HIV status awareness among people living with HIV and the effects of HIV disclosure on viral load suppression — Nigeria and Cameroon, 2017–2018 Open Access
Brown, Everett (Spring 2023)
Abstract
Background:
Identifying awareness and disclosure among people living with human immunodeficiency virus (PLHIV) in Sub-Saharan Africa (SSA) is necessary to end the epidemic. Disclosure of HIV status raises awareness and improves health outcomes among PLHIV. We aimed to use nationally representative Population-based HIV Impact Assessment (PHIA) surveys conducted in Cameroon and Nigeria to describe differences in demographic characteristics by HIV awareness status and the prevalence of disclosure to both sexual partner/spouse and anyone. We further analyzed survey data to assess whether disclosure is associated with viral load suppression.
Methods
This study used pooled data from two nationally representative PHIAs between 2017 and 2018. HIV-seropositive samples were tested for HIV-1 viral load and antiretrovirals (ARVs). The sample was weighted to represent adults aged 15–64 years who were HIV positive. We used weighted chi-squared 95% confidence intervals (CIs) and p-values with significance set to α = 0.05 to describe determinants of awareness. We fit weighted bivariable and multivariable logistic regression models to determine associations between VLS and disclosure.
Results
Among people living with HIV who were aware of their HIV-positive status by detectable ARVs, 1,295 (70.1%; 95% CI: 67.6-72.7) self-reported as HIV-positive. Among those, 553 (44.2%; 95% CI: 41.0-47.4) self-reported disclosing their HIV-positive status to a sexual partner/spouse, and 1,176 (90.2%; 95% CI: 88.4- 91.9) self-reported disclosing their HIV-positive status to anyone. Awareness was highest among women, older people (aged 35 years or older), people who resided in urban areas, and widowed people. The results of our disclosure analyses indicated no difference in the odds of viral load suppression (VLS) among those who disclosed to a sexual partner spouse compared to those who did not (adjusted OR (aOR) 1.18; 95% CI: 0.87-1.59), whereas disclosure to anyone was associated with VLS (aOR 1.65; 95% CI: 1.04–2.62).
Conclusion
Addressing disparities in the most unaware groups will require a comprehensive approach to raising awareness that considers these populations' distinctive experiences and needs. Interventions recommended should include counseling and support services for PLHIV who face stigma and other potential challenges to disclosure and awareness.
Table of Contents
Introduction, page 1
Methods, page 3
Results, page 7
Discussion, page 10
References, page 16
Table 1, page 21
Table 2, page 22
Table 3, page 23
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