SUMMARY

HIV/AIDS is a disease of public health concern with 36.7 million people living with the disease

worldwide. Sub-Saharan Africa accounts for 70% of the global burden. In Nigeria 3.5 million

people are living with the disease. The prevalence in Akwa Ibom state is 6.5% more than double

the national average (3.17%). The World Health Organization encourages all people living with

HIV to disclose their status in order to improve adherence and the use of preventive practices.

Non-disclosure of one‘s positive HIV status is criminal under Nigerian law. People living with

HIV are often reluctant to disclose their HIV status fearing stigma and discrimination. The

consequences of disclosure reflect the interplay between fear and hope, risks and benefits.

This study aimed to: determine the knowledge of HIV disclosure among people living with HIV,

the proportion of them that had disclosed, the patterns of HIV status disclosure, the determinants

of non-disclosure, as well as the barriers and consequences of HIV disclosure.

The study was conducted in General hospital Ikot Ekpene, 300 respondents were recruited. Data

were collected, entered, cleaned, coded and stored in password protected. Using EPI INFO: data

were analysed to determine frequencies and proportions, bivariate and multivariate analysis was

done to determine associations and binary logistic regression was done to adjust for confounders.

The proportion of PLHIV with good knowledge on the importance of HIV disclosure was 84%.

The proportion of PLHIV that had disclosed their status was 70.3%.The factors associated with

non-disclosure were being unmarried [adjusted odds ratio (AOR): 2.68, CI: 1.4-5.1], belonging

to religions other than Christianity or Islam (AOR: 8.37,CI: 1.3-50.6), having secondary

education and below (AOR: 2.86, CI:1.2 - 7.1), knowing one‘s status for twelve months or less

(AOR: 3.1, CI:1.5-5.9), absence of TB co-infection(AOR:14.4, CI:1.7-123)and not thinking HIV

status disclosure was important (AOR: 6.3, CI: 3.0-13.4).

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The barriers to HIV status disclosure were fear of the unknown, fear of stigma and fear of loss of

confidentiality, shame, time not being right and fear of divorce.

The consequences of HIV status disclosure were predominantly positive. Initial positive

outcomes were 52% compared to the anticipated 21%. Subsequent outcomes were 95% positive.

Other positive consequences of disclosure were: Disclosure of HIV status helped 94%

respondents to adhere to anti-retroviral therapy and keep hospital appointments .Disclosure of

HIV status reduced feelings of stress in 92% respondents. Disclosure of HIV status helped 79%

of the respondents practice preventive measures.

Knowledge of importance of HIV status was high. The determinants of non-disclosure were

socio-demographic, HIV-related and related to disclosure information. The greatest barrier to

disclosure was fear of the unknown. The consequences of disclosure were mostly positive.

It is recommended that: health workers encourage people living with HIV to disclose their HIV

status. Data on disclosure be collected by national HIV/related surveys, more research be done

on stigma and discrimination of people living with HIV.

Keywords: HIV/AIDS, Disclosure, Barriers, outcomes, people living with HIV.

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CHAPTER ONE

INTRODUCTION

1.1    Background

Worldwide HIV/AIDS is a disease of public health concern. Since the first case was diagnosed in

1981, the disease has caused widespread morbidity and mortality become a global epidemic. The

disease has been described as ‗devastating‘, ―a public health emergency‖, ―a global health

problem‖, ‗a major cause of death‘ a fatal sexually transmitted disease‘, ‗a chronic controllable

condition‘.1,2 It has also been called ‗deadly‘, ‗an incurable disease‘ ‗a manageable, chronic

illness‘ ‗an immune deficiency‘ and ‗a pandemic‘. In 2015, the Joint United nations Programme

on HIV/AIDS (UNAIDS) released a new set of guidelines to guide communication on HIV

related issues.1 In the document the use of the aforementioned terms is discouraged, and it is

advised that the use of adjectives to describe AIDS should be discouraged. The document

dissuades against the use of HIV/AIDS as a generic term. It argues that most people who have

HIV do not go one to develop AIDS and it advocates for the use of the term HIV instead. The