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FACTORS INFLUENCING HIV POSITIVE STATUS DISCLOSURE AMONG SEXUAL PARTNERS IN THE VOLTA REGION OF GHANA AMOS AYIQUAYE AMAVIH , D. Bandoh, B. Atsu , E. Kenu University of Ghana School of Public Health. Presentation Outline. Background Objectives Methods Results Discussion Conclusions

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  1. FACTORS INFLUENCING HIV POSITIVE STATUS DISCLOSURE AMONG SEXUAL PARTNERS IN THE VOLTA REGION OF GHANA AMOS AYIQUAYE AMAVIH, D. Bandoh, B. Atsu, E. Kenu University of Ghana School of Public Health

  2. Presentation Outline • Background • Objectives • Methods • Results • Discussion • Conclusions • Recommendations

  3. Background • HIV partner disclosure forms a key public health strategic approach to reduce the incidence of HIV transmission and improve treatment and care (Atuyambe et al., 2014). • Divulging HIV sero status to sexual partners is still a hurdle for people living with HIV (Aids, 2016; Qiao, Li, Zhou, Shen, & Tang, 2016). • About 36.7 million people living with HIV in the world in 2015, 40% are ignorant of their status (UNAIDS, 2016).

  4. Background cont. • HIV disclosure rate in developing counties ranges from 16.7% to 86% (“PREVENTION,” 2016). • High prevalence of HIV sero discordance among heterosexual couples (Ujah, Ezechi, & Ohihoin, 2015).

  5. Background cont. • Disclosure rate in Ghana ranges from 42.8% among women and 50% among men (GHS, 2014). • The 2.7% in the Volta Region is higher than current national prevalence of 2.4% (HIV SENTINEL SURVEY REPORT, 2016). • With the few studies conducted on disclosure among sexual partners in Ghana, there is little evidence of any done in the Volta region. • The aim of the study was to determine the prevalence of disclosure and the factors influencing the disclosure of HIV positive status in the Volta region of Ghana.  

  6. Objectives • To determine the proportion of HIV positive clients in Volta regionwho have disclosed their status to their partners • To determine the barriers accounting for the non-disclosure of HIV status among partners • To determine the factors that encourage HIV positive client to disclose their status to their partners.

  7. Methods - Study site and design • Cross-sectional study (June to July, 2017) • The Volta region is divided into 25 administrative districts/municipalities with Ho as the Regional capital. (Volta Region Annual HIV Report , 2015). • The selected sites: 7 • Ketu South Hospital, Keta Govt. Hospital, Ho municipal Hospital, St. Anthony’s Hospital, Sogakope Govt. Hospital, Sacred Heart Hospital and Akatsi Govt. Hospital.   

  8. Methods - Sample Size Using the formula: n= z2 x p (1-p) e2 (1.96)2 x 0.5 (1-0.5) (0.05)2 = 384 10% contingency for incomplete q= 0.1*384 = 423 • The sample size: Cochran’s formulae.   • A total of 423 participants • estimated prevalence of the variable of interest – HIV positive status disclosure (p)=51% • desired level of confidence (z)= 95% • acceptable margin of error (e)= 5%

  9. Methods - Data Collection Techniques and Tools • Structured questionnaire • Data collection by the principal investigator and five (5) research assistants   • administered to participants in a private room in each ART site after their ART services. • reviewed all administered daily for accuracy and completeness and • completed questionnaires were coded.

  10. Methods - Data Analysis • Data processed and analyzed using STATA IC 14.1   • Descriptive results: presented in tables and figures • Relationships of variables: Chi-square test for categorical variables • p-values less than 0.05 were considered significant • Logistic regression: describe associations • Multiple logistic regression at 5% margin of error: Identify predictors of HIV-status disclosure and account for confounders.  

