Determinants of Disclosure on HIV Sero-Status among People Living with HIV and on Antiretroviral Treatment at Mombasa County Referral Hospital, Kenya
Murei, Joshua Kailong
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It is estimated that Kenya has 1.6 million people living with HIV and 88,000 new adult infections annually. The country has adult HIV prevalence rate of between 5.6 - 7.2% and incidence rate of 0.4 – 0.7%. Recent studies on HIV disclosure among adult sexual partners revealed HIV 70-80% disclosure rates. A number of studies on HIV and AIDS have been undertaken in Kenya. However, determinants of disclosure among persons living with HIV remain unclear. The objective of this study was to explore the level of HIV sero – status disclosure and preparedness, establish preferred disclosure party, find out disclosure perceptions and determine PLHIV knowledge on spouse HIV sero-status and disclosure outcomes among PLHIV on ART treatment at the Mombasa County Referral Hospital. A cross-sectional study design was employed and both quantitative and qualitative data collected. Univariate and multivariate analyses were performed using SPSS version 20, frequencies generated for categorical variables and comparison between proportions examined using Chi– square test. A sample size of 432 was arrived at using Cochrane’s formula from a sample frame of 15,600 PLHIV at the MCRH. Simple random sampling was used to recruit the subjects into the study via administration of papers labeled and folded, where those who pick yes were enrolled into the study and the exercise continued for the entire study period. The subjects recruited were taken through the research purpose, objective, rights, risks, benefits and confidentiality before consenting. Structured questionnaires, in-depth interviews and focused group discussion tools were used to collect data. The quantitative results showed out of 432 participants recruited in the study; were 174 (40.3%) males and 258 (59.7%) females of which 32.9% were married. Majority participants were within 29-38 years range with a mean age of 35.0 years. About 40.5% had secondary education, 31.2% were employed with 17.8% getting a salary below Ksh. 10,000. About 61.1% were Christians and 36.6% Muslims. The overall disclosure rate among PLHIV was 79.2% while disclosure to spouses was 35.9%. Based on gender 53% female and 47% (P, 0<001) male had disclosed their status, while 31.7% of participants had disclosed to between 1-2 people. Key determinants of HIV disclosure were knowledge of partner HIV status and pre disclosure preparednes. Key determinants of disclosure were disease transmission (AOR 21.125; 95% CI 6.942-64.286), unfaithfulness in relationship (AOR 7.133; 95% CI 3.713-13.628) and consistent condom use (AOR 5.619; CI 2.659-11.873). Qualitative findings on disclosure perceptions showed 42.78% good, 32.97% low self esteem, 17.3% quilt and 6.22% shame, while results on disclosure outcome portray stigma (72.7%), discrimination (12.5%) and least being suicidal thoughts (2.2%). The study realized 46% of PLHIV were not aware of their spouse HIV status despite being on care. While 43% who had not disclosed their sero-status; 40% were not willing due to fear of economic loss, 35% loss of social support and 25% to blame. The knowledge of partner HIV status and pre disclosure preparedness are important determinants for HIV disclosure. Interventions that target HIV counseling and testing as well community perception on HIV disclosure should be empowered. The results of this study will help PLHIV and those not infected to seek HIV test and disclose their status in order to reduce risk of HIV transmission.