Disclosure of HIV status among Shan female migrant workers living with HIV in Northern Thailand: A qualitative study

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Abstract

Background

Disclosure of HIV status is a critical gateway to HIV prevention. Despite many studies on this topic, there is a gap in knowledge regarding HIV status disclosure and risky sexual behavior in HIV-infected female migrant workers. The current study addressed this research gap, and focused on HIV-infected Shan female migrant workers in Northern Thailand.

Methods

This study conducted in-depth interviews with 18 HIV-infected Shan female migrants (aged between 23–54 years old) and 29 healthcare workers in district hospitals in Chiang Mai. Content analysis was employed to identify particular themes related to HIV status disclosure, sexual risk behavior, and ART adherence.

Results

We found that non-disclosure to husbands/partners was mostly related to fear of marital conflict and of losing social and financial support. Non-disclosure prevented Shan female migrant workers from negotiating condom use with their partners. Reasons for not disclosing to friends, family and other community members were mostly related to feared rejection and discrimination due to HIV-related stigma. Accounts of condomless sex in the context of HIV status disclosure suggest that gender norms and male dominance over women influenced decision-making for safe sex. Lastly, some female migrant workers perceived low risk of HIV transmission with good adherence to the ART.

Conclusions

This study highlighted the complex challenges of HIV status disclosure among HIV-positive Shan female migrant workers and the link between disclosure/non-disclosure and condom use. There is a pressing need to create realistic disclosure mechanisms that take into account the socio-cultural barriers to disclosure including marital conflicts, stigma, and gender norms. Messages to encourage condom use should be delivered carefully so that knowledge of the HIV transmission reduction qualities of good ART adherence does not serve as a barrier to condom use.

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Most cited references 31

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Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes.

Amy Medley, Suzanne Maman, S McGill … (2004)

This paper synthesizes the rates, barriers, and outcomes of HIV serostatus disclosure among women in developing countries. We identified 17 studies from peer-reviewed journals and international conference abstracts--15 from sub-Saharan Africa and 2 from south-east Asia--that included information on either the rates, barriers or outcomes of HIV serostatus disclosure among women in developing countries. The rates of disclosure reported in these studies ranged from 16.7% to 86%, with women attending free-standing voluntary HIV testing and counselling clinics more likely to disclose their HIV status to their sexual partners than women who were tested in the context of their antenatal care. Barriers to disclosure identified by the women included fear of accusations of infidelity, abandonment, discrimination and violence. Between 3.5% and 14.6% of women reported experiencing a violent reaction from a partner following disclosure. The low rates of HIV serostatus disclosure reported among women in antenatal settings have several implications for prevention of mother-to-child transmission of HIV (pMTCT) programmes as the optimal uptake and adherence to such programmes is difficult for women whose partners are either unaware or not supportive of their participation. This article discusses these implications and offers some strategies for safely increasing the rates of HIV status disclosure among women.

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Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa.

J. Bogaerts, A Serufilira, P Van de perre … (1992)

To determine whether HIV testing and counselling increased condom use and decreased heterosexual transmission of HIV in discordant couples. Prospective study. Kigali, the capital of Rwanda. Cohabiting couples with discordant HIV serology results. Condom use in the couple and HIV seroconversion in the negative partners. 60 HIV discordant couples were identified, of whom 53 were followed for an average of 2.2 years. The proportion of discordant couples using condoms increased from 4% to 57% after one year of follow up. During follow up two of the 23 HIV negative men and six of the 30 HIV negative women seroconverted (seroconversion rates of 4 and 9 per 100 person years). The rate among women was less than half that estimated for similar women in discordant couples whose partners had not been serotested. Condom use was less common among those who seroconverted (100% v 5%, p = 0.01 in men; 67% v 25%, p = 0.14 in women). Roughly one in seven cohabiting couples in Kigali have discordant HIV serological results. Confidential HIV serotesting with counselling caused a large increase in condom use and was associated with a lower rate of new HIV infections. HIV testing is a promising intervention for preventing the spread of HIV in African cities.

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Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa.

L. Simbayi, S Kalichman, A Strebel … (2007)

The HIV epidemic continues to amplify in southern Africa and there is a growing need for HIV prevention interventions among people who have tested HIV positive. Anonymous surveys were completed by 413 HIV-positive men and 641 HIV-positive women sampled from HIV/AIDS services; 73% were <35 years old, 70% Black African, 70% unemployed, 75% unmarried, and 50% taking antiretroviral treatment. Among the 903 (85%) participants who were currently sexually active, 378 (42%) had sex with a person to whom they had not disclosed their HIV status in the previous 3 months. Participants who had not disclosed their HIV status to their sex partners were considerably more likely to have multiple partners, HIV-negative partners, partners of unknown HIV status and unprotected intercourse with non-concordant sex partners. Not disclosing their HIV status to partners was also associated with having lost a job or a place to stay because of being HIV positive and feeling less able to disclose to partners. HIV-related stigma and discrimination are associated with not disclosing HIV status to sex partners, and non-disclosure is closely associated with HIV transmission risk behaviours. Interventions are needed in South Africa to reduce the AIDS stigma and discrimination and to assist people with HIV to make effective decisions on disclosure.

