The spate of non-disclosure among individuals diagnosed with Human-Immunodeficiency-Virus and Acquired-Immune-Deficiency-Syndrome (HIV/AIDS) has continually been a pri-mary global concern, especially in developing countries. The low disclosure prevalence has been widely linked to most persistent problems thwarting the effort of authorities saddled with responsibilities of curbing the menace of HIV/AIDS. The unabated issues have been a global health concern with lots of committed efforts in terms of research and intervention [1]. The west and central sub-Africa alone having over 7 million populates diagnosed with HIV/AIDS accounted for over 4.94% of the global AIDS/HIV death rate [1]. In Nigeria, 1.5% prevalence of HIV infection was reported [2], invariably suggesting that approximately 1.9 million of the populace is infected with HIV/AIDS [3]. Cases of HIV/AIDS in Nigeria are prominent, such that the awareness level in Nigeria was reported as high as 93.8%, yet the non-disclosure intention rate remains so low in Nigeria. For instance, the study of Salami et al. [4] and Olley, et al. [5] reported disclosure prevalence of 12.5% and 39.5% respectively. However, the World Health Organization [6] recommended the prevalence rate of 79% as a benchmark for a developing country like Nigeria.

There are established benefits associated with self-disclosure of HIV positive status [6, 7]. Disclosures have been spotted to play significant critical duties in determining the coping mechanism of an individual diagnosed with HIV or AIDs. In other words, disclosure exerts significant impacts on victims' general and mental health, such as stress reduction, enhanced social support, readily decrease in the probabilities of transmitting HIV to self-network and others [8]. Disclosure rises access to material and social support which consequently improves both the physical and psychological health of PLWHA [9].

HIV/AIDS non-disclosure behavior is not limited to Nigeria but other African countries, e.g., Kenya. HIV disclosure rate has been reported at a low level in Kenya. For instance, it was reported in the annual spreadsheet of Kenya AIDS Indicator Survey [10] that not much than fewer individuals (35%) are knowledgeable about the HIV positive status of their spouses, while 78% people reported being not knowledgeable about their sexual partner HIV status [11]. Sarna et al. [12] reported a 63% non-disclosure rate among the Mombasa population.

In another research study, the study area was Ondo State. The state has persistently been representing southwest states being the only state in the region among the top ten states with the highest HIV prevalence in Nigeria at 4.3% [13]. There is a paucity of studies that had reported the prevalence of disclosure rate in the region. The study conducted by Olley et al. [5] revealed 22% disclosure rate among PLHIV, which invariably indicated 78% non-disclosure rate. Haven identified the disclosure prevalence of HIV/AIDS in Africa, Nigeria, and Ondo state in particular; it is worrisome to know that the rate of incidence of disclosure among people living with HIV/AIDS was far below the expected or international standards (79% disclosure rate stipulated by WHO for developing countries).

Furthermore, common cognitive barriers to self-disclosure may be the fear of getting a negative or an unpleasant reaction from their partner, fear of abandonment, broken marriages or relationships, emotional and physical emotional abuses, discrimination and stigmatization, and loss of economic support [14]. Disclosure behaviour or intention has been implicated to have a strong link with the severity of illness as determined by the CD4 counts of the participants.

The CD4 count is a reflection of the quality of the human immune system and it is otherwise referred to as CD4 T-cell. CD4 T-cells contained in the white blood cells in the human body fight bacteria and viruses potentially attacking the human’s immune system. The more the CD4 counts in the body, the better or stronger the carrier’s system. In the study, it was used as the determinant of severity of illness because CD4 counts are the cells that the HIV virus kills, such that as the HIV infection progresses, the number of these cells declines. The normal range for CD4 cells in the body is about 500-1,500, and in the situation of a drop below 200 counts, the person is diagnosed with AIDS [15].

The study of Antelman et al. [16] purported to examine the predictors of HIV status disclosure in a prospective study among HIV infected pregnant women in Dar es Salaam. It was revealed that the length of diagnosis knowledge has a strong influence on disclosure. Disclosure to a partner was reported to increase tremendously by 80% after four years. Studies among heterosexual men and women, young people, and attendees of an outpatient HIV clinic found that disclosure had a positive association with the length of time since diagnosis [17] and with disease progression [18].

Stacey et al. [19] examined the socio-demographic correlates of disclosure among children living with HIV. It was revealed that the duration of illness (HIV), diagnosis or duration of medication are strongly associated with disclosure. In other words, the longer the duration of HIV diagnosis knowledge, the higher the tendency of disclosing HIV positive status. Other identified correlates are HIV medications, deceased biological father among others. In addition, Stacey et al. [19] further revealed that CD4-T lymphocyte count and socioeconomic status are not associated with disclosure among people living with HIV.

Based on the background and literature gap, there has not been an agreement regarding the conclusion of the influence of the duration of diagnosis and CD4 counts in determining HIV/AIDS self-disclosure behaviour or intention. The inconsistency in the conclusions of the previous studies validates the necessity for the current study to hold ground on the impact of years of diagnostic knowledge on disclosure intention among PLHIV.

