social context of disclosing hiv test results: hiv testing in tanzania

More documents

Recommendations

Info

Methods This study relied primarily on open-ended conversations with individuals who had been tested for HIV. Individuals were recruited in the regions of Dar es Salaam and Iringa by contacting VCT centres and associations for people living with HIV/AIDS (PLWHA). Individuals from VCT centres were interviewed twice: once at the centre after they received their test results and again some weeks later in their homes. A second interview was necessary to give them time to disclose their test results. Five HIV testing services were contacted in Dar es Salaam and three in Iringa. Members of PLWHA associations were interviewed only once. Because the study focused on the disclosure of HIV-positive test results, the research team interviewed only those who had tested positive for HIV. Interviews were tape recorded with the permission of respondents. The final sample included 30 individuals from Dar es Salaam and 27 individuals from Iringa who had been tested at VCT centres and were interviewed twice, and 57 respondents (30 men and 27 women) from PLWHA associations, who were interviewed once. In addition, the research teams interviewed VCT counsellors, other health care providers such as medical doctors, religious leaders, and some community leaders to discuss their views about how people are tested for HIV and disclose test results. The recorded conversations were transcribed by the survey teams in Swahili, and then translated into English and typed in Microsoft Word. The research team read the transcriptions in either English or Swahili with certain themes in mind and wrote out a one- to two-page summary to facilitate analysis and compare responses. Ethical clearance for the study was provided by the National Institute of Medical Research in Tanzania and the Institutional Review Board at Macro International in Calverton, Maryland. Getting Tested The large majority of persons interviewed had been chronically ill when they were tested for HIV the first time (60 percent of those recently tested, and 68 percent of those living with HIV for some time). The symptoms of illness mentioned most often were fever, chest pain, coughing, and abdominal pain. Most of the remaining individuals came for testing because their spouse or sexual partner had died of symptoms similar to AIDS, or was chronically sick. Thus, more than 90 percent of those interviewed were tested because they or their sexual partner were ill or had been ill with symptoms that suggested a possible HIV infection. Although a small number of respondents got tested without telling anyone, the majority had discussed testing with someone before visiting a testing centre. One-fourth of married people discussed with their spouse the idea of getting tested: one-third of men and one-fifth of women. Most respondents told us that they had discussed their health situation with friend s and relatives; some of those individuals urged them to get tested for HIV. The nexus of social relations of family and friends played a direct role in the decision to get tested for many of these persons. xii
HIV Counselling The respondents were asked about their experiences in pre- and posttest counselling when they were tested for HIV. Married couples or male/female sexual partners who came for testing were given the choice of being counselled separately or together, and of receiving test results together or separately. All eight testing facilities used rapid tests, so all testing and counselling could be conducted in one visit. The pretest counselling encouraged people to get tested, discussed basic information about HIV and AIDS, explained how HIV is transmitted, obtained consent, and explained again that the test result would be positive or negative. The posttest counselling discussed ways a person with HIV can live a normal life, and provided a referral to see a doctor. About half of the interviews did not record the reaction of respondents to being told they were HIV positive because respondents made no comments about the topic, and about half said they were shocked or frightened and disturbed. Counsellors spent time explaining how to live with the virus: where to go for help or support, whom to see for medical care, and ways to maintain good health. Some respondents were also urged to tell someone else about their test results. A few respondents suggested ways the VCT services could be improved. Social Context of Disclosure This research focused on the patterns of voluntary and direct disclosure as it occurred over time. The study examined whether or not the HIV test result was shown to someone, to whom, how it was done, how long after the HIV test it was shown, and the response of the person or persons to whom the test result was shown. The study also collected information about the type of individuals to whom the respondents did not wish to disclose their test results. For those few respondents who did not show their test results at all, the study tried to understand the consequences of disclosure that individuals feared or expected. The findings indicate that respondents disclosed their HIV status selectively depending on the type of relationship in which the individual was involved. For example, mutual obligation seemed to be an underlying factor in disclosing to a family member and/or partner. Although some respondents discussed taking an HIV test with a close relative, and others made those decisions without consulting anyone, when it came time to disclosure, social relations played a very important role in determining who was told about the test results. The process of disclosing one’s results varied. Some respondents disclosed the same day they learned of their results, but others waited for a period of time. The majority of respondents disclosed their results to close relatives such as parents, spouses, siblings, aunts, and uncles. Some respondents did not want to disclose to people outside of their closest circle such as neighbours, friends, and some relatives because respondents did not trust they would keep their HIV status private. Respondents were afraid that if the news of their HIV status became widespread, they would face discrimination. xiii
Page 1: SOCIAL CONTEXT OF DISCLOSING HIV TE
Page 4 and 5: Cover photo: Iringa bus station (Jo
Page 6 and 7: 5.4 Benefits of VCT ...............
Page 9: ACKNOWLEDGEMENTS Many institutions
Page 13: Study Objectives EXECUTIVE SUMMARY
Page 17: discrimination than are women. In a
Page 20 and 21: 1.2 Statement of the Problem It is
Page 22 and 23: 1.5 Significance of the Study The s
Page 24 and 25: Major Lakes HIV prevalance (THIS 20
Page 26 and 27: Stigma tends to affect men and wome
Page 28 and 29: The other challenge that VCT facili
Page 30 and 31: to their sexual partner or did not
Page 32 and 33: Disclosure to significant others ca
Page 34 and 35: and that encouraging disclosure onl
Page 37 and 38: 4. STUDY DESIGN AND METHODS OF DATA
Page 39 and 40: testing to side-step the stigma ass
Page 41 and 42: (b) Alamano Health Centre Alamano H
Page 43 and 44: Twenty-five of the respondents (44
Page 45 and 46: 4.6.1 Conversation Guide for Respon
Page 47: showing such information in confide
Page 50 and 51: 5.2 Conditions under Which People S
Page 52 and 53: Researcher: Where did you take your
Page 54 and 55: 5.2.2 Respondents’ Other Reasons
Page 56 and 57: She, however, went to get tested as
Page 58 and 59: 5.3 Social Relations and HIV Testin
Page 61 and 62: 6.1 Introduction 6. COUNSELLING AND
Page 63 and 64: Many clients come to us with many r
Page 65 and 66:
usually insisted on getting the tes
Page 67 and 68:
There is no doubt that such a perso
Page 69 and 70:
some respondents told us that those
Page 71 and 72:
To understand the effects of ARVs o
Page 73 and 74:
7.1 Introduction 7. DISCLOSURE AND
Page 75 and 76:
Respondent: People differ. Research
Page 77 and 78:
Researcher: Do you have other reaso
Page 79 and 80:
…eeh since I became sick, I had t
Page 81 and 82:
Female respondents were often afrai
Page 83 and 84:
lose the job as well as be chased a
Page 85 and 86:
7.6 Disclosure and HIV Prevention R
Page 87:
however, that disclosure is limited
Page 90 and 91:
8.2 Respondents’ Views of Counsel
Page 92 and 93:
Patients now wait for equipment or
Page 95 and 96:
REFERENCES AMREF. 2008. Angaza HIV
Page 97 and 98:
Klitzman, R.L., S.B. Kirshenbaum, B
Page 99:
Skogmar, S., D. Shakely, M. Lans, J
Page 102 and 103:
Questions: What kind of work do you
Page 104 and 105:
Questions: What thoughts have you h
show all

social context of disclosing hiv test results: hiv testing in tanzania

Create successful ePaper yourself

Delete template?

Save as template?