HIV Serostatus Disclosure Among Men Who Have Sex with Men in China in the Era of U=U and PrEP

Given the recent evidence on “Undetectable = Untransmittable” (U=U) and pre-exposure prophylaxis (PrEP), the present study aimed to investigate HIV disclosure behaviors and their associations with sexual risk behaviors and U=U and PrEP awareness among men who have sex with men (MSM) in China. A cross-sectional survey was conducted among 689 MSM recruited through a gay-friendly non-governmental organization located in Chengdu, China in 2018–2019. Information was collected by a structured self-administrated questionnaire. The enrolled sample included 554 (80.4%) participants who were HIV-negative and 135 (19.6%) participants with an unknown HIV status. In terms of disclosure, 41.4% of participants informed all partners about their HIV status all the time (informing behavior), while 30.4% asked all partners about their HIV status all the time (asking behavior). Only one-fifth knew about U=U, but this was not statistically associated with either informing or asking behavior. Half (50.5%) had heard of PrEP but this was not statistically associated with either informing or asking behavior. Common barriers to informing and asking behaviors were lower risk perception of HIV infection, a history of sexually transmitted infections, engagement in receptive sex, and a history of sex with casual partners. We found that both U=U and PrEP awareness and HIV serostatus disclosure were infrequent and not associated in this study of Chinese MSM. These data indicate huge information gaps among MSM in China.

24-Month Clinical, Immuno-Virological Outcomes, and HIV Status Disclosure in Adolescents Living With Perinatally-Acquired HIV in the IeDEA-COHADO Cohort in Togo and Côte d'Ivoire, 2015–2017

Background: Adolescents living with perinatally-acquired HIV (APHIV) face challenges including HIV serostatus disclosure. We assessed their 24-month outcomes in relation to the disclosure of their own HIV serostatus.Methods: Nested within the International epidemiologic Database to Evaluate AIDS pediatric West African prospective cohort (IeDEA pWADA), the COHADO cohort included antiretroviral (ART)-treated APHIV aged 10–19 years, enrolled in HIV care before the age of 10 years, in Abidjan (Côte d'Ivoire) and Lomé (Togo) in 2015. We measured the HIV serostatus disclosure at baseline and after 24 months and analyzed its association with a favorable combined 24-month outcome using logistic regression. The 24-month combined clinical immuno-virological outcome was defined as unfavorable when either death, loss to follow-up, progression to WHO-AIDS stage, a decrease of CD4 count >10% compared to baseline, or a detectable viral load (VL > 50 copies/mL) occurred at 24 months.Results: Overall, 209 APHIV were included (51.6% = Abidjan, 54.5% = females). At inclusion, the median CD4 cell count was 521/mm3 [IQR (281–757)]; 29.6% had a VL measurement, of whom, 3.2% were virologically suppressed. APHIV were younger in Lomé {median age: 12 years [interquartile range (IQR): 11–15]} compared to Abidjan [14 years (IQR: 12–15, p = 0.01)]. Full HIV-disclosure increased from 41.6% at inclusion to 74.1% after 24 months. After 24 months of follow-up, six (2.9%) died, eight (3.8%) were lost to follow-up, and four (1.9%) were transferred out. Overall, 73.7% did not progress to the WHO-AIDS stage, and 62.7% had a CD4 count above (±10%) of the baseline value (48.6% in Abidjan vs. 69.0% in Lomé, p < 0.001). Among the 83.7% with VL measurement, 48.8% were virologically suppressed (Abidjan: 45.4%, Lomé: 52.5%, p <0.01). The 24-month combined outcome was favorable for 45% (29.6% in Abidjan and 61.4% in Lomé, p < 0.01). Adjusted for baseline variables, the 24-month outcome was worse in Lomé in those who had been disclosed for >2 years compared to those who had not been disclosed to [aOR = 0.21, 95% CI (0.05–0.84), p = 0.03].Conclusions: The frequency of HIV-disclosure improved over time and differed across countries but remained low among West African APHIV. Overall, the 24-month outcomes were poor. Disclosure before the study was a marker of a poor 24-month outcome in Lomé. Context-specific responses are urgently needed to improve adolescent care and reach the UNAIDS 90% target of virological success.

To Disclose or Not to Disclose? Reasons for HIV Serostatus Disclosure and Non-disclosure by People Living with HIV/AIDS in Eastern India

Background: Understanding the reasons for HIV serostatus disclosure and nondisclosure and how these reasons differ by certain characteristics of the people living with HIV/AIDS (PLWHA) is important for effective HIV prevention intervention strategies. Objectives: This study was undertaken to investigate/identify the reasons for disclosure and nondisclosure of HIV serostatus by PLWHA, and to find out any association between the reasons for disclosure or nondisclosure and certain demographic and clinical characteristics, i.e. age, gender, WHO clinical stage and CD4 count of the study population. Methods: A cross-sectional study was conducted among all patients of 18-49 years with confirmed HIV infection registered at the antiretroviral therapy (ART) center of a tertiary care hospital in eastern Uttar Pradesh, India for one year, from July 2017 to June 2018. Results: The most common reason for disclosure of HIV serostatus was the presence of any family member at the time of collection of HIV test report (68.5%), and the most common reason for not disclosing the serostatus was stigmatization (68%). The reasons for disclosure was found to be associated with the WHO clinical stage of the respondents (p <0.05). Conclusions: The findings of this study highlights the need for tailoring intervention strategies for improving disclosure decision making according to the specific needs of PLWHA. There is also a need to address the concerns of those who are reluctant to disclose. More emphasis should be given on creating awareness about HIV stigma, on the importance of serostatus disclosure and secondary HIV prevention in the community.

Determinants of HIV serostatus disclosure and assessment of the competence of health care personnel in HIV serostatus disclosure

Background: Disclosure of HIV serostatus is essential for the care and eradication of HIV infection. The World Health Organization recommends disclosure to school-age children and younger children but this practice is commonly hindered by stigmatization and other presumed psychosocial effects of the disease. Objective: To identify limitations to the disclosure of serostatus in HIV-infected children, outcomes of disclosure as well as compare the outcomes of disclosure by either parents/caregiver only with the involvement of health care personnel. Methods: A questionnaire-based study of primary caregivers of children aged 6 years to 18 years with HIV infection who were enrolled at two government-owned tertiary institutions in Lagos State, Nigeria. The healthcare personnel directly involved in the care of these children also participated in the study. Results: A total of 190 primary caregivers participated in the study. In all, 29 health care personnel completely filled the questionnaires. Disclosure (partial and full) was recorded among 31.0%. Older children and children with single parents were more likely to know their HIV status. Similar positive and negative impacts of disclosure were observed irrespective of the individuals involved in the processes. In all, 62.1% of healthcare personnel have had training on disclosure. Conclusion: Disclosure rate in HIV-infected children was low. There is a need for more training of health personnel and education of caregivers on the benefits of disclosure as well as the introduction of effective measures to tackle the barriers to disclosure.