Psychosocial Factor Influence on Disclosure Behaviors in Those Newly-Diagnosed with HIV Under “Treatment for All” in Namibia

Abstract

Background: Namibia has one of the world’s highest HIV prevalence rates. As of 2016, Namibia adopted the World Health Organization (WHO) recommendation that all newly diagnosed HIV-positive individuals begin ART, regardless of CD4 cell count. This new Treatment for All (TfA) approach requires patients to maintain continued engagement in HIV care and high ART adherence to achieve viral suppression. However, research suggests that a TfA approach may amplify existing disclosure barriers in HIV+ adults. This study explores how psychosocial factors influence the disclosure process of those who newly initiated ART under TfA guidelines. Understanding how psychosocial factors influence the disclosure process may help inform disclosure interventions as well as identify PLHIV with avoidance-focused disclosure goals who may need additional support. Methods: Qualitative data on psychosocial influences on disclosure behaviors were collected through semi-structured interviews (n=63) with newly diagnosed adults living with HIV in Namibia. Chaudoir et al’s (2011) framework on The Disclosure Processes Model (DPM) guided qualitative content analysis. Findings: Participants described a range of psychosocial factors including locus of control, support networks, future oriented concerns, and work relationships relating to the DPM’s avoidance and approach goals as well as the disclosure event that influenced the disclosure process. Conclusion: By understanding individual’s attitudes about HIV as well as the context of that individual’s social support system, we can create stronger and more curated messages and programs to support PLHIV disclosure to support systems for better overall health outcomes.