Disclosure
of HIV status did not precipitate relationship break-ups after an HIV diagnosis
for sub-Saharan African migrants living in Paris in a study conducted by Dr Mireille
Le Guen and colleagues published in the June issue of AIDS
Care. Instead, relationship characteristics and gender differences had a greater
influence on relationship survival after diagnosis.
In France,
sub-Saharan migrants represent nearly one-quarter of people diagnosed with HIV.
Prevention policies encourage partner disclosure in order to increase testing.
However, research has pointed to gender differences for migrants from
sub-Saharan Africa, with women possibly being more reluctant to disclose due to
fears of rejection, violence and discrimination.
However,
some studies indicate that women often find emotional and material support as
opposed to rejection upon disclosure. In certain instances disclosure was not
significantly linked to relationship break-up; instead the nature of the
relationship may be more relevant. Living conditions, poverty and unemployment
may also play a role. Most migrants to France experience varied hardships
shortly after migration, the period in which migrants are most
likely to acquire HIV and receive their diagnosis.
Researchers
set out to study to what extent disclosure of HIV status, relationship
characteristics and living conditions are linked to relationship break-up post
diagnosis.
The study
Data was
taken from the ANRS-Parcours life-event survey conducted between 2012 and 2013.
This study focuses on the effects of HIV infection on the life course of migrants,
born in sub-Saharan Africa and living in Paris, aged 18 to 59. Participants were
eligible if they were diagnosed with HIV after arrival in France and were in a
stable relationship at the time of diagnosis. The sample consisted of 185 men
and 269 women.
Median age was
48 for men and 41 for women. Over half of participants were born in west
Africa; nearly 60% of women had some secondary school education while nearly
40% of men had post-secondary school education. Over half of all participants
were in stable relationships when they arrived in France. Main reasons for
migrating included finding work for men (45%) and joining a family member for
women (46%). The median time lived in France was 12 years.
Participants
were interviewed, using a life-event history questionnaire, chronicling major
life events, year by year. This method is less affected by recall bias. This
included information on socio-demographics, conditions of migration and life in
France, relationship and healthcare histories.
Gender differences in diagnosis, disclosure and break-ups
HIV
diagnosis occurred later among men (median 39 years) than women (median 31
years). Time between migration and HIV diagnosis was mainly under two years for
women (48%) but varied for men from under two years (40%) to over six years
(49%).
Women were
more likely to disclose HIV status to their partners than men (70% versus 64%),
but this difference was not significant.
Women
tended to experience more rapid relationship break-ups after diagnosis than
men, with a quarter of women and 18% of men experiencing a break-up within a year.
At six years post-diagnosis, less than half the women were still in the relationship
while 69% of the men were; at ten years after HIV diagnosis, 41% of women’s and
62% of men’s relationships had survived.
Factors influencing relationship survival
Both men
and women who had disclosed their status to their partner had a reduced risk of
separation than those who did not. This finding emerged after adjusting for
socio-economic conditions and migration characteristics. Thus, both men (OR =
0.29, CI: 0.11-0.71) and women (OR = 0.40, CI: 0.23-0.69) who disclosed were
more likely to be in their relationship than those who did not.
Other factors
contributing to survival differed for men and women. For men, those who were 35
years or older were less likely to experience a break-up (OR = 0.34, CI:
0.12-0.99). Those who came for medical or political reasons (OR = 2.81, CI:
1.12-7.08) or to join family (OR = 4, CI: 1.65-9.73) experienced more rapid
break-ups post diagnosis than those who came for economic reasons. Other
important factors that contributed to more rapid break-ups included having a
partner born elsewhere than sub-Saharan Africa at the time of diagnosis, not
having children and being in a relationship of less than five years duration.
For women, migration
characteristics were less important. As with men, women in shorter-duration relationships
were more likely to break up (OR = 1.98, CI: 1.1.9-3.31). Women who were living
with family or friends were more likely to experience a break-up than those
living in a personal dwelling (OR: 3.71, CI: 1.71-8.05).
Conclusion
The
findings indicate that women experienced more rapid relationship break-ups post
diagnosis than men did. This suggests that women are more vulnerable to the
effects of receiving an HIV diagnosis than men.
Relationship
failure tended to be related to the characteristics of the relationship (such
as its duration) and living conditions. The authors offer one possible reason
for women with their own dwellings having longer relationships post diagnosis: they
are more likely to be living with their partners, as opposed to living with
family/friends. This suggests that cohabiting relationships are stronger, and possibly
more likely to last.
Interestingly,
disclosure of HIV status was not associated with a relationship break-up. When
the partner was informed, the relationship tended to last longer.
The authors
conclude: “The risk of break-up is not associated with the disclosure but with
the type of union. In addition, it seems that more well-established unions were
more durable after HIV diagnosis.”
“Our results seem to
show that HIV diagnosis accelerate break-up in less established unions in which
the secret of HIV infection would not be closely guarded whereas most
established couples are more likely to survive after the HIV diagnosis, which
allows HIV-positive people to have confidence to talk about their disease,”
they say.
