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HIV Disclosure Among Sexually Infected People Living with HIV and AIDS in China: Prevalence, Influencing Factors, and Negative Outcomes

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Abstract

HIV disclosure is crucial for HIV prevention and control, but may also lead to discrimination, insult, and even violence against people living with HIV and AIDS (PLWHAs). In this study, we examined HIV disclosure, its influencing factors, and its association with intimate partner violence (IPV) among 1153 PLWHAs through the sexual route in Jinan, Shandong Province, China. Our results showed that 76.4% (881/1153) PLWHAs had disclosed someone about their HIV infection, the HIV disclosure rates among family members, friends, spouses, and current fixed partners of PLWHAs were 43.5% (501/1153), 47.9% (552/1153), 56.8% (129/227), and 43.2% (336/777), respectively. HIV disclosure was affected by socio-demographics, disease characteristics, and psycho-social factors and varied among family members, close friends, spouses, and current fixed sexual partners. Age ≤ 33 years (aOR 1.79, 95% CI 1.27–2.53), heterosexual infection route (aOR 1.52, 95% CI 1.06–2.17), HIV diagnosis time > 36 months (aOR 1.84, 95% CI 1.30–2.59), with other chronic diseases (aOR 1.87, 95% CI 1.34–2.61), lower self-stigma (aOR 4.03–4.36, 95% CI 1.98–8.74), higher social support (aOR 1.71–1.73, 95% CI 1.03–2.83), no depression (aOR 1.54, 95% CI 1.12–2.11), and no suicidal ideation (aOR 1.79, 95% CI 1.28–2.50) were all independently associated with increased likelihood of HIV disclosure. HIV disclosure was associated with an increased risk of IPV among current fixed sexual partners (aOR 1.87, 95% CI 1.38–2.54) and spouses (aOR 2.54, 95% CI 1.41–4.56). Our findings suggest that the HIV disclosure rate of PLWHAs is still low and is affected by multiple factors. There is an urgent need to design targeted and comprehensive interventions to improve HIV disclosure. IPV prevention should also be incorporated into the intervention system of HIV disclosure to ensure adequate and continuous support for PLWHAs.

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Data Availability

The datasets generated and/or analyzed during the current study are not publicly available, but are available from the corresponding author on reasonable request.

References

  1. UNAIDS. Global HIV & AIDS statistics—2022 fact sheet. https://www.unaids.org/en/resources/fact-sheet (2012). accessed 1 Sept 2022.

  2. Joint United Nations Programme on HIV/AIDS (UNAIDS). Fast-track: ending the AIDS epidemic by 2030. Geneva: UNAIDS; 2014.

    Google Scholar 

  3. National Health Commission of China. Low prevalence level! China reports 1.14 million existing HIV infections. https://www.cn-healthcare.com/article/20211201/content-563287.html (2021). accessed 1 Dec 2021.

  4. NCAIDS. Progress in AIDS Prevention and Treatment in China. http://ncaids.chinacdc.cn/xxgx/yqxx/201811/t20181123_197488.htm (2018). accessed 19 Sept 2022.

  5. World Health Organization. Guidelines on HIV self-testing and partner notification: supplement to consolidated guidelines on HIV testing services. https://apps.who.int/iris/handle/10665/251655 (2016). accessed 1 Sept 2019.

  6. Dalal S, Johnson C, Fonner V, et al. Improving HIV test uptake and case finding with assisted partner notification services. AIDS. 2017;31(13):1867–76.

    Article  PubMed  Google Scholar 

  7. Vermandere H, Aguilera-Mijares S, Martínez-Vargas L, et al. Developing HIV assisted partner notification services tailored to Mexican key populations: a qualitative approach. BMC Public Health. 2021;21(1):555.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Sharma M, Smith JA, Farquhar C, et al. Assisted partner notification services are cost-effective for decreasing HIV burden in western Kenya. AIDS. 2018;32(2):233–41.

