HIV serostatus disclosure to sexual partners and associated factors among reproductive-age women living with HIV in Lesotho: evidence from the 2023–2024 Lesotho Demographic and Health Survey

Human Immunodeficiency Virus ( HIV) serostatus disclosure to sexual partners is essential for effective HIV management among women of reproductive age. However, nationally representative evidence from Lesotho is lacking. Therefore, this study assessed the prevalence and factors associated with HIV serostatus disclosure using the Lesotho Demographic and Health Survey (DHS) (2023–2024). The study used the most recent Lesotho DHS 2023–2024 dataset. Data were analyzed using STATA version 18, and a logistic regression model was fitted. Variables with p < 0.25 in the bivariable analysis were included in the multivariable model, and those with p < 0.05 were considered significantly associated with HIV serostatus disclosure. The prevalence of HIV serostatus disclosure was 60.7% (95% CI: 58.04, 63.3). Higher odds of disclosure were observed among women aged 25–29 (AOR = 3.65, 95% CI: 1.52, 8.76), 30–34 (AOR = 3.51, 95% CI: 1.50, 8.23), and 35–39 (AOR = 2.49, 95% CI: 1.07, 5.81), those employed in sales (AOR = 1.58, 95% CI: 1.06, 2.38), unskilled manual labor (AOR = 1.66, 95% CI: 1.21, 2.28), or the professional sector (AOR = 2.52, 95% CI: 1.26, 5.01), those with media exposure (AOR = 1.56, 95% CI: 1.04, 2.35), and residents of Quthing (AOR = 1.81, 95% CI: 1.002, 3.28) and Mokhotlong (AOR = 2.04, 95% CI: 1.07, 3.86). Lower odds were found among women who were ashamed of their HIV status (AOR = 0.74, 95% CI: 0.57, 0.98) and those who were single (AOR = 0.20, 95% CI: 0.13, 0.30), widowed (AOR = 0.22, 95% CI: 0.15, 0.34), or separated (AOR = 0.17, 95% CI: 0.12, 0.26). About 60.7% of reproductive-age women living with HIV in Lesotho disclosed their HIV status to sexual partners. Age, employment status, marital status, media exposure, feelings of shame regarding HIV status, and geographic location were significantly associated with HIV status disclosure. Strengthening media campaigns, reducing stigma, supporting women in vulnerable marital situations, and promoting supportive environments, particularly in regions with lower disclosure rates, may improve HIV serostatus disclosure.