Factors influencing HIV disclosure among people living with HIV/AIDS in Nigeria: a systematic review using narrative synthesis and meta-analysis

Abstract

Objectives: To critically review, appraise and evaluate quality of evidence on HIV disclosure among people living with HIV/AIDS (PLWHA) in Nigeria, and to identify a possible gap in knowledge on HIV/AIDS and disclosure.

Study design: A systematic review using narrative synthesis and meta-analysis.

Methods: MedLine, PsycINFO, PubMed Central, Scopus and CINAHL were searched. Data were extracted with the use of spread sheet. An analysis of heterogeneity was performed for the disclosure rate and the presence of a supportive reaction from partners. A meta-analysis was performed for the disclosure rates to sexual partners, with data available for all ten studies.

Results: Ten studies met the inclusion criteria. The outcomes show that HIV disclosure of sero-positive status is most common between spouses or sexual partners than disclosure to relatives/family members, friends, pastor/Imam or work colleagues/employers. The participants in most of these studies are women, and amongst the most influential factors on disclosure are gender, anticipated outcome, marital status and knowledge of partners' status. Some studies reported non-disclosure as a way of limiting stigma. Almost all of the studies highlighted that there is fear of stigma and social exclusion associated with disclosure.

Conclusion: This review discusses the overall experience of HIV disclosure on the management of the disease and barriers to disclosure. We found that PLWHA in Nigeria disclosed to at least one person within their social networks. Stigma is still a major consideration for PLWHA who experience a range of misconceptions around HIV transmission. The findings of this study may inform local policies and plans for improving the PLWHA quality of life. Targeted policies to increase disclosure of sero-positive status and reduce stigma may facilitate disease prevention. The methodological rigour of the included studies was appraised low.

Keywords: Africa; Disease prevention; HIV disclosure; HIV/AIDS; Nigeria; People living with HIV/AIDS; Policy; Stigma.