    Article  PubMed  Google Scholar 

  9. O’Connell AA, Reed SJ, Serovich JA. The efficacy of serostatus disclosure for HIV transmission risk reduction. AIDS Behav. 2015;19(2):283–90.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Ostermann J, Pence B, Whetten K, et al. HIV serostatus disclosure in the treatment cascade: evidence from Northern Tanzania. AIDS Care. 2015;27(sup1):59–64.

    Article  PubMed  PubMed Central  Google Scholar 

  11. Xiao Z, Li X, Qiao S, et al. Using communication privacy management theory to examine HIV disclosure to sexual partners/spouses among PLHIV in Guangxi. AIDS Care. 2015;27(sup1):73–82.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Lyimo RA, Stutterheim SE, Hospers HJ, et al. Stigma, disclosure, coping, and medication adherence among people living with HIV/AIDS in Northern Tanzania. AIDS Patient Care STDS. 2014;28(2):98–105.

    Article  PubMed  Google Scholar 

  13. Tesfaye T, Darega J, Belachew T, et al. HIV positive sero-status disclosure and its determinants among people living with HIV /AIDS following ART clinic in Jimma University Specialized Hospital, Southwest Ethiopia: a facility-based cross-sectional study. Arch Public Health. 2018;76:1.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Xu MJ, Zhao Y, Shao Y, et al. HIV serostatus disclosure to family members and its predictors among adolescents living with HIV receiving ART. Chin J AIDS STD. 2020;26(8):849–51.

    Google Scholar 

  15. Yang YM, Xiao CC, Wang W, et al. HIV disclosure to family members and its associated factors among people with HIV/AIDS. Chin J AIDS STD. 2017;23(08):706–9.

    Google Scholar 

  16. Lee S, Yamazaki M, Harris DR, et al. Social support and human immunodeficiency virus-status disclosure to friends and family: implications for human immunodeficiency virus-positive youth. J Adolesc Health. 2015;57(1):73–80.

    Article  PubMed  PubMed Central  Google Scholar 

  17. Wohl AR, Galvan FH, Myers HF, et al. Do social support, stress, disclosure and stigma influence retention in HIV care for Latino and African American men who have sex with men and women? AIDS Behav. 2011;15(6):1098–110.

    Article  PubMed  Google Scholar 

  18. Salami AK, Fadeyi A, Ogunmodede JA, Desalu OO. Status disclosure among people living with HIV/AIDS in Ilorin, Nigeria. West Afr J Med. 2011;30(5):359–63.

    CAS  PubMed  Google Scholar 

  19. Zang C, He X, Liu H. Selective disclosure of HIV status in egocentric support networks of people living with HIV/AIDS. AIDS Behav. 2015;19(1):72–80.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Longinetti E, Santacatterina M, El-Khatib Z. Gender perspective of risk factors associated with disclosure of HIV status, a cross-sectional study in Soweto, South Africa. PLoS ONE. 2014;9(4): e95440.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sun M, Chen WT, Yang JP, et al. Concerns of parental HIV disclosure in China. Clin Nurs Res. 2021;30(6):830–9.

    Article  PubMed  Google Scholar 

  22. Yang Y, Wang W, Kelifa MO, et al. HIV disclosure patterns and psychosocial correlates among people living with HIV in Nanjing, China: a latent class analysis. AIDS Res Hum Retroviruses. 2020;36(3):220–6.

    Article  PubMed  Google Scholar 

  23. Chi Y, Huang D, Lindgren T, et al. The association between HIV disclosure, spousal testing and unprotected vaginal intercourse within marriage among HIV positive married MSM in China. AIDS Care. 2022;34(1):127–34.

    Article  PubMed  Google Scholar 

  24. Adeoye-Agboola DI, Evans H, Hewson D, et al. Factors influencing HIV disclosure among people living with HIV/AIDS in Nigeria: a systematic review using narrative synthesis and meta-analysis. Public Health. 2016;136:13–28.

