Disclosure of HIV status between spouses in rural Malawi

Disclosure of HIV status after HIV voluntary counseling and testing has important implications for the spread of the HIV epidemic and the health of individuals who are HIV positive. Here, we use individual and couples level data for currently married respondents from an ongoing longitudinal study in rural Malawi to (1) examine the extent of HIV status disclosure by HIV serostatus; (2) identify reasons for not sharing one's HIV status with a spouse; and (3) evaluate the reliability of self-reports of HIV status disclosure. We find that disclosure of HIV status is relatively common among rural Malawians, where most have shared their status with a spouse, and many disclose to others in the community. However, there are significant differences in disclosure patterns by HIV status and gender. Factors associated with non-disclosure are also gendered, where women who perceive greater HIV/AIDS stigma and HIV positive are less likely to disclose HIV status to a spouse, and men who are worried about HIV infection from extramarital partners are less likely to disclose their HIV status to a spouse. Finally, we test the reliability of self-reported HIV status disclosure and find that self-reports of HIV-positive men are of questionable reliability.