Experiences of Disclosure, Resilience and Viral Suppression among People Living with HIV in Ghana.

Support for people living with HIV (PLHIV) as they disclose their HIV status can impact continuity of HIV treatment and adherence to antiretrovirals. In the presence of multi-level adversities, resilience among PLHIV can promote health-seeking behaviors and better health outcomes. However, few studies have examined how disclosure experience and resilience work together to impact HIV treatment outcomes among PLHIV. In this study, we assessed the relationships between HIV disclosure experience, resilience and viral suppression among PLHIV in Ghana. The Stigma Index 2.0 questionnaire was completed by 1827 PLHIV in Ghana in 2021 to assess demographics, experiences of HIV related stigma, resilience-factors, and other self-reported outcomes including viral suppression. Participants were also asked to classify their disclosure experience with friends and family as positive or negative. Multivariable log-binomial models estimated adjusted prevalence ratios (PR) and 95% confidence intervals (CI) for the association between disclosure experience and viral suppression. A dichotomized measure of resilience was evaluated as a potential effect measure modifier, and subgroup analyses explored associations by key population. Overall, those with a positive disclosure experience were more likely to have achieved viral suppression than participants with a negative disclosure experience (PR 1.09, 95%CI:1.00-1.19). This association increased among participants with lower resilience scores (PR 1.33, 95%CI:1.11-1.60). Findings suggest the importance of early positive social interactions for sustained engagement in ART, particularly for marginalized populations who face psychosocial and structural stigmas that challenge resilience. Ultimately, optimizing HIV treatment necessitates interventions that mitigate community stigma and promote resilience-building strategies for PLHIV in Ghana.