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dc.contributor.authorBisola O. Ojikutuen_US
dc.contributor.authorSubash Pathaken_US
dc.contributor.authorKriengkrai Srithanaviboonchaien_US
dc.contributor.authorMohammed Limbadaen_US
dc.contributor.authorRuth Friedmanen_US
dc.contributor.authorShuying Lien_US
dc.contributor.authorMatthew J. Mimiagaen_US
dc.contributor.authorKenneth H. Mayeren_US
dc.contributor.authorSteven A. Safrenen_US
dc.contributor.authorVanessa Cummingsen_US
dc.contributor.authorJames Y. Daien_US
dc.contributor.authorDavid Du Puy Celentanoen_US
dc.contributor.authorVanessa Elharraren_US
dc.contributor.authorLynda Emelen_US
dc.contributor.authorCharlotte Gaydosen_US
dc.contributor.authorErica Hamiltonen_US
dc.contributor.authorJames Hughesen_US
dc.contributor.authorCorey Kellyen_US
dc.contributor.authorAlex Londonen_US
dc.contributor.authorJonathan Lucasen_US
dc.contributor.authorAyana T. Mooreen_US
dc.contributor.authorEstelle Piwowar-Manningen_US
dc.contributor.authorSusan Shermanen_US
dc.contributor.authorHarmony Walleren_US
dc.description.abstract© 2016 Ojikutu et al. 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. Background: Serostatus disclosure may facilitate decreased HIV transmission between serodiscordant partners by raising risk awareness and heightening the need for prevention. For women living with HIV (WLWH), the decision to disclose may be influenced by culturally determined, community-level stigma and norms. Understanding the impact of community HIV stigma and gender norms on disclosure among WLWH in different countries may inform intervention development. Methods: HPTN063 was a longitudinal, observational study of sexually active HIV-infected individuals, including heterosexual women, in care in Zambia, Thailand and Brazil. At baseline, a questionnaire measuring community HIV stigma and gender norms, anticipated stigma, demographic, partner/relationship characteristics, and intimate partner violence was administered. Longitudinal HIV disclosure to sexual partners was determined via audio-computer assisted self-interview (ACASI) at the baseline and quarterly during the one year following up. Logistic regression was conducted to identify the predictors of disclosure. Results: Almost half (45%) of women living with HIV acknowledged perceived community HIV stigma (the belief that in their community HIV infection among women is associated with sex work and multiple sexual partners). Many women (42.9%) also acknowledged perceived community gender norms (the belief that traditional gender norms such as submissiveness to husbands/male sexual partners is necessary and that social status is lost if one does not procreate). HIV disclosure to current sex partners was reported by 67% of women. In multivariate analysis, among all women, those who were older [OR 0.16, 95%CI (0.06,0.48)], reported symptoms of severe depression [OR 0.53, 95%CI(0.31, 0.90)], endorsed anticipated stigma [OR 0.30, 95%CI(0.18, 0.50)], and were unmarried [OR 0.43, 95%CI(0.26,0.71)] were less likely to disclose to current partners. In an analysis stratified by marital status and cohabitation, unmarried [OR 0.41, 95%CI(0.20,0.82)] and non-cohabiting women [OR 0.31, 95%CI(0.13,0.73)] who perceived community HIV stigma were less likely to disclose to their sex partners. Conclusions: Perceived community level HIV stigma, along with individual level factors such as anticipated stigma, depressive symptoms, and older age, predict non-disclosure of HIV status to sexual partners among WLWH in diverse geographic settings. Interventions to promote disclosure among women in serodiscordant relationships should incorporate community-level interventions to reduce stigma and promote gender equality.en_US
dc.subjectAgricultural and Biological Sciencesen_US
dc.subjectBiochemistry, Genetics and Molecular Biologyen_US
dc.titleCommunity cultural norms, stigma and disclosure to sexual partners among women living with HIV in Thailand, Brazil and Zambia (HPTN 063)en_US
article.title.sourcetitlePLoS ONEen_US
article.volume11en_US and Women's Hospitalen_US Medical Schoolen_US of Washington, Seattleen_US Mai Universityen_US of Zambiaen_US of California, Los Angelesen_US Universityen_US Instituteen_US of Miamien_US Johns Hopkins School of Medicineen_US Hopkins Bloomberg School of Public Healthen_US Institute of Allergy and Infectious Diseasesen_US 360en_US Mellon Universityen_US Israel Deaconess Medical Centeren_US Hopkins Universityen_US
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