What Factors Are Most Likely to Predict Disclosing HIV Status in the Community?

Having health insurance, a higher level of education, and more money were associated with a greater likelihood of caregivers of orphans and vulnerable children (OVC) disclosing their HIV status in the community, either positive or negative, while being male and living in a rural location indicated a lesser likelihood, report study results out of Tanzania published recently in AIDS Research and Therapy.

“HIV status disclosure may lead to improved access to HIV prevention and treatment services as well as increased opportunity for risk reduction and increased opportunities to plan for the future,” note the study authors, who conducted their study because although disclosure of HIV status to outside individuals has been studied, the same outcome has not been evaluated in community-based HIV assistance programs.

Kizazi Kipya is a community-based HIV assistance program that began in 2016 and is scheduled to run through 2021, jointly funded by the United States Agency for International Development and the United States President’s Emergency Plan for AIDS Relief, in Tanzania, where the HIV status disclosure rate was a reported 60.6% in 2017, according to the authors. The program’s end goal is 100% HIV disclosure status among program beneficiaries.

The 59,683 OVC caregivers included in the present study’s cross-sectional secondary analysis were enrolled in the program from January through March 2017 from 18 regions in Tanzania, among which the HIV status disclosure rates range from 0.6% in Mjini Magharibi to 11.4% in Njombe; their mean (SD) age was 50.4 (14.8) years, and most (71.2%) were female. Data were self-reported to lead case workers and community case workers.

Overall, the results show that 37.2% of the OVC caregivers did not disclose their HIV status when enrolling in Kizazi Kipya. The following variables were associated with a greater likelihood of this outcome:

• Male sex (odds ratio [OR], 1.22; 95% CI, 1.16-1.28)
• Unmarried status (OR, 1.12; 95% CI, 14.03-1.23)
• Being widowed (OR, 1.12; 95% CI, 1.07-1.18)
• Uninsured (OR, 1.36; 95% CI, 1.28-1.45)
• Have a physical or mental disability (OR, 1.14; 95% CI,1.04-1.25)
• Live in a rural location (OR, 1.58; 95% CI, 1.34-1.86)

In addition, OVC caregivers who were 61 years or older were the least likely to disclose their HIV status compared with those 18 to 30 years and 31 to 60 years—48.0% vs 33.5% and 32.9%, respectively—as were those with no formal education (47.0%) compared with having a secondary or higher education (29.9%) and those in the lowest wealth quintile (40.7%) vs the highest (32.9%).

Disclosing HIV status often leads to greater adherence to antiretroviral therapy, can increase access to prevention and treatment services, and may highlights areas requiring risk reduction, the authors pointed out. The investigation’s dependent variable was HIV status disclosure at program enrollment, and the independent variables were sex, age, education, marital status, mental or physical disability status, whether some or all the family members are covered by a health insurance (for this study, holding a Community Health Fund or Tiba kwa Kadi [TIKA] card), household wealth quintile, food security, and type of residence (rural or urban).

“While improved education, economic strengthening support and expanding health insurance coverage appear to improve HIV status disclosure, greater attention may be required for men, unmarried, widowed, rural residents, and the elderly populations for their higher likelihood to conceal HIV status,” the authors concluded. “This is a clear missed opportunity for timely care and treatment services for those that may be HIV positive.”

Their proposed solutions include the following:

1. Promote universal formal education
2. Increase HIV status disclosure support, but especially among those with disabilities
3. Investigate further the connections between economic status, gender, and insurance status and HIV status disclosure
4. Target rural areas for HIV support and education efforts

Reference

Charles J, Exavery A, Barankena A, et al. Determinants of undisclosed HIV status to a community‑based HIV program: findings from caregivers of orphans and vulnerable children in Tanzania. AIDS Res Ther. Published online July 16, 2020. doi:10.1186/s12981-020-00299-8