In all, 73% of the sample was <35 years old and most of the participants consisted of black Africans, although there was racial diversity, with about 30% of participants self‐identifying as white, coloured or Indian. About 70% of participants were unemployed, and nearly 75% were not currently married. Participants were relatively recently diagnosed HIV positive, with the average person receiving their HIV diagnosis approximately 2½ years earlier. In terms of their health status, nearly half of the sample had been hospitalised at least once for an HIV‐related problem, and half of the sample was taking ARVs. All participants reported having physical symptoms associated with HIV infection, with an average of six current symptoms experienced. For HIV risk history, most of the sample had been diagnosed with a sexually transmitted infection other than HIV, and between 10% and 20% reported various other markers for history of HIV transmission risks. Men were considerably more likely to have given someone money or a place to stay in exchange for sex, and were more likely to have been involved with injection drugs. Table 1 shows the demographic, health and risk history characteristics of men and women living with HIV.
In all, 90% men and 81% of women reported being sexually active in the previous 3 months. For the entire sample, 40% of men and 18% of women had two or more sex partners during that time (table 1). Most of the participants had HIV‐positive partners. However, 50% of men and 32% of women reported having HIV‐negative partners, and 39% of both men and women had sex partners whose HIV status they did not know. For each category of partner status, men reported more sex partners than women. Unprotected vaginal and unprotected anal intercourse with HIV concordant and HIV non‐concordant sex partners was reported by both men and women. Men were more likely than women to have unprotected anal intercourse with concordant and non‐concordant partners. Substance use was also common in the sample, with 51% of participants reporting recent alcohol use, 17% using dagga and 11% using methamphetamine in the previous 3 months; more men reported using each substance than women did.
HIV status disclosure and sexual behaviour
Among the 903 participants who were currently sexually active, 378 (42%) indicated that they had had sex with a person they had not disclosed their HIV status to in the previous 3 months. Participants who had not disclosed to sex partners were significantly more likely to be married and were slightly more likely to identify their race as coloured (table 2).
Table 2Demographic and health characteristics of sexually active people living with HIV/AIDS who disclosed their HIV status to all their sex partners in the previous 3 months and those who did not disclose to all partners
We found a close association between having not disclosed HIV status to sex partners and engaging in practices with high risk of HIV transmission (table 3). People who had not disclosed their HIV status to partners reported more sex partners in each HIV status category and reported more unprotected vaginal and anal intercourse than people who had disclosed. Differences were most pronounced, however, for sexual behaviours involving non‐concordant partners. Those who had not disclosed to a partner were nearly six times as likely to have sex partners whose HIV status was known to be HIV negative, and nearly 28 times more likely to have partners whose HIV status was not known. Risks of exposure to HIV occurred in these sexual encounters, with 55% of people who did not disclose their HIV status indicating that they had unprotected vaginal intercourse and 38% indicating that they had unprotected anal intercourse with their non‐concordant partners. Unprotected vaginal and anal intercourse was far less common for participants who had disclosed their status to all of their recent sex partners, including unprotected acts with both concordant and non‐concordant partners.
Table 3Sexual behaviours among sexually active people living with HIV/AIDS who disclosed their HIV status to their sex partners and those who did not disclose to all partners
Disclosure of HIV status and HIV‐related discrimination
Analyses showed that participants often reported efforts to conceal their HIV status from others. Most of the participants endorsed all four items assessing concealment of their HIV status behaviours. Analyses controlling for participants' sex, race and marital status found that not having talked with friends about their HIV status and not having told others about their HIV‐positive status because they feared potential adverse reactions were significantly related to not disclosing HIV status to sex partners. In addition, those who had not disclosed their HIV status to sex partners were significantly more likely to have experienced discrimination related to their HIV status and more than twice as likely to have lost a job or a place to stay because they are HIV positive. Finally, people who had not disclosed to partners were significantly less likely to state that they were certain they can tell their sex partners that they are HIV positive (table 4)
Table 4Disclosure and history of discrimination among sexually active people living with HIV/AIDS who disclosed their HIV status to all their sex partners in the previous 3 months and those who did not disclose to all partners
A multivariate logistic regression entered having disclosed HIV status to sex partners as the dependent variable and included all the concealment, discrimination and efficacy items that significantly differentiated the groups in the crude analyses, again controlling for participants' sex, race and marital status. Results of the multivariate model showed that not disclosing HIV status to sex partners was associated with having lost a job or place to stay in relation to being HIV positive and having a lower sense of efficacy for disclosing to sex partners (table 4).