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From 'half-dead' to being 'free': resistance to HIV stigma, self-disclosure and support for PMTCT/HIV care among couples living with HIV in Kenya.

  • Spangler, Sydney A1
  • Abuogi, Lisa L2
  • Akama, Eliud3
  • Bukusi, Elizabeth A3
  • Helova, Anna4
  • Musoke, Pamela4
  • Nalwa, Wafula Z5
  • Odeny, Thomas A3
  • Onono, Maricianah3
  • Wanga, Iris3
  • Turan, Janet M4
  • 1 a Nell Hodgson Woodruff School of Nursing , Emory University , Atlanta , USA.
  • 2 b Department of Pediatrics , University of Colorado Denver , Denver , USA.
  • 3 c Center for Microbiology Research , Kenya Medical Research Institute , Nairobi , Kenya. , (Kenya)
  • 4 d Department of Health Care, Policy and Organization , University of Alabama at Birmingham , Birmingham , USA.
  • 5 e Migori County Referral Hospital , Kenya Ministry of Health , Migori , Kenya. , (Kenya)
Published Article
Culture, health & sexuality
Publication Date
Aug 16, 2017
DOI: 10.1080/13691058.2017.1359338
PMID: 28812457


In sub-Saharan Africa, self-disclosure of HIV-positive status may be a pivotal action for improving access to prevention of mother-to-child transmission services. However, understanding of HIV stigma and disclosure, and their effects on demand for care remains incomplete - particularly in the current context of new antiretroviral therapy guidelines. The purpose of this study was to explore these issues among self-disclosed couples living in southwest Kenya. We conducted 38 in-depth interviews with HIV-positive pregnant or postpartum women and their male partners. Of the 19 couples, 10 were HIV seroconcordant and 9 were serodiscordant. The textual analysis showed that HIV stigma continues to restrict full participation in community life and limit access to care by promoting fear, isolation and self-censorship. Against this backdrop, however, participants' narratives revealed varying forms and degrees of resistance to HIV stigma, which appeared to both produce and emerge from acts of self-disclosure. Such disclosure enabled participants to overcome fears and gain critical support for engaging in HIV care while further resisting HIV stigma. These findings suggest that programme interventions designed explicitly to stimulate and support processes of HIV stigma resistance and safe self-disclosure may be key to improving demand for and retention in HIV services.

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