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Do women disclose their HIV-status more than men? Results from a community-‐based research among PLHIV in Morocco
MOROCCO o Low prevalence Muslim country (< 0,1%) o Concentrated epidemic among MARPS (Agadir : 5,6% of prevalence among MSM -‐ 5,1% among FSW) o HIV infecLon is a socio-‐cultural taboo o High rates of sLgma against PLHIV -‐> Difficulty to disclose one’s HIV-‐status Disclosure: o Seems parLcularly difficult for women o No scienLfic data on this issue available to date
A. Abadie1, M.K. Hilali2, M. Loukid2, E. Henry3, J. Otis4, M. Karkouri5, N. Rafif1,O. Mellouk1, H. Himmich5, L. Ouarsas6, M. Préau7
1Association de Lutte Contre le SIDA, Marrakech, Morocco, 2University Cadi Ayyad, Laboratoire d'Ecologie Humaine, Marrakech, Morocco, 3Coalition Plus SIDA, Paris, France, 4Université de Québec à Montréal, CREcES, Montréal, Canada, 5Association de Lutte Contre le SIDA, Casablanca, Morocco, 6Association
de Lutte Contre le SIDA, Agadir, Morocco, 7Université de Nantes, LABECD, Nantes, France
AN INTERNATIONAL STUDY 'PARTAGES’
• InternaLonal research consorLum engaging academics and NGOs from Mali, DemocraLc Republic of Congo, Ecuador, Romania, Morocco, France, Canada in a community-‐based research
-‐> Development of a research program to study serostatus disclosure in order to inform policies and propose suitable intervenLons
• A standardized quesLonnaire was developed • Eligibility criteria for parLcipaLon: PLHIV aged 18 or older and knowing its for at least six months
• Data collecLon between May and October 2011
IN MOROCCO
• Mixed team: ALCS (AssociaLon de Lu^e Contre le Sida)/ Cadi Ayyad University (Human Ecology Laboratory) of Marrakesh
• 300 PLHIV in contact with ALCS interviewed in 5 ciLes: Agadir, Casablanca, Marrakesh, Rabat, Fes
• Preliminary descripLve analysis using SPSS 10
q Women are less likely to disclose their HIV-‐status and feel more vulnerable aber disclosure. The socio-‐cultural and religious context may explain this situaLon. q Disclosure of HIV-‐status is crucial regarding prevenLon and treatment adherence and may influence PLHIV behaviors and aftudes. q The results of this study need to be used to develop a comprehensive and gender-‐oriented approach of disclosure programs.
DISCLOSURE E 75,8% have disclosed their status, essenLally with their regular sexual partner
E Men have disclosed with the partner sexual more than women but not significantly E Women were more likely to disclose with female family members: mother (51,2%), sister (44,6%) versus father (15,38%), brother (15,8%). ASSISTANCE TO DISCLOSURE E Few PLHIV have already asked for assistance to disclose (10,4%) E More women have asked for assistance to disclose than men (W: 12,4%; M: 7,6%; p < 0.18) DISCLOSURE PERCEPTION AND CONCEALMENT E Both men and women (89%) considered disclosure risky E More women would have asked their relaLves to keep their HIV-‐status secrete (W: 82,5%; M: 60,2%; p < 0.001) E More women felt the "need to hide” it (W: 90,6%; M: 84%; p < 0.09) E 46,5% of women who disclosed considered it was a mistake (M: 28% ; p < 0.004)
* among those who disclosed their status
Abstract number: WEPE427
Background
Methods
Results
Conclusion
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Women Men
Figure 1: Percentage of disclosure with regular sexual partner by gender
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father mother sister brother
Figure 2 : Pecentage of disclosure with family members by gender
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Men
SOCIO-‐DEMOGRAPHIC CHARACTERISTICS E 56,7% female, 39,7% male and 3,7% transgender. Transgender people are not integrated in this analysis.
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is risky ask their relaLves to keep it secrete
feel the "need to hide" is a mistake*
Figure 3: Disclosure percepUon by gender (in percent)
women
men
Variables Men (%) Women (%) Marital status: Ø Married Ø Concubinage Ø Divorced/ separated
45.4 3.4 8.4
32.9 7.6 30.6
Educa-on Ø No educaLon Ø Primary/ Secondary level Ø Post secondary level
16.1 73.7 10.2
45.9 50.6 1.2
Main financial ressources for living Ø Self-‐income Ø Family network
55.5 26.9
19.4 54.7