The Association of Disclosure of HIV-Serostatus with Adherence, Mental Health, and Sexual Behaviors in Young People Living with HIV in Zambia

Background: Disclosure of HIV status is viewed to positively affect preventive and treatment behaviors among young people living with HIV (YPLH) in Zambia. Prior studies have shown a heterogeneous association between disclosure and HIV prevention and treatment. Although previous research has investigated whether the association of self-disclosure with antiretroviral treatment (ART) adherence, mental health, and sexual behavior, few studies have been conducted with YPLH in low-resource settings. This study explored the association of HIV disclosure, ART adherence, mental health, and sexual behavior outcomes among YPLH in Zambia.

Methods: Cross-sectional data were obtained from a sample of YPLH (N = 103) in Eastern Province, Zambia. ART adherence was measured using a visual analog scale and the CASE adherence index. HIV self-efficacy disclosure was measured using an adaptation of the Adolescent HIV Disclosure Cognitions and Affect Scale. Mental health was measured using the Children’s Depression Inventory short-form version. Sexual behaviors referred to practices that heighten HIV transmission. Analyses were conducted using linear and logistic regression methods. Missing data were imputed using multiple imputations by chained equations.

Results: Sixty-three percent of participants were female; 62% were enrolled in school at data collection. The mean age was 19 years old. HIV self-efficacy disclosure was positively associated with self-esteem (β = 0.38, 95% CI: 0.15, 0.61). YPLH who were adherent reported higher levels of HIV self-efficacy disclosure (β = 2.53, 95% CI: 0.14, 4.92) than YPLH who were nonadherent. Disclosure was not significantly associated with mental health and sexual behavior.

Implications: Study findings suggest that adherence to treatment positively affects HIV self-disclosure efficacy. In turn, HIV self-disclosure efficacy is associated with higher levels of self-esteem. Consistent with previous research, we did not find a conclusive effect of HIV disclosure on mental health and sexual behaviors. Disclosure remains a critical factor that may shape positive and negative health outcomes. Further research is needed to understand when and why interpersonal disclosure of HIV status may be beneficial or harmful. In turn, appropriate and relevant interventions that distinguish and address potential benefits and harms of disclosure can be developed. Interventions may support disclosure when youth believes that disclosure will result in desirable outcomes. On the other hand, interventions may remediate gaps when youth believes that disclosure will be harmful.