Objective: HIV status disclosure to sexual partner is important for optimal outcomes in prevention of transmission of HIV. The object of this study was to assess the predictors and reasons of HIV status disclosure in Iranian people living with HIV(IPLWH).
Method: A cross sectional study conducted at Voluntary Counseling and Testing Center (VCT) and Positive Club of Imam Khomeini Hospital. Samples of 340 individuals were selected by using randomized sampling techniques between August 2017 and March 2018. Data were collected through interviewer-administered questionnaire with 38-item and analyzed using SPSS version 21.0 software. Results: Majority of samples (93.6%) were revealed their HIV positive status to anyone. Disclosure was done towards the spouse (78%), casual sexual partner (7%), close family (34/2%) and friends (9/1%). From those undergoing Antiretroviral Therapy (93.4%), majority (76.4%) knew their partner’s HIV status. Most (57.8%) had HIV-positive partners, while 71(20.9%) participants reported having HIV-negative partners and 72(21.2%) had sexual partners whose HIV status they did not know. The binary analysis showed that disclosure was significantly related to age (COR=3.662, 95%CI=1.396, 9.604),
The HIV/AIDS continues to be a major global public health issue. Globally, at the end of 2017, an estimated 36.9 million people were living with HIV, including 33 million deaths. In the same year, there were 1.8 million new HIV Infections in 2017 worldwide. It is estimated that currently only 75% of people with HIV know their status. In 2017, 21.7 million people living with HIV (PLWH) were receiving antiretroviral therapy (ART) globally . At the end of 2017, there is more than 60 thousand PLWH in Iran, with 10 thousands death. The annual number of people newly infected with HIV increased by 21% in Iran since 2010. The number of people dying from AIDS-related causes has increased more than fourfold between 2000 to 2015. More than 40% of people living with HIV know their status and 19% of them are on ART [2, 3]. Injectable drug abuse remains the main mode of HIV transmission in Iran and unprotected sexual intercourse is the new mode of HIV transmission that is increased during last few years .
HIV had come to be a chronic illness because of ART usage, where people live for a longer period of time [5, 6]. As PLWH live longer, sero-status disclosure become a significant concern in managing patients and prevention of new infections. Sero-status disclosure is the act of revealing the HIV status to someone (e.g., sex partner, family member, or friends) [7-10]. Disclosure of HIV status because of its negative and positive outcomes is one of the most complex situations for PLWH . Disclosure of HIV status to partner is imperative in preventing HIV transmission. In addition, it has beneficial effects, such as adherence to ART, receiving continuous emotional and financial support, reduction of stress, prevention of risky behaviors, and better-quality health effects. Moreover, HIV disclosure will motivate the sex partner to undergo voluntary HIV testing [12, 13]. So far, there is little known on HIV-positive status disclosure Iran. This study assessed the factors affecting disclosure of HIV-seropositive status to sexual partners among patients referring to two HIV-related center of Imam Khomeini Hospital of Tehran, Iran.
Material and methods
Study design and setting
This cross-sectional study was conducted between August 2017 and March 2018. The study was designed to understand the rates and context of disclosure among PLWH. The study was conducted in Voluntary Counseling and Testing Center (VCT) and HIV Positive Club of Imam Khomeini Hospital of Tehran, Iran and it was selected based on the high amount of referrals of PLWH.
Study participants and recruitment
The sample was selected by using single population proportion formula according to the national report on HIV/AIDS cases . We targeted a sample size of 340 participants in Tehran, 95% level of confidence, and 5% marginal error. Approximately 25 patients attend the VCT each day. We invited every patients attending to the center to participate in an interview until the required sample of 340 was recruited. No patients interviewed twice during the recruitment period. Eligible individuals were HIV-positive, 18 years old and older, had sexual partner (including casual partner, intimate lover and spouse), were aware of being sero-positive for more than 6 months, were born in Iran, were receiving or had previously received health services at the study site.
Two trained study stuffs conducted face-to-face interviews using a structured questionnaire. The interviewer took notes during the interview. The questionnaire was translated from English to Persian by two native translators who were experienced medical literature translation. Then, the primary translation reviewed by means of readability and understandability. Afterward, two other bilingual and experienced translators whom know about the aim of study back translated the questionnaire to English. After doing additional amendments, the Persian version of questionnaire assessed by 13 HIV expert researchers to determine the validity and reliability. The six-section structured questionnaire was used to simultaneously collect quantitative data. The first section of the questionnaire collected information about participant socio-demographic characteristics (gender, age, marital status, income, occupation, educational level). The second section collected partner’s features (education, living together, HIV status, number of partners). The third section collected health and health care related factors related to disclosure (duration of HIV positive status, whom to initiate to test, counseling, antiretroviral therapy). The forth section asked “do you think disclosure to your partner is important?” Responses were assessed using Likert scale. This section included information about importance of disclosure, disclosed to whom, disclosure status, membership of the Positive Club). The outcome variable was the question “After you knew that you were HIV-positive, to whom did you disclosed?” This question was followed by other questions to determine the process of disclosure, and in fifth section by asking “What is your reason for disclosing/ not disclosing your sero-positive HIV status to your sexual partner?”. The sixth section collected outcomes of disclosure in who disclosed to sexual partner by asking “what happened after you disclosed to your sexual partner?”
The collected data were entered and analyzed using SPSS Version 21.0 statistical software. Descriptive, bivariate and regression analysis were carried out to describe the variables. Odds ratio with 95% CI was used to determine the significant level of association between predictors and disclosure.
The study was approved by the ethical review committee of the Iran University of Medical Sciences- IR.IUMS. REC 1396.9411690003. The study subjects were told about the details of the study and after obtaining written informed consent they were enrolled in the study. All interviews took place in private room at study site. Each interview lasted 30 to 45 minutes, and all the information collected from the respondents was kept confidential. Healthcare workers at study sites neither participated in, nor observed the study sessions.
A total of 340 people receiving HIV/AIDS care at VCT were interviewed with 100% response rate. Among the participants 95.8% (n=326) were urban residents. Number of female participants were equal to male participants, and 72.4% (n= 246) belonged to the age group of 30-49 years. Most participants (68.5%) were married (Table1).
HIV-positive status disclosure
From the 340 participants, disclosure of HIV-positive status occurred for 318 participants (93.6%), and out of these, 291 of participants (85.2%) disclosed their status to their sexual partner(s). only 28.2% disclosed immediately after diagnosis and 7.4% had late disclosure after one year (Table 2). Most study participants (93.4%) were taking ART. About 76% of them knew their partner’s HIV status. About 58% had HIV-positive partners, while 71(20.9%) participants reported having HIV-negative partners and 72(21.2%) had sexual partners whose HIV status were not known to them.