Community cultural norms, stigma and disclosure to sexual partners among women living with HIV in Thailand, Brazil and Zambia (HPTN 063)

HIV Prevention Trials Network 063 Team

Research output: Contribution to journalArticle

Abstract

Background: Serostatus disclosure may facilitate decreased HIV transmission between serodiscordant partners by raising risk awareness and heightening the need for prevention. For women living with HIV (WLWH), the decision to disclose may be influenced by culturally determined, community-level stigma and norms. Understanding the impact of community HIV stigma and gender norms on disclosure among WLWH in different countries may inform intervention development. Methods: HPTN063 was a longitudinal, observational study of sexually active HIV-infected individuals, including heterosexual women, in care in Zambia, Thailand and Brazil. At baseline, a questionnaire measuring community HIV stigma and gender norms, anticipated stigma, demographic, partner/relationship characteristics, and intimate partner violence was administered. Longitudinal HIV disclosure to sexual partners was determined via audio-computer assisted self-interview (ACASI) at the baseline and quarterly during the one year following up. Logistic regression was conducted to identify the predictors of disclosure. Results: Almost half (45%) of women living with HIV acknowledged perceived community HIV stigma (the belief that in their community HIV infection among women is associated with sex work and multiple sexual partners). Many women (42.9%) also acknowledged perceived community gender norms (the belief that traditional gender norms such as submissiveness to husbands/male sexual partners is necessary and that social status is lost if one does not procreate). HIV disclosure to current sex partners was reported by 67% of women. In multivariate analysis, among all women, those who were older [OR 0.16, 95%CI (0.06,0.48)], reported symptoms of severe depression [OR 0.53, 95%CI(0.31, 0.90)], endorsed anticipated stigma [OR 0.30, 95%CI(0.18, 0.50)], and were unmarried [OR 0.43, 95%CI(0.26,0.71)] were less likely to disclose to current partners. In an analysis stratified by marital status and cohabitation, unmarried [OR 0.41, 95%CI(0.20,0.82)] and non-cohabiting women [OR 0.31, 95%CI(0.13,0.73)] who perceived community HIV stigma were less likely to disclose to their sex partners. Conclusions: Perceived community level HIV stigma, along with individual level factors such as anticipated stigma, depressive symptoms, and older age, predict non-disclosure of HIV status to sexual partners among WLWH in diverse geographic settings. Interventions to promote disclosure among women in serodiscordant relationships should incorporate community-level interventions to reduce stigma and promote gender equality.

Original languageEnglish (US)
Article numbere0153600
JournalPLoS One
Volume11
Issue number5
DOIs
StatePublished - May 1 2016

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Zambia
Sexual Partners
Disclosure
Thailand
stigma
Brazil
Logistics
HIV
gender
Multivariate Analysis
Violence
marital status
violence
Sex Work
Depression
HIV infections
observational studies
multivariate analysis
Heterosexuality
Marital Status

ASJC Scopus subject areas

  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Medicine(all)

Cite this

Community cultural norms, stigma and disclosure to sexual partners among women living with HIV in Thailand, Brazil and Zambia (HPTN 063). / HIV Prevention Trials Network 063 Team.

In: PLoS One, Vol. 11, No. 5, e0153600, 01.05.2016.

