Tell or Not to Tell: Changes in Ukrainian Older Adults’ HIV Status Disclosure Practices During Intersecting Covid-19 and War Crises

Humanitarian crises exacerbate challenges to accessing HIV care. Older people with HIV (OPWH, aged ≥ 50 years) may seek additional support with HIV care, which often requires disclosing their HIV status to healthcare providers, family, or friends. We sought to understand how crises, including COVID-19 and the war with the Russian Federation, have changed OPWH disclosure behaviours over time. We surveyed OPWH in Kyiv, Ukraine, by phone at four-time points: May-June 2020 (Wave 1), January-February 2021 (Wave 2), January-February 2022 (Wave 3) and May-June 2022 (Wave 4). Participants' responses were compared longitudinally. The primary outcome was new HIV status disclosure, and the independent variables were living conditions (living alone, not living alone) and HIV care support. Other variables analysed were age, gender, comorbidities, social support, depressive and anxiety symptoms, time since diagnosis, and history of addiction. A mixed-effects multivariable logistic regression model was used to assess the relationship between HIV status disclosure and independent variables. Of the 123 participants recruited, 90 OPWH completed the survey across all four-time points, of which 46 (51.1%) were women, and the mean age was 54.3 (SD = 6.38) in Wave 1 and 58.8 (SD = 6.64) in Wave 4. Men were less likely to disclose their HIV status (adjusted odds ratio [aOR] = 0.29; 95% CI [0.09, 0.94], p = 0.04) as were OPWH living alone (aOR 0.29, 95% CI [0.10 - 0.85], p = 0.02). Other variables were not statistically significant (p > 0.05). Findings underscore the pressing need for interventions that prioritise comprehensive, inclusive, and tailored to address key barriers to HIV disclosure, such as gender norms and social isolation. Future HIV care and support programs should integrate targeted strategies to foster community support, mitigate stigma, and promote disclosure as a pathway to adherence, overall health outcomes, and well-being of OPWH, particularly those living alone or within marginalised subgroups.