Correlates of HIV status non-disclosure by pregnant women living with HIV to their male partners in Uganda: a cross-sectional study

Background: HIV status disclosure by pregnant women living with HIV (PWLHIV) to their male partners is associated with improved maternal and infant outcomes. Understanding relationship factors associated with non-disclosure of HIV status by PWLHIV to their partners can inform the design of interventions to facilitate status disclosure. Methods: We conducted a cross-sectional study using enrollment data from 500 PWLHIV participating in a randomized controlled trial assessing secondary distribution of HIV self-testing kits in Kampala, Uganda. HIV status non-disclosure was the primary outcome of interest. We conducted univariate and multivariate binomial regressions to assess the association between socio-demographic, HIV history, and relationship characteristics and non-disclosure of HIV status. Results: Overall, 68.2% of women in our sample had not disclosed their HIV status to their partners. Factors that increased the likelihood of non-disclosure included shorter relationship duration <1 year (adjusted prevalence ratio (aPR=1.25); 95% CI: 1.02-1.54), being in a polygamous relationship (aPR=1.21; 95% CI: 1.07-1.36), not married (aPR=1.20; 95% CI: 1.07-1.35), reporting uncertainty about whether their partner had ever HIV-tested (aPR=1.55; 95% CI: 1.28-1.88), and reporting lack of social support from people aware of their status (aPR=1.32; 95% CI: 1.18-1.49). Conclusion: Relationship factors, including shorter-term, unmarried, and polygamous relationships, and uncertainty about the partner’s HIV testing history, were associated with increased likelihood of non-disclosure of HIV status by pregnant women to their partner. Interventions that facilitate couples’ disclosure, provide counseling messaging to reduce relationship dissolution in sero-discordant couples, and provide opportunities for women to benefit from peer support may help improve disclosure. Clinicaltrials.gov ID number: NCT03484533