HIV status disclosure by Nigerian men who have sex with men and transgender women living with HIV: a cross-sectional analysis at enrollment into an observational cohort

Abstract

Background: Men who have sex with men (MSM) and transgender women (TGW) are disproportionately impacted by HIV and may face barriers to HIV status disclosure with negative ramifications for HIV prevention and care. We evaluated HIV status disclosure to sexual partners, HIV treatment outcomes, and stigma patterns of MSM and TGW in Abuja and Lagos, Nigeria.

Methods: Previously-diagnosed MSM and TGW living with HIV who enrolled in the TRUST/RV368 cohort from March 2013 to August 2018 were asked, "Have you told your (male/female) sexual partners (MSP/FSP) that you are living with HIV?" In separate analyses, robust Poisson regression models were used to estimate risk ratios (RRs) and 95% confidence intervals (95% CIs) for characteristics associated with HIV status disclosure to MSP and FSP. Self-reported stigma indicators were compared between groups.

Results: Of 493 participants living with HIV, 153 (31.0%) had disclosed their HIV status to some or all MSP since being diagnosed. Among 222 with FSP, 34 (15.3%) had disclosed to some or all FSP. Factors independently associated with disclosure to MSP included living in Lagos (RR 1.58 [95% CI 1.14-2.20]) and having viral load < 50 copies/mL (RR 1.67 [95% CI 1.24-2.25]). Disclosure to FSP was more common among participants who were working in entertainment industries (RR 6.25 [95% CI 1.06-36.84]) or as drivers/laborers (RR 6.66 [95% CI 1.10-40.36], as compared to unemployed) and also among those married/cohabiting (RR 3.95 [95% CI 1.97-7.91], as compared to single) and prescribed ART (RR 2.27 [95% CI 1.07-4.83]). No differences in self-reported stigma indicators were observed by disclosure status to MSP but disclosure to FSP was associated with a lower likelihood of ever having been assaulted (26.5% versus 45.2%, p = 0.042).

Conclusions: HIV status disclosure to sexual partners was uncommon among Nigerian MSM and TGW living with HIV but was associated with improved HIV care outcomes. Disclosure was not associated with substantially increased experiences of stigma. Strategies to encourage HIV status disclosure may improve HIV management outcomes in these highly-marginalized populations with a high burden of HIV infection.

Keywords: Disclosure; HIV; HIV management outcomes; Nigeria; Sexual and gender minorities; Social stigma.

Fig. 1

Associations of HIV Status Disclosure with HIV Care Outcomes and Self-Reported Stigma among Nigerian Men who have Sex with Men and Transgender Women. Medical records were reviewed at study enrollment to ascertain ART prescription status. HIV viral load and CD4 count were enumerated for all enrolled participants living with HIV. Participants were asked whether or not they had ever experienced a variety of specific indicators of anticipated and enacted stigma. The percentage of participants demonstrating each key HIV care outcome is presented with stratification by disclosure of HIV status to male sexual partners (Panel a) and to female sexual partners (Panel b). The percentage of participants who reported each stigma indicator is presented with stratification by disclosure of HIV status to male sexual partners (Panel c) and to female sexual partners (Panel d). Statistically significant p-values (p ≤ 0.05) for comparisons by disclosure status are in bold