XIX International AIDS Conference


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TUAC0104 - Oral Abstract

Impact of antiretroviral therapy on HIV-positive status disclosure in rural South Africa

Presented by Benjamin Bearnot (South Africa).

B. Bearnot1,2, L. Werner1, A. Kharsany1, S. Abdool Karim1,3, J. Frohlich1, Q. Abdool Karim1,3, CAPRISA060 Study Team

1CAPRISA, UKZN, Durban, South Africa, 2New York University, New York, United States, 3Columbia University, New York, United States

Background: HIV-positive individuals risk transmission to uninfected sexual partners. This risk may be elevated in the absence of disclosure of HIV status, but could be ameliorated given several options to prevent sexual transmission once HIV status is known. The purpose of this study was to assess the impact of antiretroviral therapy (ART) on degrees of HIV status disclosure.
Methods: In this prospective cohort study, we enrolled consenting, HIV-positive adults from the CAPRISA Vulindlela AIDS Treatment programme into one of two arms: ART experienced or ART naïve. Disclosure of HIV status was not a prerequisite for care or treatment. Data were collected at two time points using structured questionnaires including demographic, clinical, and HIV status disclosure information.
Results: Between June 2006-August 2009, 687 HIV-positive individuals were enrolled; 73.3% were female. At enrollment, 414 participants (60.3%) were on ART (median days on ART 54, IQR 11-167; median CD4 138/µL, IQR 86-199) and 273 (39.7%) were in care but not eligible for ART (median CD4 346/µL, IQR 254-476). Disclosure was common in ART and non-ART groups, with ART experienced participants more likely to have disclosed to at least one person than ART naïve individuals (99% versus 83.3%; p< 0.001). Disclosure occurred soon after HIV diagnosis (median: 0-1 day, respectively).

Disclosure rates to sexual partners were marked­ly lower in both ART and non-ART groups (31.6% and 26.0%), and was less common among females compared to males (23.7% versus 45.1%; p< 0.001). Low rates of further partner disclosure persisted at a median of 4.4 months post-enrollment (Females 9.9% versus Males 19.2%; p=0.003).

Table 1 - revised
[Table 1 - revised]

Conclusions: Patients on ART had higher rates of disclosure. HIV-positive individuals in both arms readily disclosed to family members and wider social networks. Rates of disclosure to sexual partners were much lower, particularly among female participants. This represents an addressable risk for HIV transmission in sero-discordant partnerships.

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