HIV Status Disclosure Among Postpartum Women in Zambia with Varied Intimate Partner Violence Experiences
HIV-positive pregnant and postpartum women’s status disclosure to male sexual partners is associated with improved HIV and maternal and child health outcomes. Yet, status disclosure remains a challenge for many women living with HIV in sub-Saharan Africa, particularly those who are fearful of violence. The objective of the present study is to advance the current understanding of the relationship between intimate partner violence against women and their HIV status disclosure behaviors. We specifically evaluate how the severity, frequency, and type of violence against postpartum HIV-positive women affect status disclosure within married/cohabiting couples. A cross-sectional survey was administered by trained local research assistants to 320 HIV-positive postpartum women attending a large public health center for pediatric immunizations in Lusaka, Zambia. Survey data captured women’s self-reports of various forms of intimate partner violence and whether they disclosed their HIV status to the current male partner. Multiple logistic regression models determined the odds of status disclosure by the severity, frequency, and type of violence women experienced. Our findings indicate a negative dose–response relationship between the severity and frequency of intimate partner violence and status disclosure to male partners. Physical violence has a more pronounced affect on status disclosure than sexual or emotional violence. Safe options for women living with HIV who experience intimate partner violence, particularly severe and frequent physical violence, are urgently needed. This includes HIV counselors’ ability to evaluate the pros and cons of status disclosure among women and support some women’s decisions not to disclose.
KeywordsHIV status disclosure Couples affected by HIV Intimate partner violence Sub-Saharan Africa Zambia
The authors would like to thank Dr. Yusuf Ahmed, Christine Chewe Sakala, Grace Lungeani Phiri, Franklin Munsanje, and Bibi Lambert Manda for their contribution to the study. Research reported in this publication was supported by the National Institute of Mental Health of the National Institutes of Health (Award Number F31MH107348) and the University of Colorado Center for Global Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.
Compliance with Ethical Standards
This study was funded by the National Institute of Mental Health of the National Institutes of Health (Award Number F31MH107348) and the University of Colorado Center for Global Health. Dr. Hampanda declares that she has no conflict of interest. Dr. Rael declares that she has no conflict of interest. All procedures performed involving human participants were in accordance with the ethical standards of the institutional research committee and with the 1964 Helsinki declaration and its later amendments. The study was approved by the Colorado Multiple Institutional Review Board (COMIRB) and the Excellence in Research Ethics and Science (ERES) Converge Zambia. Informed written consent (or a thumbprint) was obtained from all individual participants included in the study.
Conflict of interest
The authors declare no conflicting interests.
- 2.Matthews C, et al. Disclosure of HIV status and its consequences. S Afr Med J. 1999;89:1238.Google Scholar
- 11.CSO, Zambia Demographic and Health Survey 2013-14. Central Statistical Office, Ministry of Health, and ICF International: Rockville, Maryland, USA; 2014.Google Scholar
- 18.National Statistical Office and ICF Macro, Malawi Demographic and Health Survey 2010. 2011, NSO and ICF Macro: Zomba, Malawi, and Calverton, Maryland, USA.Google Scholar
- 19.World Health Organization (WHO). Putting women first: ethical and safety recommendations for research on domestic violence against women. Department of Gender and Women’s Health Family and Community Health. 2012. http://www.who.int/gender/violence/womenfirtseng.pdf.
- 21.CSO, Zambia Demographic and Health Survey 2007. Central Statistical Office (CSO), Ministry of Health (MOH), Tropical diseases research centre (TDRC), University of Zambia, & Macro International Inc.: Calverton, Maryland, USA; 2009.Google Scholar
- 22.MacQuarrie KL, Winter R, Kishor S. Spousal violence in Sub-Saharan Africa: structure, forms, and levels, in population association of America. Annual Meeting. Boston, MA; 2014.Google Scholar
- 24.Raghunathan TE, Lepkowski JM, Van Hoewyk J, Solenberger, P. A multivariate technique for multiply imputing missing values using a sequence of regression models. Surv Methodol. 2001;27(1):85–95.Google Scholar
- 25.StataCorp. Stata statistical software: release 11. College Station, TX: StataCorp LP; 2009.Google Scholar