Tanzania study finds two-thirds of HIV positive women tell their partners
Study reveals higher levels of disclosure than previously thought among women in Tanzania, especially amongst those in relationships where sexual and reproductive health issues are discussed.
A Tanzanian study has found around two-thirds of women with HIV who are in care disclose their status to partners, a higher proportion than previous sub-Saharan African studies have found.
The findings, published by PLOS One, show that women in relationships where the number of children, condom use, HIV testing and contraceptives are discussed are more likely to disclose a positive HIV diagnosis to their partners – signalling a clear link between a general comfortableness to communicate on sexual and reproductive health matters and HIV disclosure.
The cross-sectional study was conducted in 2014 in three districts in the Kilimanjaro region, one urban (Moshi, the regional capital) and two rural (Hai and Mwanga).
A total of 672 HIV-positive women (aged 15–49) receiving routine HIV care at 19 clinics were enrolled, 89% of whom were on antiretroviral treatment (ART). A total of 609 participants had a regular partner (defined as a steady sexual relationship of three months or more) and half (50%) were married or cohabiting.
The women took part in face-to-face interviews where they answered questions on topics ranging from their age and relationship status to questions on reproductive health and partner communication. Multivariate logistic regression analyses were used to determine links between these factors and disclosure of a positive HIV status.
Around two-thirds (66%) of women in the study who were in a relationship had told their partner they were HIV positive. Of these, 56% had disclosed their status within a month of being diagnosed and 27% had told their partner within a year.
Among the third of women (34%) who had not told their partner they were HIV positive, one in four (24.7%) said they had not disclosed because they were afraid the news would lead to their partner leaving or divorcing them. Around 3% did not disclose because they were afraid of a fight or that their partner might harm them.
Of the women who had told their partners they were HIV positive, 81% said their partner had either been understanding or neutral. Around 4.5% reported their partners wanted to go and get tested for HIV immediately, and that their disclosure had helped them to discuss using condoms.
Around 20% of those who disclosed – one in five – had experienced a negative reaction from partners. Around 10% said that disclosing their HIV status had resulted in a fight or being blamed for having HIV, 7% reported that their partners either ran away or left them, and 3% reported that their partners became confused and/or depressed.
Researchers found women in relationships where sexual and reproductive health issues were discussed – namely condom use, HIV testing and how many children a couple wanted – were more likely to be open about their HIV positive status. Women in relationships where condoms or some form of contraceptives were used were also more likely to tell their partner they were HIV positive, as were married or cohabiting women, women on ART, and those who were aware of their partner’s HIV status.
Among all women enrolled in the study, 66% were sexually active. Around 71% reported ever using condoms, of whom 79% were currently using condoms. However, only 66% of those who said they did not want any more children were using any form of modern contraceptive – further evidence of an unmet need for contraception among women in the region.
The proportion of women disclosing their HIV positive status in this study is higher than rates previously reported by similar Tanzanian studies. For example, a recent study of pregnant women in Dar es Salaam found 44% disclosed, while a study among HIV positive women in Morogoro found 41% did. It is also significantly higher than the 16.7% disclosure rate recorded in Tanzania in 2001, suggesting more HIV positive women in the country feel able to disclose their status to partners than ever before. The disclosure rate is also higher than those recently observed among HIV positive women in South Africa (59%), Makonde, Zimbabwe (55%), Abidjan, Ivory Coast (46%) and Burkina Faso (17.6%).
The findings suggest that offering couples communication and negotiation skills-building may help to further increase the number of women living with HIV who feel able to tell their partners. In turn, it is hoped that increasing HIV disclosure among women will prompt more men in relationships who are living with HIV to get diagnosed earlier. Currently, men in sub-Saharan Africa are far more likely to be diagnosed at late stage of HIV infection than women, and as a result are more likely to die of AIDS-related illnesses. Efforts to involve men in more general aspects of sexual and reproductive health, such as family planning, may also improve HIV disclosure and communication among couples.