Objectives: HIV-related stigma and low rates of HIV serostatus disclosure to sexual partners affect prevention efforts and contribute to negative health and social outcomes. However, empirical data on the effects of antiretroviral therapy (ART) rollout on stigma and disclosure in sub-Saharan Africa are generally lacking. Longitudinal data from the Rakai, Uganda, were used to evaluate changes in disclosure of positive HIV serostatus before and after ART introduction in 2004; quantify the inter-spousal reliability of disclosure reporting; and explore the prevalence, correlates, and clinical outcomes of discrimination experienced by ART patients.
Methods: To assess the probability of self-reported disclosure of positive HIV results to a spouse, we identified 557 married individuals from the 50 village Rakai Community Cohort Study (RCCS) who received positive HIV test results for the first time between 2000-2008. Discrete-time proportional hazards models were used to estimate the effect of ART availability, and of individual and relationship-level predictors, on disclosure within three years of diagnosis.
A complementary serial cross-sectional analysis of 1,522 RCCS marital couples measured the inter-spousal reliability of reported disclosure.
The third analysis utilized data from 1,466 patients participating in the ART- Related Clinical Study between 2006-2009. Multivariable logistic regression models were used to estimate the demographic, psychosocial, and health correlates of discrimination, and assess the association between discrimination, adherence, and treatment failure.
Results: The cumulative probability of disclosing positive HIV status to spouse increased after ART rollout (58% to 81% for men; 51% to 71% for women), and rates were highest among those who had initiated ART.
The trend in partner-confirmed disclosure paralleled that of self-reported disclosure, but remained significantly lower at all time points.
Rates of reported discrimination were low among ART users (11% among women, 6% among men). However, discrimination was linked with poorer adherence, but not treatment failure, six months after ART initiation.
Conclusions: The increase in disclosure rates suggests a synergy between HIV treatment and prevention in this rural population, where rates of discrimination were low. Study findings may assist in the design of interventions to support disclosure and further reduce stigma.