HIV status disclosure among women living with HIV in Ghana: Experiences, influences, and consequences

Background: In Ghana, women bear a larger burden of HIV infection and the effects of stigma than their male counterparts. Within this environment, disclosure can be beneficial or detrimental to them and their families, depending, in part, on the reaction of their confidants. Treatment with antiretroviral medications (ART) may impact a woman\u27s overall health and post-diagnosis experiences. ART minimizes physical symptoms of HIV infection, possibly reducing stigma, and allows daily activities, including activities for wage earning, to be performed. Overall aim: The purpose of this qualitative study was to investigate women\u27s experiences of HIV status disclosure and related factors in Ghana. Methods: An Akan-speaking native Ghanaian research assistant and I (a Ghanaian born and raised in the U.S.) conducted semi-structured interviews with 40 women living HIV (WLHIV) in the Greater Accra region and 15 stakeholders between January and March 2014. The stakeholders were affiliated with Ghanaian government organizations and non-governmental organizations (NGOs) involved in HIV-related work. I utilized thematic content analysis to review the interview transcripts and used ATLAS.ti version 7 software to manage the data. Interviews were transcribed verbatim; Akan interviews were translated during transcription. The research was approved by the University of Ghana Noguchi Memorial Institute for Medical Research Institutional Review Board and the University of Texas Health Science Center at Houston Committee for the Protection of Human Subjects. Results: Stakeholders (nine women, six men) represented five NGOs, one healthcare facility, and one governmental organization. Nineteen WLHIV revealed their ages (range = 32 – 60 years). The median time from diagnosis was eight years (n = 36, range = 0.5 - 24 years). All of the WLHIV were on ART. The first paper presents a portion of Ghana\u27s ART program. The stakeholder and WLHIV interviews revealed that ART can provide economic improvements for WLHIV. However, frequent drug stock outs, limited government funding, and the difficult financial circumstances of many WLHIV threaten their ability to continue uninterrupted administration of ART. In the second paper I explore why women disclose their HIV status through the themes comfort and support, and education and prevention interventions. I describe strategies for disclosure, and negative and positive consequences. Lastly, I discuss refusing to disclose from the perspective of the WLHIV. Women\u27s stories reveal that stigma-induced negative experiences continue to have devastating consequences, particularly economically. It is not surprising that among those interviewed, selective disclosure, if any disclosure at all, was considered the best course of action. Conclusion: ART benefits WLHIV by allowing them to avoid stigma and its economically-related consequences. However, inconsistent access to ART threatens these advantages. WLHIV disclose based on an assessment of needs, and employ different strategies to examine a confidant before choosing to disclose. Despite several positive consequences, negative consequences continue to occur as a result of disclosure. The findings contribute to the literature by exploring the disclosure process and consequences of disclosure for a group of women with a wide range of diagnosis dates, allowing experiences over time to be examined. The review of ART provides the voices of important stakeholders in Ghana\u27s HIV program, in addition to a description of the benefits of ART. The findings highlight the need to reconsider recommendations for HIV status disclosure, continue efforts for stigma reduction, and work toward efficient and sustained ART supply in Ghana