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Author and article information

Contributors

Arratee Ayuttacorn:

ORCID: http://orcid.org/0000-0001-8549-1950

Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: Writing – original draft

Arunrat Tangmunkongvorakul:

ORCID: http://orcid.org/0000-0002-9096-6372

Role: ConceptualizationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: Writing – review & editing

Patou Masika Musumari: Role: ConceptualizationRole: Formal analysisRole: Writing – review & editing

Kriengkrai Srithanaviboonchai: Role: ConceptualizationRole: Formal analysisRole: Writing – review & editing

Amporn Jirattikorn: Role: Formal analysisRole: Writing – review & editing

Linda Aurpibul:

ORCID: http://orcid.org/0000-0003-0246-8187

Role: InvestigationRole: Writing – review & editing

Syed Imran Ahmed: Role: Editor

Journal

Journal ID (nlm-ta): PLoS One

Journal ID (iso-abbrev): PLoS ONE

Journal ID (publisher-id): plos

Journal ID (pmc): plosone

Title: PLoS ONE

Publisher: Public Library of Science (San Francisco, CA USA )

ISSN (Electronic): 1932-6203

Publication date (Electronic): 2 May 2019

Publication date Collection: 2019

Volume: 14

Issue: 5

Electronic Location Identifier: e0216382

Affiliations

[1 ] Faculty of Social Sciences, Chiang Mai University, Chiang Mai, Thailand

[2 ] Research Institute for Health Sciences, Chiang Mai University, Chiang Mai, Thailand

[3 ] Department of Global Health and Socio-epidemiology, Kyoto University School of Public Health, Kyoto, Japan

[4 ] Japan Foundation for AIDS Prevention, Tokyo, Japan

[5 ] Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand

International Medical University, MALAYSIA

Author notes

Competing Interests: The authors have declared that no competing interests exist.

* E-mail: arunrat@ 123456rihes.org

Author information

Arratee Ayuttacorn http://orcid.org/0000-0001-8549-1950

Arunrat Tangmunkongvorakul http://orcid.org/0000-0002-9096-6372

Linda Aurpibul http://orcid.org/0000-0003-0246-8187

Article

Publisher ID: PONE-D-18-08475

DOI: 10.1371/journal.pone.0216382

PMC ID: 6497284

PubMed ID: 31048890

SO-VID: c0ede57e-5942-4eed-b137-aa0e9151c984

License:

This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

History

Date received : 20 March 2018

Date accepted : 21 April 2019

Page count

Figures: 0, Tables: 4, Pages: 17

Funding

Funded by: funder-id http://dx.doi.org/10.13039/501100002842, Chiang Mai University;

Award Recipient :

ORCID: http://orcid.org/0000-0002-9096-6372

Arunrat Tangmunkongvorakul

This study was supported by the Chiang Mai University Center of Excellence in HIV/AIDS Research. The funder had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Custom metadata

Data Availability All audio recordings of the in-depth interviews were transcribed in Thai. The qualitative data include sensitive information. The Thai transcripts and field notes constituted the final material for analysis. Passages most relevant to the study were later translated into English and presented in the current paper. We cannot provide our qualitative data publicly due to ethical restrictions. However, the in-depth interview guideline for participants and healthcare providers (English version) has been provided in a supporting file. Qualitative data are available from the Research Institute for Health Sciences, Chiang Mai University, Data Access / Ethics Committee (CONTACT INFORMATION: The Human Experimentation Committee, Research Institute for Health Sciences, Chiang Mai University, 110 Intavaroros Road, Sriphum, Muang, Chiang Mai 50200 THAILAND, Tel: 66 5393 6148 ext.263, Fax: 66 5322 1849, 66 5394 5053, E-mail: rihes.hec@ 123456gmail.com ) for researchers who meet the criteria for access to confidential data.

Disclosure of HIV status among Shan female migrant workers living with HIV in Northern Thailand: A qualitative study

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Most cited references 31

Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes.

Effect of serotesting with counselling on condom use and seroconversion among HIV discordant couples in Africa.

Disclosure of HIV status to sex partners and sexual risk behaviours among HIV-positive men and women, Cape Town, South Africa.

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