 8907 women were interviewed. Overall, 19.26% and 24.86% of non-virgin men and women, respectively, reported to have previously tested and received their result. Rates of disclosure for men and women stratified by HIV infection status are shown in table 1. Manicaland cohort In the third survey, 8.61% (1079/12533) of non-virgin participants reported to have tested and collected their result previously. Of these, 23.8% (257/1079) reported to tested together with a spouse, or prospective spouse. Those who reported that they did not receive testing and counselling with a spouse or prospective spouse were asked about disclosure to their spouse (N=719). Overall, the rate of disclosure was similar among men and women (75.93% vs. 73.61%, p=0.476) and significantly higher among uninfected individuals than infected individuals (76.92% vs. 61.94%, p=0.001). Rates of disclosure for men and women stratified by HIV infection status are shown in table 2. Of those who tested and had a spouse or regular partner, 2.57% (25/974) reported that they separated from their partner after receiving the test results. Surprisingly, of those who separated (N=25), 19 had received a negative test result, suggesting that the test result was unlikely to be a reason for separation. Those who reported to have received a positive test result (N=128), were asked who they disclosed to; 35.9% disclosed to their spouse or regular partner, 19.5% to a family member, 12.5% to someone else and 32.0% did not disclose to anybody. Of those self-reported infected individuals who did disclose (N=87), 72.4% reported that response they received was supportive.
Discussion: Discussion Overall, although the uptake of testing in the Manicaland cohort is low, the level of disclosure following testing is relatively high and is broadly representative of national levels of disclosure, and is consistent with reported disclosure rates among women in other developing countries (3). Unlike in other developing countries, the reported frequency of separation subsequent to testing and disclosure in Manicaland is low. As VCT services become increasingly available throughout Manicaland, counselling should continue to encourage the beneficial disclosure of HIV status. Table 1: Rate of disclosure of HIV test results among men and women in Zimbabwe 2005-06 DHS survey, stratified by HIV status. Note: weighted N’s are rounded to the nearest whole number. Table 2: Rate of disclosure of HIV test results among men and women in Manicaland (2003-2005 survey), stratified by HIV status. Footnote: this work will be developed to include more detailed analysis of the profile of those who disclose their HIV status (with respect to marital status and other demographic characteristics) and of mutual disclosure between partners who test separately. References 1. De Cock, K.M. et al. A serostatus-based approach to HIV/AIDS prevention and care in Africa. Lancet. 362 (9398): 1847-9 (2003). 2. UNAIDS. Opening up the HIV/AIDS epidemic: Guidance on encouraging beneficial disclosure, ethical partner counselling and appropriate use of HIV case-reporting. (2000). 3. Medley, A. et al. Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes. Bull World Health Organ. 82 (4): 299-307 (2004).
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