    Article  CAS  PubMed  Google Scholar 

  25. Abler L, Sikkema KJ, Watt MH, Hansen NB, Wilson PA, Kochman A. Depression and HIV serostatus disclosure to sexual partners among newly HIV-diagnosed men who have sex with men. AIDS Patient Care STDS. 2015;29(10):550–8.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Sulstarova B, Poglia Mileti F, Mellini L, et al. HIV disclosure and nondisclosure among migrant women from sub-Saharan Africa living in Switzerland. AIDS Care. 2015;27(4):451–7.

    Article  PubMed  Google Scholar 

  27. Colombini M, James C, Ndwiga C, et al. The risks of partner violence following HIV status disclosure, and health service responses: narratives of women attending reproductive health services in Kenya. J Int AIDS Soc. 2016;19(1):20766.

    Article  PubMed  PubMed Central  Google Scholar 

  28. Kidman R, Violari A. Dating violence against HIV-infected youth in South Africa: associations with sexual risk behavior, medication adherence, and mental health. J Acquir Immune Defic Syndr. 2018;77(1):64–71.

    Article  PubMed  PubMed Central  Google Scholar 

  29. Stangl AL, Singh D, Windle M, et al. A systematic review of selected human rights programs to improve HIV-related outcomes from 2003 to 2015: what do we know? BMC Infect Dis. 2019;19(1):209.

    Article  PubMed  PubMed Central  Google Scholar 

  30. Wang N, Huang B, Ruan Y, et al. Association between stigma towards HIV and MSM and intimate partner violence among newly HIV-diagnosed Chinese men who have sex with men. BMC Public Health. 2020;20(1):204.

    Article  PubMed  PubMed Central  Google Scholar 

  31. Obermeyer CM, Baijal P, Pegurri E. Facilitating HIV disclosure across diverse settings: a review. Am J Public Health. 2011;101(6):1011–23.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Ko NY, Lee HC, Hsu ST, et al. Differences in HIV disclosure by modes of transmission in Taiwanese families. AIDS Care. 2007;19(6):791–8.

    Article  PubMed  Google Scholar 

  33. Mak WW, Cheung RY. Self-stigma among concealable minorities in Hong Kong: conceptualization and unified measurement. Am J Orthopsychiatry. 2010;80(2):267–81.

    Article  PubMed  Google Scholar 

  34. Shi Y. Assessment of effect of perceived social support on school readiness, mental wellbeing, and self-esteem: mediating role of psychological resilience. Front Psychol. 2022;13: 911841.

    Article  PubMed  PubMed Central  Google Scholar 

  35. Kroenke K, Spitzer RL, Williams JB. The Patient Health Questionnaire-2: validity of a two-item depression screener. Med Care. 2003;41(11):1284–92.

    Article  PubMed  Google Scholar 

  36. Spitzer RL, Kroenke K, Williams JB, Löwe B. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med. 2006;166(10):1092–7.

    Article  PubMed  Google Scholar 

  37. Li XY, Fei LP, Zhang YD, et al. Reliability and validity of the Chinese version of Beck Scate for Suicide Ideation (BSI-CV) among university students. Chin Ment Health J. 2011;25(11):862–6.

    Google Scholar 

  38. Yu Y, Xiao S, Liu KQ. Dating violence among gay men in China. J Interpers Violence. 2013;28(12):2491–504.

    Article  PubMed  Google Scholar 

  39. Cui Y, Zhou YJ, Li XM, et al. Status and impacts of parental HIV disclosure to children. Chin J AIDS STD. 2019;25(6):588–91.

    Google Scholar 

  40. Omunakwe HE, Okoye H, Efobi C, Onodingene M, Chinenye S, Nwauche CA. Disclosure amongst adult HIV patients on antiretroviral therapy in Port Harcourt, Nigeria. Int J STD AIDS. 2015;26(10):729–32.

    Article  PubMed  Google Scholar 

  41. He SF, Wang J, Chen J, et al. HIV status disclosure to sexual partners and its related factors among HIV-positive college students reported from 2016 to 2019 in Beijing. Chin J AIDS STD. 2021;27(8):817–21.

