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. 2023 Oct;26 Suppl 4(Suppl 4):e26167.
doi: 10.1002/jia2.26167.

The role of internalised HIV stigma in disclosure of maternal HIV serostatus to children perinatally HIV-exposed but uninfected: a prospective study in the United States

Mariam Davtyan  1 , Deborah Kacanek  2 , Jessica Lee  2 , Claire Berman  3 , Ellen G Chadwick  4 , Renee Smith  5 , Liz Salomon  3 , Toinette Frederick  1 ; Pediatric HIV/AIDS Cohort Study
Affiliations

The role of internalised HIV stigma in disclosure of maternal HIV serostatus to children perinatally HIV-exposed but uninfected: a prospective study in the United States

Mariam Davtyan et al. J Int AIDS Soc. 2023 Oct.

Abstract

Introduction: Decisions to disclose HIV serostatus may be complicated by internalised HIV stigma. We evaluated the association of internalised HIV stigma in biological mothers living with HIV with disclosure of their serostatus to their children perinatally HIV-exposed but uninfected (CHEU).

Methods: Mothers and their CHEU were enrolled in the United States (U.S.)-based Surveillance Monitoring for Antiretroviral Therapy (ART) Toxicities (SMARTT) study of the Pediatric HIV/AIDS Cohort Study (PHACS), a longitudinal study of outcomes related to in utero exposure to HIV and ART among CHEU. Mothers completing at least one stigma and disclosure assessment starting at the child's age 11-, 13-, 15- and/or 17-year study visits between 16 August 2016 and 1 October 2020 were eligible. Stigma was measured with the 28-item Internalised HIV Stigma Scale (IHSS). Mean stigma scores were linearly transformed to a range of 0-100, with higher scores indicating greater levels of stigma. At each visit, mothers were asked if their child was aware of their HIV diagnosis and at what age the child became aware. The Kaplan-Meier estimator evaluated the cumulative probability of disclosure at each child age. Logistic regression models with generalised estimating equations to account for repeated measures were fit to examine the association between stigma and disclosure, controlling for relevant socio-demographic variables.

Results: Included were 438 mothers of 576 children (mean age 41.5 years, 60% U.S.-born, 60% Black/African American and 37% with household income ≤$10,000). The prevalence of disclosure across all visits was 29%. Mothers whose children were aware versus not aware of their serostatus reported lower mean IHSS scores (38.2 vs. 45.6, respectively). The cumulative proportion of disclosure by age 11 was 18.4% (95% CI: 15.5%, 21.8%) and 41% by age 17 (95% CI: 35.2%, 47.4%). At all child ages, disclosure was higher among children of U.S.-born versus non-U.S.-born mothers. After adjusting for age, marital status and years since HIV diagnosis, higher IHSS scores were associated with lower odds of disclosure (OR = 0.985, 95% CI: 0.975, 0.995).

Conclusions: Providing support to women as they make decisions about serostatus disclosure to their children may entail addressing internalised HIV stigma and consideration of community-level factors, particularly for non-U.S.-born mothers.

Keywords: PHACS; SMARTT; internalised HIV stigma; maternal HIV disclosure; parental HIV disclosure; perinatal HIV exposure.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Figure 1
Figure 1
Study population selection. Abbreviations: SMARTT, Surveillance Monitoring for Antiretroviral Therapy Toxicities; IHSS, Internalised HIV Stigma Scale.
Figure 2
Figure 2
Estimated probability of disclosure by mother's birth region across child's age.
Figure 3
Figure 3
Mean stigma scores overall and for each subscale, by maternal HIV disclosure status. Error bars represent 95% confidence intervals.
See this image and copyright information in PMC

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