Prevalence, Associated Factors, Barriers and Facilitators of Disclosure of HIV status to sexual partners among Young People Living with HIV/AIDS in care at an Urban HIV Clinic, Kampala, Uganda.

Abstract

Background: HIV/AIDs remains of great public health concern globally. The disclosure rates of positive HIV status by young people living with HIV (YPLHIV) to their sexual partners are low. This has consequences of poor ART adherence, interruptions in HIV care, viral nonsuppression and ultimately new HIV infections. Disclosure among YPLHIV is influenced by various factors and different barriers and facilitators. Few studies have been done about disclosure to sexual partners among YPLHIV and worse still they are limited in Uganda. The objective of this study was to assess the prevalence, associated factors, barriers and facilitators of disclosure of HIV status to sexual partners by YPLHIV at the HIV clinic at Baylor Uganda. Methods: The study used a mixed methods parallel approach. Using quantitative methods, 281 randomly selected sexually active YPHIV aged 18 to 24 years were interviewed for prevalence and factors associated with disclosure of HIV status to their sexual partners while 16 in depth interview were done to assess barriers and facilitators. Quantitative data was analyzed in STATA v.17 using modified Poisson regression to determine factors associated with HIV status disclosure. IDIs were conducted to assess the barriers and facilitators of HIV status disclosure to partners and analyzed using thematic analysis by the help of NVivo software. Results: The prevalence of HIV status disclosure to sexual partners was 45.2%. Having a known HIV negative partner (aPR=0.6, P<0.001), being a complete orphan (aPR=1.4, P=0.022), knowing one’s HIV status for >1 year (aPR=0.7, P <0.001), and having few sexual partners (aPR =1.7, P=0.013) were associated with HIV status disclosure to sexual partners. Health worker/ peer support, nature and status of relationship, protection of sexual partners against contracting HIV, need for social and financial support were the major facilitators while fear of the sexual partners reaction, knowledge of undetectable HIV viral load being equal to no HIV transmission (U=U), the lack of confidence to open up, and negative influence from health worker and parents and nature of the relationship with the partner were the major barriers to disclosure. Conclusion: There was a low HIV status disclosure rate among YPLHIV to their sexual partners at the clinic and it was influenced by various factors such as partner’s status, number of sexual partners, orphan hood and duration knowing one’s HIV status while lack of confidence, fear of partner’s reaction and negative parent/health workers’ influence were among the barriers. Counselling about disclosure to sexual partners, comprehensive health education, and creating supportive environments are crucial in improving disclosure rates, ultimately ensuring continuity of HIV care, and reducing HIV spread to sexual partners of YPLHIV.