  11. Methods - Ethical Consideration • Ethical approval: GHS Ethics Review Committee (ERC) • Approval from Volta Regional Health Directorate • Consent from the selected (ART sites and participants) before administration of the questionnaire • Refusal or withdrawal would not affect the services they received at the facility in future. • No personal identifiers collected for confidentiality

  12. Results – Participant Characteristics • A total of 423 PLWHIV  participated in this study. • Mean age: 41.7 (±12.6) • range -18-79 years • Age group 35-44 years: Most respondents, 31.7% (134/423) • Females- 77.8% (329/423); married - 49.6% (210/423) • Self-employed - 49.4% (209/423), • Income level was fairly low; 74.5% (315/423)

  13. Results –Prevalence of disclosure • Disclosure rate among partners who patronized ART services in seven (7) selected sites in the Volta Region of Ghana: 40.2% (170/423) • The highest age-specific prevalence of disclosure: age group 25-34 years, 45.3% (77/170).

  14. Results – Predictors of disclosure • Males were 11.7 times more likely to disclose their HIV positive status to their sexual partners higher compared to females (AOR: 11.69; 95% CI, 2.12-64.24, p<0.05 )   • The odds of primary school leavers disclosing their HIV positive status to their sexual partners was 1.6 times higher compared to the other levels of education (AOR: 1.61; 95% CI, 0.02-0.65, p<0.05 )

  15. Results – Predictors of disclosure cont. • Participants with one sexual partner were 6 times more likely to disclose their HIV positive status to their partners compared to the others (AOR: 5.95; 95% CI, 1.58-22.38, p<0.05 )   • Participants who were not aware of the importance of disclosure were 0.15 times less likely to disclose their status to their sexual partners compared to those who were aware (AOR: 0.15; 95% CI, 0.00-0.23, p<0.05 )  

  16. Results – Predictors of disclosure cont. • Participants who used condoms always were 0.14 times less likely to disclose their HIV positive status to their sexual partners compared to other levels of condom usage (AOR: 0.14; 95% CI, 0.03-0.60, p<0.05 ) • Participants who were urban dwellers were 0.06 times less likely to disclose their HIV positive status to their sexual partners compared to other settlement types (AOR: 0.06; 95% CI, 0.01-0.34, p<0.05 )    

  17. Results – Reasons mentionedfor non-disclosure

  18. DISSUSSION – Prevalence of Disclosure • The high non-disclosure rate; may result in increase infections and re-infections among partners. • conforms with studies in some developing countries (16.7% to 86%) (Bott & Obermeyer, 2013; “PREVENTION,” 2016). • A higher proportion  of males had disclosed their HIV status to their partners compared with females; culture • Supported by studies in developing countries (10% to 78%) of women do not disclose their status, compared to only 3% to 10% in developed countries (Medley et al., 2004). • HIV status disclosure was prevalent among respondents with primary level education. • Stigma

  19. Conclusions • The study observed a low disclosure rate among the participants. • Fear of partner withdrawal was the primary reason for non-disclosure. • Non-disclosure of HIV status was significantly associated with sex, educational level, lack of knowledge on the importance of disclosure, regular condom use, having multiple partners and settlement type.