    Google Scholar 

  42. Lan GH, Liang NX, Zhou YJ, et al. Influencing factors of HIV positive serostatus disclosure to the regular female sexual partners by HIV infected men who have sex with men in Guangxi. Chin J AIDS STD. 2020;26(9):949–53.

    Google Scholar 

  43. Huang ZC, Mao X, Zhang W, Hu, et al. Resistance factors influencing HIV serostatus disclosure to spouses among married men who have sex with men (MSM) in Shenyang. Chin J AIDS STD. 2018;24(3):250–3.

    Google Scholar 

  44. Haberlen SA, Nakigozi G, Gray RH, et al. Antiretroviral therapy availability and HIV disclosure to spouse in Rakai, Uganda: a longitudinal population-based study. J Acquir Immune Defic Syndr. 2015;69(2):241–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Madiba S, Ralebona E, Lowane M. Perceived stigma as a contextual barrier to early uptake of HIV testing, treatment initiation, and disclosure; the case of patients admitted with AIDS-related illness in a rural hospital in South Africa. Healthcare (Basel). 2021;9(8):962.

    Article  PubMed  Google Scholar 

  46. Maman S, van Rooyen H, Groves AK. HIV status disclosure to families for social support in South Africa. AIDS Care. 2014;26(2):226–32.

    Article  PubMed  Google Scholar 

  47. Zhang K, Zhao J, Li X, et al. Perceived facilitators and barriers regarding partner notification in people living with HIV in Hunan, China: a qualitative study from the patient perspective. J Assoc Nurses AIDS Care. 2019;30(6):658–67.

    Article  PubMed  Google Scholar 

  48. Pei JH, Pei YX, Ma T, et al. Prevalence of suicidal ideation, suicide attempt, and suicide plan among HIV/AIDS: a systematic review and meta-analysis. J Affect Disord. 2021;292:295–304.

    Article  PubMed  Google Scholar 

  49. Ren Y, Yan Y, Chen JD. Qualitative research on the psychology of malicious transmission of HIV/AIDS patients. Chin J Modern Nurs. 2017;23(2):212–5.

    Google Scholar 

  50. Maman S, Groves AK, McNaughton Reyes HL, Moodley D. Diagnosis and disclosure of HIV Status: implications for women’s risk of physical partner violence in the postpartum period. J Acquir Immune Defic Syndr. 2016;72(5):546–51.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Stark L, Seff I, Weber AM, et al. Perpetration of intimate partner violence and mental health outcomes: sex- and gender-disaggregated associations among adolescents and young adults in Nigeria. J Glob Health. 2020;10(1): 010708.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Ho IK, Dinh KT, Smith SA. Intimate partner violence and physical health outcomes among Southeast Asian American women. J Health Psychol. 2017;22(4):515–25.

    Article  PubMed  Google Scholar 

  53. Dunkle KL, Decker MR. Gender-based violence and HIV: reviewing the evidence for links and causal pathways in the general population and high-risk groups. Am J Reprod Immunol. 2013;69(Suppl 1):20–6.

    Article  PubMed  Google Scholar 

  54. Siemieniuk RA, Krentz HB, Miller P, et al. The clinical implications of high rates of intimate partner violence against HIV-positive women. J Acquir Immune Defic Syndr. 2013;64(1):32–8.

    Article  PubMed  Google Scholar 

  55. Centers for Disease Control and Prevention (CDC). Advancing HIV prevention: new strategies for a changing epidemic–United States, 2003. MMWR Morb Mortal Wkly Rep. 2003;52(15):329–32.

    Google Scholar 

  56. Webber DW. Self-incrimination, partner notification, and the criminal law: negatives for the CDC’s “prevention for positives” initiative. AIDS Public Policy J. 2004;19(1–2):54–66.

