Disclosure of HIV serostatus among pregnant and postpartum women in sub-Saharan Africa: a systematic review
Disclosure of HIV serostatus among pregnant and postpartum women in sub-Saharan Africa: a systematic review
复制标题
DOI：
10.1080/09540121.2014.997662
复制
发表时间：
2015-04-03
影响因子：
1.7
通讯作者：
Phelps, B. Ryan
中科院分区：
文献类型：
--
作者：
Tam, Melanie;Amzel, Anouk;Phelps, B. Ryan
披露自己的艾滋病毒状况有助于提高预防母婴传播艾滋病毒服务的接受率和保留率;然而，这对许多妇女来说仍然是一个挑战。本系统性综述评估了撒哈拉以南非洲地区孕妇和产后妇女的披露率、披露时间以及影响披露决定的因素。检索PubMed和EMBASE数据库，以识别2000年1月至2014年4月期间发表的相关研究。向任何人披露艾滋病毒血清状态的比率范围为5.0%至96.7%（合并估计值：67.0%，95% CI：55.7%-78.3%）。选择向伴侣透露自己身份的女性更经常这样做（合并估计值：63.9%; 95% CI：56.7%-71.1%）（合并估计值：40.1; 95% CI：26.2%-54.0%），朋友（合并估计值：6.4%; 95% CI：3.0%-9.8%）或宗教领袖（合并估计值：7.1%; 95% CI：4.3%-9.8%）。大多数妇女在分娩前就透露了。透露的决定与女性自身的因素有关（年龄较小，第一次怀孕，认识艾滋病毒感染者，内化的耻辱水平较低，回避应对水平较低），伴侣（以前的艾滋病毒检测史和较高的教育程度），他们的伙伴关系（无家庭暴力史和经济独立）和家庭（住房质量较高，没有配偶或大家庭成员居住）。需要采取干预措施，鼓励和支持妇女安全地披露其身份。
Disclosure of one's HIV status can help to improve uptake and retention in prevention of mother-to-child transmission of HIV services; yet, it remains a challenge for many women. This systematic review evaluates disclosure rates among pregnant and postpartum women in sub-Saharan Africa, timing of disclosure, and factors affecting decisions to disclose. PubMed and EMBASE databases were searched to identify relevant studies published between January 2000 and April 2014. Rates of HIV serostatus disclosure to any person ranged from 5.0% to 96.7% (pooled estimate: 67.0%, 95% CI: 55.7%-78.3%). Women who chose to disclose their status did so more often to their partners (pooled estimate: 63.9%; 95% CI: 56.7%-71.1%) than to family members (pooled estimate: 40.1; 95% CI: 26.2%-54.0%), friends (pooled estimate: 6.4%; 95% CI: 3.0%-9.8%), or religious leaders (pooled estimate: 7.1%; 95% CI: 4.3%-9.8%). Most women disclosed prior to delivery. Decisions to disclose were associated with factors related to the woman herself (younger age, first pregnancies, knowing someone with HIV, lower levels of internalized stigma, and lower levels of avoidant coping), the partner (prior history of HIV testing and higher levels of educational attainment), their partnership (no history of domestic violence and financial independence), and the household (higher quality of housing and residing without co-spouses or extended family members). Interventions to encourage and support women in safely disclosing their status are needed.