Abstract / Summary
HIV disclosure among women living with HIV remains an important social and public health concern in sub-Saharan Africa, where stigma, patriarchal norms, and socio-cultural expectations shape disclosure experiences. Although disclosure may facilitate antiretroviral therapy (ART) care, psychosocial support, partner involvement, and prevention of mother-to-child transmission (PMTCT), many women delay or avoid disclosure because of anticipated rejection, discrimination, and marital instability. Evidence on the socio-cultural realities surrounding disclosure in Northern Nigeria remains limited. This study examined the social context of HIV disclosure among women receiving ART services at Usmanu Danfodiyo University Teaching Hospital, Sokoto. A qualitative interpretive design was adopted. In-depth interviews were conducted with 20 ever-married women living with HIV (WLWH), while key informant interviews involved eight healthcare workers comprising adherence counsellors, nurses, pharmacists, and medical doctors. Participants were purposively selected from the hospital’s ART clinic. Semi-structured interviews were audio-recorded, transcribed verbatim, and analysed thematically using Braun and Clarke’s six-step approach. Rational Choice Theory and Social Support Theory guided interpretation. Disclosure decisions were shaped by relationship dynamics, gendered power relations, stigma, fear of divorce, accusations of infidelity, and socio-cultural associations between HIV and immorality. Women described strategically delaying, concealing, or selectively disclosing their status because of anticipated rejection, marital instability, discrimination, and social exclusion. Antenatal care was an important pathway through which several women first learned their HIV status. Healthcare workers described supporting disclosure through counselling, mediation, emotional reassurance, and psychosocial support. Participants perceived supportive spouses and trusted family members as facilitating treatment engagement, emotional wellbeing, PMTCT-related care, and continuity of care. Conversely, unsupportive relationships were associated in participants’ accounts with stigma, social isolation, and difficulties coping. Disclosure networks were highly selective and shaped by trust, confidentiality, and perceived emotional safety. HIV disclosure among ever-married WLWH in Sokoto reflects complex interactions between stigma, gender relations, socio-cultural norms, and social support. Strengthening psychosocial support, healthcare-assisted disclosure, stigma-reduction interventions, and male-partner engagement may facilitate safer disclosure, treatment engagement, continuity of care, and supportive PMTCT-related experiences.