HIV Disclosure Patterns And Its Associated Factors Among People With HIV/AIDS

Objective:Using latent class analysis to assess patterns of HIV disclosure and its related factors among people with HIV/AIDS(PLWHA)for providing evidences for targeted intervention.Methods:Participants were recruited from the Second Affiliated Hospital of Southeast University providing services to PLWHA from July,2016 to August,2016.Anonymous face-to-face interviews were carried out in a separate room.The questionnaire included socio-demographics,HIV infections(transmission route,duration of infection and highly active antiretroviral therapy,coinfections),psychosocial factors(perceived stigma,social support,depression,resilience)and disease disclosure.Data was entered by Epidata 3.0 software and analyzed by SPSS 22.0 including univariate,bivariate and multiple logistic regression analysis.Latent class analysis and confirmatory factor analysis were completed by Mplus7.1 software.Results:1.475 subjects were recruited totally,466 individuals offered their effective questionnaires data,and the rate was 98.1%.The mean age was 36.4 years,ranging from 17 to 76 years.Overall,individuals were primarily male,never married,highly educated,employed,and self-identified as 'homosexual'.Additionally,homosexual is the main route of infection,and most of them were diagnosed and treated recently.The mean score of perceived stigma,social support,resilience and depression was 81.3,34.2,39.8,13.9 respectively.2.The proportions of PLWHA who disclosed their HIV infection to stable sexual partners,spouse,brothers and sisters,friends,mother,father,sons and daughters,cousins,other relatives and work colleagues were 76.7%(115/150),71.1%(128/180),31.7%(114/360),30.6%(142/464),29.9%(119/399),28.5%(107/376),27.7%(52/188),7.3%(33/454),7.0%(32/459)and 6.3%(29/461)respectively.PLWHA were more likely to disclose to family members,especially spouse and stable sexual partners.81.0%(377/466)PLWHA disclosed their HIV seropositive status to at least one person.3.The study was classified six latent classes of HIV disclosure among PLWHA receiving HAART,including systematic disclosure(3.43%),disclosure to parents(17.81%),systematic concealment(39.49%),disclosure to family members(5.58%),not concerned(13.52%),disclosure to spouse(20.17%).The majority of the participants were systematic concealment.4.Univariate analysis showed that six classes distributed differently between age,gender,major,marital status,monthly income,living situations,education level,employment status,sexual orientation,route of infection,duration of infection and highly active antiretroviral therapy,perceived stigma,social support.5.Multinomial logistic regression was conducted to explore group membership characteristics further with Class 3(systematic concealment)as the reference category.Compared with PLWHA of the systematic concealment,PLWHA of class 1(systematic disclosure)were more likely to be older(OR=1.134)and lived with friends or others(OR= 13.694).In addition,PLWHA in Class 1 were significantly less likely to have high scores of perceived stigma(OR=0.932).PLWHA of class 2(disclosure to parents)were approximate 2.5 and 3 times more likely to be employed and live with family members(OR=2.576 and OR=3.103,respectively).In addition,PLWHA in Class 2 were significantly more likely to have low monthly income(OR=4.489 and OR=2.264,respectively)and time of diagnosis over 2 years(OR=2.313).PLWHA in Class 4(disclosure to family members)were significantly more likely to be married(OR=8.453)and have lower education level(OR=21.555),less likely to be female(OR=0.043),never married(OR=0.064)and have higher perceived stigma(OR=0.945).PLWHA in Class 5(not concerned)were more prone to be older(OR=1.269)and have lower education level(OR=4.933).PLWHA in Class 6(disclosure to spouse)were significantly more likely to be married(OR=5.401)and less likely to be never married(OR=0.103),which is similar to class4.In addition,they were significantly more prone to be older(OR=1.075).6.The developed perceived stigma scale consisted of 30 items,including 4 factors,namely,anticipated stigma,disclosure concerns,negative self-image,concern with public attitudes.57.81%of the total variance was explained.It had satisfying structure validity(?2= 621.86,df=465,P<0.001;CFI=0.900;SRMR=0.064;RMSEA=0.065;TLI=0.852).The Cronbach coefficients of the whole scale and its four factors were 0.833?0.925.The total score of perceived stigma scale was positively correlated with the total score of center for epidemiological studies depression(CES-D).Conclusions:1.The rate of HIV disclosure was low totally,while PLWHA were more likely to disclose to family members,especially spouse and stable sexual partners.2.The study was classified six latent classes and systematic concealment was the largest one.3.PLWHA who conceal their status were more likely to be younger,never married,live alone or have short duration of infection,higher education level,higher score of perceived stigma.4.The developed perceived stigma scale has been proved to be reliable and valid in Chinese PLWHA.