However, there is a paucity of studies that have attempted to explore the concept of disclosure from the internalizing perspective (self-intention); instead, overwhelming studies have explored disclosure from the behavioural perspective (majorly, involuntary disclosure), which has been proven to be significantly ineffective in tackling the menace associated with non-disclosure among PLWHA [20].

The general purpose of the study is therefore to investigate the implication of duration of diagnosis knowledge and CD4 counts in the prediction of HIV disclosure intention among people seeking HIV treatment. The following are the specific research objectives of the study, which are to;

• Examine that being a respondent with early years (1-5years) of diagnosis knowledge will significantly decrease the tendency of self-disclosing HIV positive status when compared to counterparts in other categories (5years and above) in a 6 months follow-up.
• Explore that being a respondent with lower (>100) CD4 T-cell will significantly decrease the tendency of self-disclosing HIV positive status than counterparts with higher (>200) CD4 T-cell in a 6 months follow-up.

This section presents the results and interpretation of data collected on the implication of duration of diagnosis knowledge and CD4 counts on disclosure intentions among three hundred and ninety (390) treatment-seeking people living with HIV/AIDS. The collected data was analyzed using the SPSS package (version 20). The analyses of binomial logistic regression are presented below.

The study found that respondents in the category of early years (1-5years) of diagnosis knowledge reported a decreased tendency of self-disclosure of HIV positive status when compared to respondents with older (5 years and above) years of diagnosis knowledge in a 3 months follow-up. Further analysis revealed that after 6 months, chances of disclosing HIV positive increased by 13% (-0.49 – 0.36) in the space of three months. This result is in agreement with the study of Antelman et al. [16], O'Brien et al. [18], and Niccolai et al. [17], that concluded a significant positive relationship between the length of time since diagnosis and disclosure, indicating that the longer the time of HIV diagnosis, the higher the rate of disclosing HIV positive status among people living with HIV. The study of Antelman et al. [16], O'Brien et al. [18], and Niccolai et al. [17] found that disclosure had a positive association with the length of time since diagnosis or disease progression.

The study further found that respondents with lower viral load (>100 CD4 T-cell) reported decreased likelihood of self-disclosing HIV positive status when compared to respondents with higher viral load (>200 CD4 T-cell) in a 3 months follow-up. However, further analysis revealed that after a 6 months follow-up, the likelihood of disclosing HIV positive increased by 13% (-0.49 – 0.36) in the space of three months. This result is in agreement with numerous studies that examined the implication of the duration of diagnosis on disclosure among PLHIV. For instance, the study of Kankou, Bouchaud, and Lele [22] reported that the HIV viral load is significantly associated with disclosure among PLWHA in France. On the contrary, the earlier findings of Stacey et al. [19] reported that CD4-T lymphocyte count and socioeconomic status were not associated with disclosure among people living with HIV. The findings may be due to the variation in the possibilities that some relatives and loved ones of the asymptomatic people living with HIV/AIDs may be sensitive enough to notice a slight change in physical and emotional signs, which may elicit mounting pressure till intention to disclose is achieved.

The results of the study should be interpreted with caution due to a handful of limitations. The findings of the study are limited to HIV/AIDS patients who are asymptomatic and with not less than 100 CD4 counts during the data collection in a basic treatment center in Nigeria. Further, data collection is limited to just the southwestern part of the six geopolitical zones in Nigeria; therefore, findings cannot be generalized. Most of the variables considered in the study were assessed through respondents’ self reported means, which may be prone to introspective biases or socially desired responses. In addition, the error called classifier bias is reported in the study due to sampling bias. The focus in the study was on people diagnosed with HIV and therefore data classification prevailed the duration of diagnoses [23]. This is considered a rare event for the longer the years of diagnosis, the higher the chances of being diagnosed with AIDs (exclusion criterion for the study).

Furthermore, the sample size of the population at the end of the study was considered relatively small and may have introduced an outcome bias [24]. Moreso, numerous concepts/variables that may influence the respondents' disclosure intention or actual intention were not integrated or a part of this study’s scope and should be included in future researches. In other words, the phi coefficient value revealed the contributory role of the study’s independent variables over the dependent variable in the binomial logistic regression, which however depicts that some other variables (not accounted for in the current study) may have influence disclosure intention.

The study in a 6-month follow-up found that among people living with HIV (PLHIV), respondents with an earlier duration of diagnosis knowledge usually between day 1 to 5 years are less likely to disclose their HIV positive status than respondents with the older duration of diagnosis knowledge, usually 5 years and above. In other words, the higher the time of diagnosis, the higher the likelihood of disclosing HIV positive status. However, the more the CD4 counts of the respondents over the period of 6 months, the higher the intention of disclosing HIV positive status to helpful disclosure targets.