HIV Serostatus Disclosure Among a High Risk Kenya's Population

Purpose:Serostatus disclosure is an important HIV prevention measure found to reduce HIV infection and increase social support (Suzanne, van Rooyen, & Groves, 2014). Yet, promoting disclosure of HIV serostatus is a critical challenge in many traditional tribal cultures (Yoshioka, & Schustack, 2001). The current study seeks to assess disclosure patterns among a high risk HIV Kenyan population.  

Methods:  Our study uses standardized couples’ data obtained from the Kenya Demographic and Health Surveys (KDHS 2008/09). Demographic characteristics such as age, ethnic identity, wealth status, level of education, religion, and marital status were assessed. Chi-square tests were used to assess the association of willingness to disclose and support for disclosure by the intent to be tested for HIV. Hierarchical logistic regression was used to test the models for best predictor of likelihood to disclose.

 

Results: Results show that 31.10% (n=890) Kenyan couples reported keeping their sero-status a secret from their partners, while 63.70% (n=1820) reported disclosure.  Significantly less men (36.4%) kept their AIDS status a secret compared to women (63.60%); [c²(2, N =2859) = 99.32, p ≤ .000]. Odds of women disclosing sero-status is lesser compared to males by (OR, 0.46; 95% CI, .39 – 0.54).  Disclosure differed among various ethnic groups of Kenya; [c²(24, N =2858) = 149.81, p ≤ .000]. The odds of disclosure to their partners differed among Kamba (OR, 0.44; 95% CI, .28 – 0.69); Kisii women (OR, 0.62; 95% CI, 0.41 -0.93); Masai (OR, 1.81; 95% CI, 1.21 – 2.71) and Meru (OR, 0.14; 95% CI, 0.05 – 0.41). Disclosure pattern also differed among the same gender of different tribes: females [c²(24, N =1427) = 79.02, p ≤ .000] and males [c²(24, N =1431) = 121.62, p ≤ .000]. Although other contexts such as level of education, wealth status, type of residence and religion appear to be associated with disclosure pattern, only literacy predicted disclosure (OR, 0.70; 95% CI, .95 – 1.05). Disclosure pattern didn’t make a difference on marital status [c²(2, N=2859) = 2.78, p =.249]. Motivations to get tested for HIV/AIDS [c²(2, N =2846) = 6.13, p ≤ .05] seems to be associated with disclosure yet it’s not a predictor of likelihood to disclose. Omnibus model and Hosmer and Lemeshow insignificant tests predicted final fit model.

Implications: The findings of this study highlight an important conclusion: HIV/AIDS is more stigmatizing in some tribes across Kenya. Fear of disclosure seems to persist among distinct demographics such as the uneducated, poor and rural groups. Almost a third of Kenya’s couples still keep HIV secret, and marriage did not make a difference. In fact, being married is a risk factor for HIV infection (Hageman, et al., 2010).  In order to effectively address HIV/AIDS, policy initiatives should promote literacy, gender and culturally variant interventions, and promote disclosure as a preventative measure. Further research needs to be conducted to better understand the role of disclosure in HIV/AIDS prevention, and the role played by gender. Women HIV status maybe known particularly for childbearing women attending neonatal compared to their male partners.