Predictors of HIV-1 serostatus disclosure: a prospective study among HIV-infected pregnant women in Dar es Salaam, Tanzania

Objectives: To examine the socio-demographic and behavioral factors predict ive of women's disclosure of an HIV-positive test result in Dar es Salaam, Tanzania. Design: From April 1995 to May 2000, 1078 HIV-positive pregnant women parti cipated in an ongoing randomized trial on micronutrients and HIV-1 vertical transmission and progression. Disclosure to a partner or to a female relat ive was assessed 2 months after post-test counseling and at 6 monthly follo w-up visits. Socio-demographic, health, behavioral and psychological factor s were measured at baseline and during follow-up. Methods: Predictors of time to disclosure of HIV serostatus were determined using Cox proportional hazards regression models. Results: Prevalence of disclosure to a partner ranged from 22% within 2 mon ths to 40% after nearly 4 years. Women were less likely to disclose to thei r partners if they were cohabiting, had low wage employment, had previously disclosed to a female relative, or reported ever-use of a modern contracep tive method. Women reporting fewer than six lifetime sexual partners or kno wing someone with HIV/AlDS were more likely to disclose to their partners. Disclosure to a female relative was predicted by knowing more than two indi viduals with HIV/AIDS, full economic dependency on their partner, high leve ls of social support, and prior attendance at a support group meeting. Conclusions: A substantial proportion of HIV-infected pregnant women never disclosed their result to a partner or a close female relative. Lack of dis closure may have limited their ability to engage in preventive behaviors or to obtain the necessary emotional support for coping with their serostatus or illness. (C) 2001 Lippincott Williams & Wilkins.