    Google Scholar 

  57. Mao X, Leuba SI, Hu Q, et al. Use of multiple recreational drugs is associated with new HIV infections among men who have sex with men in China: a multicenter cross-sectional survey. BMC Public Health. 2021;21(1):354.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  58. He L, Pan X, Wang N, et al. New types of drug use and risks of drug use among men who have sex with men: a cross-sectional study in Hangzhou, China. BMC Infect Dis. 2018;18(1):182.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Lei Y, Wang H, Xiao X, et al. Status and influencing factors of rush poppers use and HIV infection among men who have sex with men in Changsha. Chin J Prev Med. 2016;50(2):148–52.

    Google Scholar 

  60. Stoicescu C, Ameilia R, Irwanto, et al. Syndemic and synergistic effects of intimate partner violence, crystal methamphetamine, and depression on HIV sexual risk behaviors among women who inject drugs in Indonesia. J Urban Health. 2019;96(3):477–96.

    Article  PubMed  PubMed Central  Google Scholar 

  61. Gabbidon K, Chenneville T, Peless T, Sheared-Evans S. Self-disclosure of HIV status among youth living with HIV: a global systematic review. AIDS Behav. 2020;24(1):114–41.

    Article  PubMed  Google Scholar 

  62. Parker R, Aggleton P, Attawell K, et al. HIV/AIDS-related stigma and discrimination: A conceptual framework and an agenda for action. Horizons report. 2010.

  63. Thapa S, Hannes K, Cargo M, et al. Building a conceptual framework to study the effect of HIV stigma-reduction intervention strategies on HIV test uptake: a scoping review. J Assoc Nurses AIDS Care. 2017;28(4):545–60.

    Article  PubMed  Google Scholar 

  64. Frye V, Paige MQ, Gordon S, et al. Developing a community-level anti-HIV/AIDS stigma and homophobia intervention in New York city: the project change model. Eval Program Plann. 2017;63:45–53.

    Article  PubMed  Google Scholar 

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Acknowledgements

We extend our gratitude to all PLWHAs who completed the survey. We further thank the HIV specialist nurses and doctors at the Center for Disease Control and Prevention (CDC) of the Central District of Jinan City,China for their effort in recruiting respondents to complete the surveys.

Funding

This study was supported by the Special Funding Project for High-level Innovation Teams and Outstanding Scholars Plan of Guangxi Colleges and University: Research on Emergencies in Guangxi (Department of Education of Guangxi Province, China, Grant No. GuijiaoRenCai[2020]6), the Scientific research project of Hunan Education Department (19B517), and the Guangxi Philosophy and Social Science Foundation Project (22FSH012).

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Authors and Affiliations

  1. School of Politics and Public Administration, Guangxi Normal University, Guilin, 541006, Guangxi, China

    Yong Yu, Keke Qin, Fuqun Xiao, Huilin Cai, Yinmeng Sun, Jiahong Li, Zhi Cao, Kun Yang, Qianyue Huang & Ziyu Wei

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  1. Yong Yu
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  2. Keke Qin
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  3. Fuqun Xiao
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  4. Huilin Cai
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Contributions

All authors contributed to the study conception and design. Material preparation and data collection were performed by YY, KQ, FX, HC, YS, JL, ZC, KY, QH, and ZW. Data analysis was performed by YY, KQ, FX, and all authors contributed to the interpretation of data. The first draft of the article was written by YY, KQ, FX, and all authors commented on previous versions of the article. All authors read and approved the final article.

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Correspondence to Keke Qin.

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The authors have no conflicts of interest to declare that are relevant to the content of this article.

Ethical Approval

This study was performed in line with the principles of the Declaration of Helsinki. Approval was granted by the Ethics Committee of Guangxi Normal University (GXNU [2020] 2002). Informed consent was obtained from all individual participants included in this study.

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Yu, Y., Qin, K., Xiao, F. et al. HIV Disclosure Among Sexually Infected People Living with HIV and AIDS in China: Prevalence, Influencing Factors, and Negative Outcomes. AIDS Behav 27, 2411–2429 (2023). https://doi.org/10.1007/s10461-022-03968-z

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