Gender, Family Communication and Social Support Factors Associated with HIV Disclosure and HIV-Related Stigma Among Adolescents Living with HIV in Uganda

Background and Purpose: HIV-related stigma has been documented as one of the greatest obstacles to reducing HIV spread, engagement in HIV treatment, and poor mental health functioning among people living with HIV (PLWH), including children and adolescents. While HIV status disclosure is essential for people to receive social support, the fear of stigma and discrimination prevents PLWH from disclosing their status. Yet, social support and disclosure are important factors for adherence to HIV treatment protocols, as well as HIV-related health outcomes. Therefore, for children and adolescents growing up with HIV –with no opportunity for normal transition through adolescence due to stigma, it is important to identify additional family and community support systems, to promote acceptance and improve their health outcomes. This study examined family communication and social support factors associated with HIV disclosure and HIV-related stigma among adolescent boys and girls living with HIV in Uganda.

Methods: We analyzed baseline data from an NICHD-funded Suubi+Adherence study (N=702), implemented in Uganda. Adolescents (boys =306, girls =396), ages 10-16 years at baseline, were eligible to participate if they were: 1) HIV positive and knew their HIV status, 2) prescribed antiretroviral therapy, 3) lived within a family, not an institution, and 4) enrolled in one of the 39 health centers in the study area. Regression analyses were conducted to determine family communication (frequency and level of comfort communicating with caregiver), and social support factors (family cohesion, perceived child-caregiver support and social support from classmates, teachers and caregivers), associated with HIV disclosure, disclosure comfort, and HIV internalized and anticipated stigma among adolescent boys and girls living with HIV.

Results: Results show that while girls reported higher levels of family communication, family cohesion and social support from multiple sources compared to boys, they had lower odds for HIV disclosure (OR= -0.35, 95% CI =0.50, 1.01, p≤.05) and lower disclosure comfort (b = -1.14, 95% CI = -2.65, -.62, p≤.001), compared to boys. In addition, family communication, specifically, higher level of comfort communicating with caregiver was associated with both HIV disclosure (OR= 0.06, 95% CI = 1.02, 1.09, p≤.001), and disclosure comfort (b = 0.09, 95% CI = 0.04, 0.13, p≤.001). Moreover, support from within the school environment, i.e. from teachers and classmates, was uniquely associated with both HIV disclosure and HIV internalized and anticipated stigma.

Implications and Conclusions: Low levels of HIV disclosure and disclosure comfort among adolescent girls point to the need for targeted HIV stigma-reduction interventions. In addition, programming aimed at improving HIV care and treatment outcomes for HIV positive adolescents, should consider incorporating both family communication strengthening and HIV stigma reduction strategies in their efforts, to improve the overall HIV-health related outcomes. Moreover, our findings point to schools as potential for implementing HIV stigma-reduction interventions and programs for children and adolescents, especially in low-resource countries.