Global HIV statistics reported that there were almost 36.7 million people living with HIV of which 1.8 million people became newly infected by HIV in 2016. However, cumulatively, about 76.1 million people were living with HIV and 35.0 million people died from AIDS-related illness since last epidemic [
Disclosure of HIV status was an important variable, as disclosure of HIV status to a sexual partner, close relatives, and friends might benefit people living with HIV/AIDS (PLWHA), partners, and society. Some of the potential benefits were improving emotional and psychological well-being [
However, the pattern of disclosure of HIV status varies among community, such as disclosure to sexual partner (56 to 81%), family members (70 to 87%), and friends (26 to 88%) in the United States [
There is insufficient study available in Malaysia, particularly Sarawak, and this study aimed at determining the willingness to disclose HIV status among adult community in Sarawak, if they are found positive.
This was a cross-sectional study conducted in Sarawak, Malaysia, for a duration of two years from year 2016 to 2017. A gender-stratified multistage cluster sampling technique was adapted. For the sampling procedure, the Sarawak state was divided into three zones, namely, the northern, southern, and central zone. From each zone, a division was randomly selected followed by two districts selected randomly from each division. From each district, five villages were selected randomly. Then, 30 households were selected by a stratified systematic random sampling where adult males and females aged 18 years and above were selected at every
Sample size was calculated with base proportion of stigma and discrimination of 60% [
In this study, inclusion criteria for respondents were adults aged 18 years and above, physically healthy and not being diagnosed with HIV/AIDS, and Malaysian citizens agreeing to participate and able to understand Malay or English. Failure to be interviewed after three attempts was excluded.
We developed a data collection instrument after studying with past studies [
A pretest of questionnaire was conducted among 30 respondents in a nonsampled area. The purpose of this was to test the consistency, understandability, and flow of questions. Moreover, the data quality is believed to be high as the interviewers were thoroughly trained for one-week, close supervision of the interviewers during data collection and the questionnaires were thoroughly edited to make sure that relevant questions have been responded to and coded according to the code designed for the study. Three attempts were made to get the sampled respondents.
Data coding and verification of response were made on the same day immediately after interview. Any missing information was corrected on the following day to get the correct information. The cleaned data were entered into the computer using SPSS version 22.0 platform [
Ethical approval was obtained from the Medical Ethics Committee of Universiti Malaysia Sarawak (UNIMAS/NC-21.02/03–02 Jld.2 (08)) dated on 11 February 2016, Clinical Research Centre, and the National Medical Research Register, Ministry of Health (NMRR-16-192-29374 (IIR)) dated on 31 March 2016. All the respondents were briefed about the objectives of the study, and a written informed consent was obtained before data collection.
A total of 900 respondents (450 males and 450 females) from 30 villages in Sarawak participated in this study. The mean age of males was 41.57 years and that of females was 38.99 years, and the mean age difference between males and females was statistically significant (
Sociodemographic characteristics (
Characteristics | Male | Female |
| ||
---|---|---|---|---|---|
Frequency | % | Frequency | % | ||
a
|
41.57 (13.45) | 38.99 (13.09) |
|
||
b
|
|||||
Iban | 77 | 49.0 | 80 | 51.0 | 0.988 |
Malay | 200 | 50.6 | 195 | 49.4 | |
Bidayuh | 73 | 49.7 | 74 | 50.3 | |
Others | 100 | 49.8 | 101 | 50.2 | |
b
|
|||||
Christianity | 106 | 49.3 | 109 | 50.7 | 0.705 |
Islam | 313 | 49.8 | 316 | 50.2 | |
Others | 31 | 55.4 | 25 | 44.6 | |
b
|
|||||
Living with partner | 329 | 73.1 | 325 | 72.2 | 0.765 |
Living without partner | 121 | 26.9 | 125 | 27.8 | |
c
|
5.0 | 5.0 | 0.716 | ||
b
|
|||||
No formal education | 76 | 36.2 | 134 | 63.8 |
|
Primary school | 105 | 55.6 | 84 | 44.4 | |
Secondary school | 233 | 53.9 | 199 | 46.1 | |
Tertiary and above | 36 | 52.2 | 33 | 47.8 | |
b
|
|||||
Unemployed | 63 | 17.2 | 303 | 82.8 |
|
Self-employed | 187 | 75.1 | 62 | 24.9 | |
Government job | 61 | 66.3 | 31 | 33.7 | |
Private job | 139 | 72.0 | 54 | 28.0 | |
c
|
900.0 | 800.00 |
|
a
Two-thirds (68.4%) of the respondents desired to disclose if he or she had HIV positive. The highest percentage of the respondents wanted to disclose the status to their partner (56.8%) followed by parents (52%), family (42.4%), and friends (18.4%). However, 14.2% had no choice or preference of person to be disclosed (Table
Percentage distribution of respondents by disclosure of HIV status and its pattern.
