To Tell or Not to Tell: changes in Ukrainian older adults’ HIV status disclosure behaviours during humanitarian crisis

BACKGROUND: During the war, HIV care becomes a key concern for older people with HIV (OPWH). Due to logistical and informational obstacles, they may require support with HIV care from new contacts. We sought to understand longitudinally how crises have changed OPWH disclosure behaviours.
METHODS: We surveyed OPWH in Kyiv, Ukraine, by phone between May-June 2020 (Wave 1), January-February 2021 (Wave 2), January-February 2022 (Wave 3) and May-June 2022 (Wave 4). Participants’ binary responses were compared between Wave 1, Wave 2, Wave 3 and Wave 4 to assess changes in HIV disclosure status. The primary outcome was new HIV disclosure, and the exposure variables were living conditions (living alone, not living alone) and HIV care support. Other variables were: age, gender, comorbidities, social support, anxiety and depressive symptoms defined as scores on the Patient Health Questionnaire-9 (PHQ-9) >5 and the Generalized Anxiety Disorder-7 scale (GAD-7) >5, time since disclosure, and history of substance use disorder (SUD) and/or alcohol use disorder (AUD). Associated factors were identified using logistic regression.
RESULTS: 98 OPWH completed the survey across all four waves. In Wave 4, there were 47 (48%) women, and the average age was 56.9 (SD=6.4). Men appeared less likely to disclose their HIV status, with 40 (64.5%) during Wave 1, 48 (85.7%) during Wave 2, 41 (85.4%) during Wave 3, and 43 (89.6%) during Wave 4, compared to 48 (78.7%) women in Wave 1, 50 (87.7%), 54 (100%) and 49 (96.1), respectively. During Wave 4, only twenty-five (26%) reported HIV care support, while 71 (72%) reported increased depressive symptoms, 58 (59%) indicated anxiety symptoms and 3 out of 4 OPWH reported having social support. History of SUD and/or AUD (OR 3.34, p< 0.05) and time since disclosure (OR 1.10, p =0.01) were associated with increased HIV status disclosure. Living condition was not associated with disclosure.
CONCLUSIONS: The war challenged accessing HIV care for OPWH in Ukraine. As many confidantes fled the war, OPWH experienced adverse psychological outcomes and were forced to disclose to new supports, with higher disclosure rates in Wave 4. Interventions to support disclosure processes among OPWH are needed.