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.
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).
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.
Le Guen M et al. Union break-up after HIV diagnosis among sub-Saharan African migrants in France: disclosing HIV status is linked with staying in union. AIDS Care 31: 699-706, 2019.