To know or not to know? HIV-status disclosure and protective sexual practices among adolescent girls and boys in South Africa
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Background: To stem AIDS-morbidity and stop HIV transmission, UNAIDS recommends that 90% of HIV-positive people know their status by 2020, including adolescents. HIV-positive adolescents who engage in unsafe sex are at risk of transmitting HIV to partners and children. Little is known about linkages between knowing and disclosing one’s HIV-positive status and practicing safe sex among adolescents. Methods: This study tests whether (1) knowledge of one’s own HIV-positive status, (2) disclosure of HIV-positive status to partners, and (3) knowledge of partner HIV-status – positive or negative – are associated with protective sexual practices. The study interviewed n=1,527 HIV-positive and negative adolescents (10-19 years old, 57% female) in a health district in South Africa’s poorest province. N=1,425 adolescents who were either HIV-positive status aware or status-unaware (positive or negative) were included in the analyses, N=794 of whom were HIV-positive status-aware adolescents. Interviews used standardised questionnaires and validated scales. Analyses used multivariate logistic regressions, controlling for socio-demographic covariates. Results: n=467 (32.8%) of the sample were sexually-active, with n=389 (27.3%) reporting a boy/girlfriend. Among sexually active adolescents, 44% of HIV-positive status-aware adolescents reported protective sexual practices compared to 35% among the rest of the sample (p=0.067). In a final multivariate regression including all three types of disclosure, knowing own HIV-positive status was associated with protective sexual practices (OR1.59, 95%CI 1.10-2.30, p=0.014), disclosing one’s HIV-positive status to a partner was not associated with protective sexual practices, while knowledge of partner HIV-status was associated with less protective sexual practices (OR0.46, 95%CI 0.28-0.74, p=0.002). Gender did not moderate the effect of disclosure on protective sexual practices. Conclusion: Knowing one’s HIV-positive status has a positive effect on adolescent safer sex practices. However, these findings suggest that HIV-status disclosure in sexual relationships may not be protective for adolescents, whose ability to practice safer sex is premised on factors beyond the mere disclosure of HIV-positive status. Better understanding of the mechanisms through which different types of disclosure are associated with protective sexual practices is necessary to inform healthcare practices that support HIV-positive adolescents engage in safe sex.