Effects of HIV status disclosure on safe sex practices among youths living with HIV and AIDs in the lea toto program, Nairobi County, Kenya

Abstract

HIV serostatus disclosure is an immense challenge for youth living with HIV, their sexual partners, and health workers. In Kenya, however, little guidance is available to the youth on the HIV disclosure process. The purpose of this study was to examine the effects of HIV status disclosure on safe sex practices among youths living with HIV and AIDS. The objectives of the study include: to examine the effect of voluntary self-disclosure on safe sex practices among youths living with HIV; to assess the effect of voluntary shared-disclosure on safe sex practices among youths living with HIV; to determine the effect of involuntary disclosure on safe sex practices among youths living with HIV, and to establish the relationship between HIV status disclosure outcomes and safe sex practices among youths living with HIV. The Communication Privacy Management theory and the theory of Planned Behaviour were used. This study adopted the correlational research design. The target population was 1573, YLWH, aged between 15-24 years, who were accessing care at the Lea Toto program, Nairobi. The sampling technique was stratified random sampling. The sample size was 157 YLWH, 14 key informants and 2 Focused Group Discussions. Pilot testing was conducted at AMREF Lang’ata with 16 respondents. 143 questionnaires were obtained from YLWH, in-depth interviews were conducted with 11 health workers, counsellors and social workers, and 2 focused group discussions with 10 participants each with YLWH. The cleaned and coded data were entered into the Statistical Package for Social Science (SPSS) statistical software version 25 for analysis. Descriptive and inferential statistical analyses were performed for the quantitative data while qualitative data from Focus Group Discussions (FGDs) and Key Information Interviews (KIIs) was subjected to thematic/content analysis. Pearson Correlation Analysis show that there was significant relationship between safe sex practices and all the independent variables (voluntary self-disclosure, r=0.502, p<0.05; voluntary shared-disclosure, r=0.392, p<0.05; involuntary/accidental disclosure, r=0.015, p<0.05 and disclosure outcomes, r=0.502, p<0.05) at significance level of 0.05. This was corroborated by findings from Analysis Variance that shows that all independent variables statistically significantly predict safe sex practices (F=26.182, p<0.05). There were also high levels of willingness to disclose their HIV status to their sexual partners. FGDs and KIIs show that disclosure was often challenged by negative effects such as stigma, marriage/relationship breakup, depression, violence, and suicide in some cases. In most cases, there were no instances of forced disclosures by health care providers. Disclosure had positive effects such as adherence to treatment and safe sex practices, especially if it was followed by support. The study recommends the need for encouraging and supporting more YLWH to disclose their statuses. The community should be educated so as to support those who disclose their statuses and avoid stigmatisation. Counselling strategies and government policies on safe sex should be strengthened. This study will form a critical auxiliary to the HIV management process through the mobilization of positive community attitudes, reduction of stigma on HIV related issues, and promotion of “courage” for HIV status disclosure.