A new study on African women, who had an HIV test during pregnancy, has identified three key times when they are likely to disclose their HIV status to their male partner.
The study, conducted by Annabel Desgrées-du-Loû and colleagues within a program for prevention of mother-to-child transmission of HIV in Abidjan, Cote d'Ivoire, points out that targeting counselling to these key moments could help decrease the sexual transmission of HIV within stable relationships in sub-Saharan Africa.
The authors suggest that the end of pregnancy, the early stage of weaning and the resumption of a woman's sexual activity with her partner are the moments at which specific counselling should be targeted to support women to reveal their status and to persuade their partner to take an HIV test.
The program provided support and testing to more than 900 women, both HIV infected and uninfected, during and following pregnancy. Fewer than half of the women infected with HIV told their partners about their status two years after childbirth.
Of those did tell their partners, two-thirds did so before delivery, and many others disclosed at the time of early weaning at 4 months. These times were related to the mother's decision on how to feed the child: HIV can be transmitted by breast feeding, and the women needed considerable support from their partners in order to formula feed from birth or to wean early.
The third peak time for disclosure, around the resumption of sexual relations, may reflect the women's desire to protect their partners through the use of condoms.
The study also found that the partners of the HIV-positive women who had disclosed their status were about three times more likely to take an HIV test that those who had not been told.
Although the women in the program are encouraged to communicate their status to their partner, the fear of rejection (which could lead to accusations of infidelity and loss of housing or food and) can make this disclosure difficult.
The study is published in journal PLoS Medicine.