Research output: Contribution to journalArticle

@article{b5ac7b12561b448984b4c372a65e1cb6,
title = "Community cultural norms, stigma and disclosure to sexual partners among women living with HIV in Thailand, Brazil and Zambia (HPTN 063)",
abstract = "Background: Serostatus disclosure may facilitate decreased HIV transmission between serodiscordant partners by raising risk awareness and heightening the need for prevention. For women living with HIV (WLWH), the decision to disclose may be influenced by culturally determined, community-level stigma and norms. Understanding the impact of community HIV stigma and gender norms on disclosure among WLWH in different countries may inform intervention development. Methods: HPTN063 was a longitudinal, observational study of sexually active HIV-infected individuals, including heterosexual women, in care in Zambia, Thailand and Brazil. At baseline, a questionnaire measuring community HIV stigma and gender norms, anticipated stigma, demographic, partner/relationship characteristics, and intimate partner violence was administered. Longitudinal HIV disclosure to sexual partners was determined via audio-computer assisted self-interview (ACASI) at the baseline and quarterly during the one year following up. Logistic regression was conducted to identify the predictors of disclosure. Results: Almost half (45{\%}) of women living with HIV acknowledged perceived community HIV stigma (the belief that in their community HIV infection among women is associated with sex work and multiple sexual partners). Many women (42.9{\%}) also acknowledged perceived community gender norms (the belief that traditional gender norms such as submissiveness to husbands/male sexual partners is necessary and that social status is lost if one does not procreate). HIV disclosure to current sex partners was reported by 67{\%} of women. In multivariate analysis, among all women, those who were older [OR 0.16, 95{\%}CI (0.06,0.48)], reported symptoms of severe depression [OR 0.53, 95{\%}CI(0.31, 0.90)], endorsed anticipated stigma [OR 0.30, 95{\%}CI(0.18, 0.50)], and were unmarried [OR 0.43, 95{\%}CI(0.26,0.71)] were less likely to disclose to current partners. In an analysis stratified by marital status and cohabitation, unmarried [OR 0.41, 95{\%}CI(0.20,0.82)] and non-cohabiting women [OR 0.31, 95{\%}CI(0.13,0.73)] who perceived community HIV stigma were less likely to disclose to their sex partners. Conclusions: Perceived community level HIV stigma, along with individual level factors such as anticipated stigma, depressive symptoms, and older age, predict non-disclosure of HIV status to sexual partners among WLWH in diverse geographic settings. Interventions to promote disclosure among women in serodiscordant relationships should incorporate community-level interventions to reduce stigma and promote gender equality.",
author = "{HIV Prevention Trials Network 063 Team} and Ojikutu, {Bisola O.} and Subash Pathak and Kriengkrai Srithanaviboonchai and Mohammed Limbada and Ruth Friedman and Shuying Li and Mimiaga, {Matthew J.} and Mayer, {Kenneth H.} and Safren, {Steven A.} and Vanessa Cummings and Dai, {James Y.} and Celentano, {David D} and Vanessa Elharrar and Lynda Emel and Gaydos, {Charlotte A} and Erica Hamilton and James Hughes and Corey Kelly and Alex London and Jonathan Lucas and Moore, {Ayana T.} and Estelle Piwowar-Manning and Susan Sherman and Harmony Waller",
year = "2016",
month = "5",
day = "1",
doi = "10.1371/journal.pone.0153600",
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T1 - Community cultural norms, stigma and disclosure to sexual partners among women living with HIV in Thailand, Brazil and Zambia (HPTN 063)

AU - HIV Prevention Trials Network 063 Team

AU - Ojikutu, Bisola O.

AU - Pathak, Subash

AU - Srithanaviboonchai, Kriengkrai

AU - Limbada, Mohammed

AU - Friedman, Ruth

AU - Li, Shuying

AU - Mimiaga, Matthew J.

AU - Mayer, Kenneth H.

AU - Safren, Steven A.

AU - Cummings, Vanessa

AU - Dai, James Y.

AU - Celentano, David D

AU - Elharrar, Vanessa

AU - Emel, Lynda

AU - Gaydos, Charlotte A

AU - Hamilton, Erica

AU - Hughes, James

AU - Kelly, Corey

AU - London, Alex

AU - Lucas, Jonathan

AU - Moore, Ayana T.

