The proportion,process drivers and factors associated with disclosure of HIV status among HIV infected older adolescents and young adults in Ampath, Eldoret, Kenya

Abstract

Background: Disclosing HIV status to sexual partners remains a significant challenge despite being associated with positive outcomes such as reduction of transmission, strengthening relationships, and decreasing risky sexual behaviors. Kenya has progressed in fighting HIV, however, current data indicate high numbers of infections particularly among teenagers and young adults accounting for 60% of new infections. There is limited research on HIV-status disclosure to sexual partners in young adults yet rising HIV infections rates threaten Kenya’s goal to combat HIV by 2030 emphasizing the need for disclosure to sexual partners to reduce transmission. Objectives: The objective of this study was to determine rates of HIV status disclosure to sexual partners, to explore disclosure experiences, and to explore factors associated with disclosure of HIV status to sexual partners among Adolescents and Young Adults Living with HIV (AYALWH) at AMPATH-Rafiki center between August and December 2023. Methods: The study utilized a cross-sectional mixed method approach, integrating both quantitative and qualitative data collection techniques. Male and female AYALWH, 15- 24 years attending Rafiki center were interviewed. 257 participants were selected through systematic sampling methods to complete structured questionnaires. Additionally, purposive sampling was utilized to recruit participants for focus group discussions (FGDs), where interview guides were employed. Quantitative data was analyzed using descriptive statistics to determine rates Chi-square tests were used to examine associations, with findings presented in tables. Qualitative data was transcribed, translated and coded thematically to capture disclosure experiences and factors influencing disclosure of HIV status to sexual partners. The study adopted a pragmatist research philosophy for better understanding. Results: The study determined that the rate of HIV status disclosure to sexual partners among AYALWH was low at 36.6% (95%, CI=30.1%-43. 8%).There was notable variation of HIV status disclosure between age groups. Age group 20-24 had a higher proportion (65.7%) compared to 15-19(34.3%). Females were more likely to disclose than males (p-value of 3.84 10 ). Positive and negative disclosure experiences were noted including: reduced anxiety and acceptance, relationship termination, psychological disturbance and increased anxiety. Barriers to disclosure included, fear of rejection, discrimination and perception of partner’s reaction towards disclosure. Challenges experienced included, insufficient knowledge on how to disclose, denial, and fear of negotiating for safe sex. Some factors influencing disclosure included; individual economic status, partner’s temperance and AYALWH’s attitude towards HIV disclosure. Conclusion: Study findings determined low rates of HIV status disclosure to sexual partners among AYALWH. While participants acknowledge the crucial role of HIV disclosure in minimizing infections, the study reveals significant knowledge gaps of effective disclosure strategies. Additionally, it highlights key challenges and barriers and lack of guidance which hinder successful disclosure. Recommendations: To encourage disclosure among AYALWH, tailored strategies should be developed to address key barriers. Emphasizing positive messaging and resilience-building through sharing successful disclosure experiences could help mitigate fears. Additionally, interventions should consider economic support mechanisms to reduce financial barriers linked to rejection fears. By implementing targeted support programs, young adults can be better equipped to navigate the challenges of HIV status disclosure, ultimately contributing to reduced transmission rates.