Variables |
|
% |
---|---|---|
|
||
No | 284 | 31.6 |
Yes | 616 | 68.4 |
|
||
Partner | 511 | 56.8 |
Parents | 468 | 52.0 |
Family | 382 | 42.4 |
Friends | 166 | 18.4 |
Religious leader | 125 | 13.9 |
Neighbour | 113 | 12.6 |
Employer | 100 | 11.1 |
Others | 128 | 14.2 |
Analysis revealed that among the males, the percentage of disclosure was 66.7% compared with females (70.2%) and the difference was statistically significant (
Gender-stratified percentage distribution of disclosure of HIV/AIDS.
Disclosure of HIV | Male ( |
Female ( |
|
|
Phi coefficient | ||
---|---|---|---|---|---|---|---|
|
% |
|
% | ||||
No | 150 | 33.3 | 134 | 29.8 | 1.31 (1) | 0.251 | 0.038 |
Yes | 300 | 66.7 | 316 | 70.2 |
To identify the potential factors that predict the disclosure of HIV status, stepwise binary logistic regression analysis was done. The variables, namely, age, ethnicity, occupation, knowledge on HIV transmission, and content of discussion on HIV/AIDS, were found to be statistically significant in preliminary analysis by Pearson’s chi-square test of independence and were entered into the regression model. The dependent variable was dichotomous into “yes” and “no.” A forward stepwise method was selected to identify potential factors that predict disclosure of HIV status in both genders.
From bivariate analysis, age, ethnicity, occupation, knew someone had HIV, knowledge on HIV transmission, and content of discussion of HIV/AIDS appeared as significant influencing factors for predicting disclosure of HIV-positive status (
An analysis indicated that age group 40 to 49 years (AOR = 2.253, 95% CI: 1.218, 4.167), age group 50 to 59 years (AOR = 4.686, 95% CI: 2.133, 10.293), occupation as self-employed (AOR = 0.588, 95% CI: 0.347, 0.997), poor knowledge on HIV transmission (AOR = 2.837, 95% CI: 1.294, 6.129), average knowledge on HIV transmission (AOR = 4.582, 95% CI: 2.582, 8.131), and no or poor content of discussion (AOR = 1.890, 95% CI: 1.183, 3.021) and moderate content of discussion (AOR = 4.847, 95% CI: 1.664, 14.118) appeared to be important predictors of disclosure of HIV-positive status. Apart from that, it showed that male respondents aged between 40 and 49 years were 2.253 times likely to be disclosed HIV status compared with those aged less than 30 years. Meanwhile, male respondents aged between 50 and 59 years were 4.686 times likely to be disclosed HIV status, if positive. However, 41.2% of those who worked as self-employed were less likely to be disclosed HIV status compared with those who had gainful job. Apart from that, male respondents who had poor knowledge on HIV transmission were 2.837 times likely to be disclosed HIV status compared with those who had good knowledge on HIV transmission. Similarly, male respondents who had average knowledge on HIV transmission were 4.582 times likely to be disclosed HIV status compared with those who had good knowledge on HIV transmission. Besides, those who had no or poor content of discussion were 1.890 times likely to be disclosed HIV status compared with those who had extensive content of discussion on HIV/AIDS. Similarly, those who had average content of discussion were 4.847 times likely to be disclosed HIV status compared with those who had extensive content of discussion (Table
Gender-stratified factors affecting the disclosure of HIV status: binary logistic regression analysis.
