Predictors of hiv self disclosure to sexual partners by Sero-positive adults in informal settlements: a case of Central division, Nairobi County, Kenya
Ndayala, Phoebe Didi
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The purpose of the study was to determine the predictors of HIV self disclosure to sexual partners by sero-positive adults, in Central division, Huruma location, Nairobi County, Kenya. The objectives of the study were to examine the prevalence of HIV self disclosure among PLWHA, and to analyze the relationships between self-disclosure of HIV sero-positive status and the following factors: individual factors of PLWHA; anticipated and enacted consequences of HIV disclosure; sexual practices and cultural factors among PLWHA. The study was a cross-sectional descriptive survey with a sample of 232 PLWHA drawn from HIV support groups in the study area. Data were collected using questionnaires and Focus Group Discussions (FGDs). Qualitative data were analyzed using content analysis and quantitative data by use of SPSS. Research findings showed that 50.5% of PLWHA had disclosed their sero-positive status mainly to regular sexual partners. Chi-square results revealed significant relationships between HIV self disclosure and financial constraints (p=0.003); employment status (p=0.001); condom use in last sexual encounter (p=0.001); type of sexual relationship (p=0.024); discussion of HIV testing with partner (p=0.039); knowledge of sexual partners’ HIV sero status (p=0.011); method of finding out sexual partners sero status (p=0.039); gender power control in sexual relations (p=0.010); isolation by friends after HIV self-disclosure (P=0.011); being spoken ill of by friends (p=0.006); consequences of disclosure at the workplace (P=0.011); women roles in sexual relations (p=0.001); community beliefs on HIV (p=0.019) and exclusion from rite of wife inheritance (p=0.002). Further analysis using Binary Logistic regression determined eight (8) positive predictors of self-disclosure of HIV sero-positive status to sexual partners. The positive predictors were: regular sexual relationship (AOR=2.703; p= 0.046), employment status (AOR=1.691; p=0.001), gender power control in sexual relations (AOR=4.129; p= 0.011), discussion of HIV testing with partner (AOR=2.560; p=0.002), anticipated consequences of disclosure from the religious group and (AOR=3.949; p= 0.015) anticipated positive consequences from the workplace (AOR=1.955; p= 0.001), enacted consequences of disclosure from the workplace (AOR=1.990; p=0.002) and expected violent reaction to disclosure by partner (AOR=3.374; p=0.005). The factors that emerged as negative predictors or barriers to HIV self-disclosure to sexual partners were enacted consequences of disclosure from friends (AOR=0.136; p=0.001) and exclusion from the rite of wife inheritance of PLWHA (AOR=0.410; p=0.002). It was concluded that four main factors were positively associated HIV self-disclosure among the study participants. These included (1) the nature of relationship with the sexual partner(s); (2) anticipated positive outcomes of disclosure from the religious group; (3) Enacted positive consequences at the workplace; not expecting job loss; or being in informal employment; and (4) experiencing financial constraints. The study recommended: promotion of HIV self-disclosure to sexual partners by PLWHA; Safe sexual practices; provider initiated testing and counseling of sexual partners, training of PLWHA with communication skills and strategies to cope with negative consequences of HIV self-disclosure, promotion of community acceptance of PLWHA and cultural practices that promote self-disclosure of HIV sero-positive status to sexual partners among PLWHA.