(P16) HIV status disclosure and fears of negative social consequences among pregnant women in antenatal care: Multi-centre survey in western Kenya
Björn Nordberg [1, 2], Erin E Gabriel , Edwin Were , Eunice Kaguiri , Anna M Ekström [1, 6], Susanne Rautiainen [1, 7]
Department of Public Health Sciences, Global and Sexual Health (GloSH), Karolinska Institutet, Stockholm, Sweden  Department of Infectious Diseases, Helsingborg Hospital, Helsingborg, Sweden  Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden  Department of Reproductive Health, Moi University, Eldoret, Kenya  Partners in Prevention, Moi University, Eldoret, Kenya  Department of Infectious Diseases, Karolinska University Hospital, Stockholm, Sweden  Brigham and Women’s Hospital, Boston, USA 
HIV status disclosure has been shown to be important for successful prevention of mother-to-child transmission (PMTCT) of HIV. In recent years, PMTCT care has improved across sub-Saharan Africa, with increased access to antiretroviral therapy and integration of PMTCT services into antenatal care. However, HIV stigma is still an issue hampering disclosure and access to services. Our aim was to investigate potential barriers to HIV status disclosure among pregnant women living with HIV in Kenya.
We performed a cross-sectional analysis of 437 pregnant women living with HIV at enrolment in four out of six sites in a multicentre mobile phone intervention trial (WelTel PMTCT) in western Kenya (June 2015-July 2016). Women diagnosed with HIV the same day were excluded. To investigate fears and characteristics associated with HIV status disclosure we used multivariable-adjusted logistic regression to estimate odds ratios and 95% confidence intervals.
A large proportion, 87% of women in our study had disclosed to someone, with 46% having disclosed to a relative, 8% having disclosed to a friend or other person, and 80% of women in a current relationship having disclosed to a partner. The most prevalent fears related to PMTCT care were fear of involuntary status disclosure (22%), fear of being a burden or source of worry for others (16%) and fear of losing respect in family or community (11%). In logistic regression analysis, fear of isolation or lack of support from family and friends was the most prevalent fear (reported by 9%) that was associated with lower odds of disclosure to someone (OR 0.29; 95%CI: 0.10-0.83), a partner (OR 0.33; 95%CI: 0.12-0.85), and a relative (OR 0.37; 95%CI: 0.16-0.85). Fear of separation (OR 0.17; 95%CI: 0.05-0.57) and conflict with a partner (OR 0.18; 95%CI: 0.05-0.67) were associated with lower odds of disclosure to a partner. Older women (age 35-44 years) had lower odds of disclosure to a partner (OR 0.15; 95%CI: 0.05-0.44) compared to younger women (age 18-24 years). Recent HIV diagnosis (<6 compared to ≥6 months) was associated with lower odds of disclosure to someone (OR 0.09; 95%CI: 0.04-0.20), a partner (OR 0.19; 95%CI: 0.09-0.39) and a relative (OR 0.20; 95%CI: 0.10-0.39). Women in a current relationship (81% of the study population) had lower odds of HIV disclosure to a relative (OR 0.35; 95%CI: 0.19-0.64) but higher odds of disclosure to a partner (OR 40.54; 95%CI: 17.80-92.35).
Fears of isolation or lack of support from family and friends as well as fear of separation and conflict with a partner still hampers HIV status disclosure in Kenya. However, younger women may be more willing to disclose to their partners compared to older women, suggesting a positive trend in Kenyan society towards more openness related to HIV in younger couples. Our results also suggest that women need time after their HIV diagnosis to process and cope prior to disclosure, and that disclosure to a current partner may be preferred over disclosure to a relative. It is important to discuss disclosure fears more carefully with patients as part of routine PMTCT counselling.