Variables |
|
Male |
|
Female | ||
---|---|---|---|---|---|---|
AOR | 95% CI | AOR | 95% CI | |||
|
NI | |||||
<30 (RC) | 1 | |||||
30–39 | −0.113 | 0.893 | 0.465, 1.713 | |||
40–49 |
|
2.253 | 1.218, 4.167 | |||
50–59 |
|
4.686 | 2.133, 10.293 | |||
>60 | 0.725 | 2.064 | 0.907, 4.695 | |||
|
||||||
Malay |
|
6.184 | 2.921, 13.090 | |||
Iban | NI |
|
2.917 | 1.722, 4.943 | ||
Bidayuh |
|
4.468 | 2.211, 9.027 | |||
Others (RC) | 1 | |||||
|
||||||
Gainful job (RC) | 1 | |||||
Self-employed |
|
0.588 | 0.347, 0.997 | NI | ||
Unemployed | 0.559 | 1.749 | 0.946, 3.235 | |||
|
NI | |||||
Poor (≤6) |
|
2.837 | 1.294, 6.129 | |||
Average (7–14) |
|
4.582 | 2.582, 8.131 | |||
Good (≥15) (RC) | 1 | |||||
|
||||||
No or poor (≤2.30) |
|
1.890 | 1.183, 3.021 | −0.001 | 0.999 | 0.624, 1.598 |
Moderate (2.31–5.13) |
|
4.847 | 1.664, 14.118 |
|
4.317 | 1.212, 15.371 |
Extensive (≥5.14) (RC) | 1 | 1 | ||||
Constant | −1.393 | 0.248 | −0.177 | 0.838 | ||
|
||||||
Model chi-square (df) | 79.751 (10) |
43.336 (5) |
||||
|
450 | 450 | ||||
Goodness of fit | 9.976 (8); 0.267 | 6.351 (6); 0.385 | ||||
Nagelkerke |
0.226 | 0.130 | ||||
Cox and Snell |
0.162 | 0.092 |
Among the female samples, ethnicity and content of discussion of HIV/AIDS appeared as statistically significant influencing factors for predicting disclosure of HIV status (
The contents of discussion of HIV/AIDS issues appeared to be important predictor in both male (AOR = 4.847, 95% CI = 1.664, 14.118) and female (AOR = 4.317, 95% CI = 1.212, 15.371) respondents (
In our study, the intention to disclose HIV-positive status among respondents was 56.8% to their sexual partner, 52.0% to parents, 42.4% to family members, and 18.4% to friends. This finding indicated that most of them were willing to disclose HIV status if positive to sexual partner and this is similar to other studies in Africa [
In our study, several factors predicting the disclosure of HIV/AIDS if positive among males were age, occupation, knowledge on HIV transmission, and content of discussion; meanwhile, ethnicity and content of discussion were influencing HIV/AIDS disclosure among female respondents. Male with older age, self-employed, average knowledge on HIV transmission, and moderate discussion on HIV/AIDS increase the disclosure of HIV/AIDS status, whereas females with Malay, Iban, and Bidayuh ethnicity and moderate discussion on HIV/AIDS were associated with disclosure of HIV/AIDS status.
Age was a predictor of willingness to disclose HIV status among male respondents. Those aged 40 to 49 years and 50 to 59 years were more likely to disclose their HIV status if positive compared with others. This indicated older males were more likely to disclose HIV status compared with younger males. This is consistent with other studies [
Ethnicity was one of the predictors for HIV disclosure among females. The current study reported that being Malay, Iban, and Bidayuh, females were more likely to disclose their HIV status if positive. The possible reason was that married or cohabited females were more likely to disclose HIV status to sexual partner due to their intimacy of partners and the confidence they have with each other facilitating open communication and later enhance disclosure of HIV status [
Occupation is one of the socioeconomic factors that can influence the disclosure of HIV status among males. This finding was similar to other studies [
Knowledge on HIV transmission was a predictor for disclosure of HIV status among male respondents but not among female respondents. The current study reported that respondents with average knowledge on HIV transmission were 4.5 times more likely to disclose HIV status among males compared with those who had good knowledge on HIV transmission. This is supported by another study [
The content of discussion was an important predictor for HIV disclosure among male respondents. This reflected that open discussion and communication on HIV/AIDS among partners and family members particularly encourage the disclosure of HIV status [
A few limitations were encountered in the current study. First, the data for this study were collected from rural population; thus, generalisation to the urban population should be done with caution. Second, by nature of cross-sectional study, it is unable to establish causal relationship.
As a conclusion, this study found that knowledge on HIV transmission and contents of discussion were important issues for disclosure of HIV status, if a person is positive for HIV. Thus, this finding would provide a benchmark and basic information for policymakers and future researchers. Thus, intervention through policymakers should be enhanced through government and nongovernment organization imparting knowledge on HIV transmission and contents of discussion on HIV/AIDS among individual, families, and health-care providers. Besides, researcher may provide evidences to support intervention in order to improve disclosure of HIV among community.
People living with HIV/AIDS
Human immunodeficiency virus
Acquired immunodeficiency syndrome
Adjusted odds ratio
Confidence interval
Standard deviation.
The data used to support the findings of this study are available from the corresponding author upon request.
The authors declare that they have no competing interests.
Aren Sinedeh Lemin and Md Mizanur Rahman developed the concept and contributed to design, analysis, interpretation of data, and manuscript writing of the study. Aren Sinedeh Lemin organized and collected data. All authors helped in the editing and refining of the manuscript. All authors read and approved the final manuscript.
The authors are very grateful to