Antiretroviral Therapy Availability and HIV Disclosure to Spouse in Rakai, Uganda: A Longitudinal Population-Based Study

August 2015 - Structural Prevention

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Haberlen, S., Nakigozi, G., Gray, R.H. et al. Journal of Acquired Immune Deficiency Syndromes (June 2015), 69(2): 241–247, doi: 10.1097/QAI.0000000000000600.

In rural Rakai district, Uganda, the authors used longitudinal population-based data collected between 2000 and 2008 to evaluate the association between availability of antiretroviral therapy (ART) and disclosure of newly diagnosed HIV infection to spouses by men and women in stable unions. ART was introduced in this population in mid-2004 and became widely available through fixed and mobile clinics by 2005. The study included 557 married adults; 264 were diagnosed with HIV before ART was available (2000–2004), and 293 were diagnosed after ART was introduced (2005–2008). The authors reported that disclosure increased from an estimated 58 percent in the pre-ART period to 75 percent following ART introduction. Disclosure increased between the pre-ART and post-ART periods among both men (63 percent to 78 percent, respectively) and women (55 percent to 73 percent). Additionally, 127 of the 139 disclosures in the pre-ART period, and 190 of the 198 disclosures in the post-ART period, occurred within the first follow-up interval after HIV diagnosis. Disclosure to a spouse was strongly associated with utilization of HIV treatment services. However, the likelihood of disclosure was lower among adults who reported alcohol use. The authors concluded that access to ART can help to prevent transmission to uninfected partners and can enhance linkage to treatment for infected couples.

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