AU - Piwowar-Manning, Estelle

AU - Sherman, Susan

AU - Waller, Harmony

PY - 2016/5/1

Y1 - 2016/5/1

N2 - Background: Serostatus disclosure may facilitate decreased HIV transmission between serodiscordant partners by raising risk awareness and heightening the need for prevention. For women living with HIV (WLWH), the decision to disclose may be influenced by culturally determined, community-level stigma and norms. Understanding the impact of community HIV stigma and gender norms on disclosure among WLWH in different countries may inform intervention development. Methods: HPTN063 was a longitudinal, observational study of sexually active HIV-infected individuals, including heterosexual women, in care in Zambia, Thailand and Brazil. At baseline, a questionnaire measuring community HIV stigma and gender norms, anticipated stigma, demographic, partner/relationship characteristics, and intimate partner violence was administered. Longitudinal HIV disclosure to sexual partners was determined via audio-computer assisted self-interview (ACASI) at the baseline and quarterly during the one year following up. Logistic regression was conducted to identify the predictors of disclosure. Results: Almost half (45%) of women living with HIV acknowledged perceived community HIV stigma (the belief that in their community HIV infection among women is associated with sex work and multiple sexual partners). Many women (42.9%) also acknowledged perceived community gender norms (the belief that traditional gender norms such as submissiveness to husbands/male sexual partners is necessary and that social status is lost if one does not procreate). HIV disclosure to current sex partners was reported by 67% of women. In multivariate analysis, among all women, those who were older [OR 0.16, 95%CI (0.06,0.48)], reported symptoms of severe depression [OR 0.53, 95%CI(0.31, 0.90)], endorsed anticipated stigma [OR 0.30, 95%CI(0.18, 0.50)], and were unmarried [OR 0.43, 95%CI(0.26,0.71)] were less likely to disclose to current partners. In an analysis stratified by marital status and cohabitation, unmarried [OR 0.41, 95%CI(0.20,0.82)] and non-cohabiting women [OR 0.31, 95%CI(0.13,0.73)] who perceived community HIV stigma were less likely to disclose to their sex partners. Conclusions: Perceived community level HIV stigma, along with individual level factors such as anticipated stigma, depressive symptoms, and older age, predict non-disclosure of HIV status to sexual partners among WLWH in diverse geographic settings. Interventions to promote disclosure among women in serodiscordant relationships should incorporate community-level interventions to reduce stigma and promote gender equality.

AB - Background: Serostatus disclosure may facilitate decreased HIV transmission between serodiscordant partners by raising risk awareness and heightening the need for prevention. For women living with HIV (WLWH), the decision to disclose may be influenced by culturally determined, community-level stigma and norms. Understanding the impact of community HIV stigma and gender norms on disclosure among WLWH in different countries may inform intervention development. Methods: HPTN063 was a longitudinal, observational study of sexually active HIV-infected individuals, including heterosexual women, in care in Zambia, Thailand and Brazil. At baseline, a questionnaire measuring community HIV stigma and gender norms, anticipated stigma, demographic, partner/relationship characteristics, and intimate partner violence was administered. Longitudinal HIV disclosure to sexual partners was determined via audio-computer assisted self-interview (ACASI) at the baseline and quarterly during the one year following up. Logistic regression was conducted to identify the predictors of disclosure. Results: Almost half (45%) of women living with HIV acknowledged perceived community HIV stigma (the belief that in their community HIV infection among women is associated with sex work and multiple sexual partners). Many women (42.9%) also acknowledged perceived community gender norms (the belief that traditional gender norms such as submissiveness to husbands/male sexual partners is necessary and that social status is lost if one does not procreate). HIV disclosure to current sex partners was reported by 67% of women. In multivariate analysis, among all women, those who were older [OR 0.16, 95%CI (0.06,0.48)], reported symptoms of severe depression [OR 0.53, 95%CI(0.31, 0.90)], endorsed anticipated stigma [OR 0.30, 95%CI(0.18, 0.50)], and were unmarried [OR 0.43, 95%CI(0.26,0.71)] were less likely to disclose to current partners. In an analysis stratified by marital status and cohabitation, unmarried [OR 0.41, 95%CI(0.20,0.82)] and non-cohabiting women [OR 0.31, 95%CI(0.13,0.73)] who perceived community HIV stigma were less likely to disclose to their sex partners. Conclusions: Perceived community level HIV stigma, along with individual level factors such as anticipated stigma, depressive symptoms, and older age, predict non-disclosure of HIV status to sexual partners among WLWH in diverse geographic settings. Interventions to promote disclosure among women in serodiscordant relationships should incorporate community-level interventions to reduce stigma and promote gender equality.

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