Serostatus disclosure among a cohort of HIV-infected pregnant women enrolled in HIV care in Moshi, Tanzania: A mixed-methods study
Serostatus disclosure among a cohort of HIV-infected pregnant women enrolled in HIV care in Moshi, Tanzania: A mixed-methods study
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DOI：
10.1016/j.ssmph.2018.11.007
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发表时间：
2019-04-01
影响因子：
4.7
通讯作者：
Watt, Melissa H.
中科院分区：
文献类型：
--
作者：
Knettel, Brandon A.;Minja, Linda;Watt, Melissa H.
感染艾滋病毒的孕妇面临着是否以及如何披露其血清状况的复杂决定。先前的研究表明，披露艾滋病毒与更好的护理参与、对疾病的情绪调整和降低艾滋病毒传播风险有关，但妇女在披露方面面临着现实和感知的障碍。我们研究了坦桑尼亚乞力马扎罗山地区200名在产前诊断或确认感染艾滋病毒的妇女的艾滋病毒披露模式和预测因素，并对参与者进行了产后三个月的随访。20名妇女还在怀孕期间和产后3个月完成了定性深入访谈。在怀孕期间（诊断后至少30天），79.5%的妇女至少向另一个人透露过情况，通常仅限于孩子的父亲和/或少数亲密家庭成员。到产后3个月，11.9%的女性仍然没有向任何人透露。接受产前检查并确诊为艾滋病毒的妇女和已婚妇女更有可能报告披露情况。社会支持与信息披露呈正相关。在定性访谈中，女性指出，社区流言蜚语和污名是她们披露信息的障碍。那些没有向孩子的父亲透露情况的人表示，在脆弱的怀孕期间担心被遗弃。尽管表达了恐惧，但参与者报告了总体上积极的信息披露经历，从而增加了支持。综上所述，这些结果表明，需要采取全面、灵活和文化知情的干预措施，帮助孕妇和产后妇女决定何时以及如何披露。此类干预措施应承认并探讨阻碍披露的共同障碍，包括担心公开羞辱和个人后果。鉴于信息披露、社会支持和社区耻辱感之间的强烈关联，信息披露的干预措施应嵌套在更广泛的公共教育和减少艾滋病毒耻辱感的努力中。
HIV-infected pregnant women face complex decisions about whether and how to disclose their serostatus. Previous studies have shown that HIV disclosure is associated with better care engagement, emotional adjustment to the disease, and reduced risk of HIV transmission, but women face both real and perceived barriers to disclosure. We examined patterns and predictors of HIV disclosure in a cohort of 200 women diagnosed or confirmed to have HIV during antenatal care in the Kilimanjaro region of Tanzania and followed participants to three months postpartum. Twenty women also completed qualitative in-depth interviews during pregnancy and three months postpartum. During the pregnancy period (at least 30 days post-diagnosis), 79.5% of women had disclosed to at least one other person, with disclosures generally restricted to the father of the child and/or a small number of close family members. By three months postpartum, 11.9% of women had still not disclosed to anyone. Women who presented to antenatal care with an established HIV diagnoses and married women were more likely to report disclosures. Social support was positively associated with disclosure. In qualitative interviews, women pointed to community gossip and stigma as barriers to disclosure. Those who had not disclosed to the father of the child noted fears of abandonment during the vulnerable pregnancy period. Despite expressed fears, participants reported overall positive experiences of disclosure that led to increased support. Taken together, these results point to the need for comprehensive, flexible, and culturally informed interventions that assist pregnant and postpartum women in deciding when and how to disclose. Such interventions should acknowledge and explore common barriers to disclosure, including fears of public stigma and personal consequences. Given the strong associations between disclosure, social support, and community stigma, interventions for disclosure should be nested in broader efforts of public education and HIV stigma reduction.