  20. Thank you

  21. References • Aids, G. (2016). GLOBAL AIDS UP. • Amoran, O. E. (2012). Predictors of disclosure of sero-status to sexual partners among people living with HIV / AIDS in Ogun State , Nigeria, 15, 1–12. http://doi.org/10.4103/1119-3077.104507 • Atuyambe, L. M., Ssegujja, E., Ssali, S., Tumwine, C., Nekesa, N., Nannungi, A., … Wagner, G. (2014). HIV/AIDS status disclosure increases support, behavioural change and, HIV prevention in the long term: a case for an Urban Clinic, Kampala, Uganda. BMC Health Services Research, 14(1), 276. http://doi.org/10.1186/1472-6963-14-276 • Baidoo, I., & Rheinla, T. (2016). The “ Fears ” of Disclosing HIV Status to Sexual Partners : A Mixed Methods Study in a Counseling Setting in Ghana, 126–136. http://doi.org/10.1007/s10461-015-1022-1 • Bott, S., & Obermeyer, C. M. (2013). The social and gender context of HIV disclosure in sub-Saharan Africa: A review of policies and practices. SAHARA-J: Journal of Social Aspects of HIV/AIDS, 10(sup1), S5–S16. http://doi.org/10.1080/02664763.2012.755319 • Cissé, M., Diop, S., Abadie, A., Henry, E., Bernier, A., Dembele, B., … Preau, M. (2015). of Biosocial Science : FACTORS ASSOCIATED WITH HIV VOLUNTARY DISCLOSURE TO ONE â€TM S STEADY SEXUAL PARTNER IN MALI : RESULTS FROM A COMMUNITY-BASED STUDY FACTORS ASSOCIATED WITH HIV VOLUNTARY DISCLOSURE TO ONE ’ S STEADY SEXUAL PARTNER IN MALI : RESULTS FRO. http://doi.org/10.1017/S0021932014000546 • Clum, G. A., Czaplicki, L., Andrinopoulos, K., Muessig, K., Hamvas, L., & Ellen, J. M. (2013). Strategies and outcomes of HIV status disclosure in HIV-positive young women with abuse histories. AIDS Patient Care and STDs, 27(3), 191–200. http://doi.org/10.1089/apc.2012.0441 • Colombini, M., James, C., Ndwiga, C., & Mayhew, S. H. (2016). The risks of partner violence following HIV status disclosure , and health service responses : narratives of women attending reproductive health services in Kenya, 19. http://doi.org/10.7448/IAS.19.1.20766 • Idindili, B., Selemani, M., Bakar, F., Thawer, S. G., Gumi, A., Mrisho, M., … Massaga, J. J. (2015). Enhancing hiv status disclosure and partners’ testing through counselling in Tanzania. Tanzania Journal of Health Research, 17(3). http://doi.org/10.4314/thrb.v17i3.4

  22. Lugalla, J., Yoder, S., Sigalla, H., & Madihi, C. (2012). Social context of disclosing HIV test results in Tanzania. Culture, Health and Sexuality, 14(SUPPL. 1). http://doi.org/10.1080/13691058.2011.615413 • Medley, A., Garcia-moreno, C., Mcgill, S., & Maman, S. (2004). hhjjjj (Vol. 3913). • O’Brien, M. E., Richardson-Alston, G., Ayoub, M., Magnus, M., Peterman, T. A., & Kissinger, P. (2003). Prevalence and correlates of HIV serostatus disclosure. Sexually Transmitted Diseases, 30(9), 731–735. http://doi.org/10.1097/01.OLQ.0000079049.73800.C2 • PREVENTION. (2016). • Qiao, S., Li, X., Zhou, Y., Shen, Z., & Tang, Z. (2016). AIDS impact special issue 2015: interpersonal factors associated with HIV partner disclosure among HIV-infected people in China. AIDS Care, 28(sup1), 37–43. http://doi.org/10.1080/09540121.2016.1146397 • Survey, H. (2014). Ghana. • Tshisuyi, E. T. (2014). DISCLOSURE OF HIV POSITIVE STATUS TO SEXUAL PARTNERS AMONG PREGNANT WOMEN IN A HEALTH DISTRICT OF BOTSWANA by, (April). • Ujah, I. A. O., Ezechi, O. C., & Ohihoin, A. G. (2015). ORIGINAL RESEARCH ARTICLE HIV Status Discordance : Associated Factors Among HIV Positive Pregnant Women in Lagos , Southwest Nigeria, 2065(June), 107–115. • UNAIDS. (2016). Fact sheet 2016 | UNAIDS. Retrieved from http://www.unaids.org/en/resources/fact-sheet • Volta Region records high HIV prevalence. (n.d.).

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