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

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1.2 Statement of the Problem It is evident that disclosure of HIV test results is important to garnering social support and to accessing care and medical treatment. Disclosure of test results can be an effective action because it can facilitate the prevention of HIV transmission to sexual partners. In this light, it is important to encourage intervention programmes that promote VCT and disclosure of test results. These programmes can be effectively promoted only if people know the factors that compel people to seek an HIV test, as well as the circumstances under which people show their test results to others. Although there are many people in Tanzania who voluntarily take an HIV test and who may also show the results of their test to others, no systematic studies have been carried out to thoroughly understand the dynamics that characterize the nature of VCT combined with disclosure. At present there are many unknowns: Why do people decide to take an HIV test? Under what circumstances do they get tested? How do they decide to disclose or not to disclose the test results to others? To whom do they disclose? How do those who receive the information react? And finally, what is the impact of disclosure on the infected person? We also do not know what patterns of disclosure exist and how social relations determine these patterns. Understanding these issues is critically important to promoting intervention programmes that aim not only to encourage people to take an HIV test but also to disclose the results of the test to others. Generating this kind of information and understanding was the prime objective of this study. 1.3 Major Research Questions The main research questions that guided this study were the following: What are the factors that compel people to take an HIV test? What are the factors that affect the disclosure of HIV test results to others? Are those factors primarily individual characteristics that push an individual toward disclosure or not? To what extent are those factors aspects of the social relations maintained by individuals? The study focused not only on whether or not the HIV test result was shown to someone, but also to whom, how it was done, how long a time after the HIV test, and the response of the person or persons to the news of the test results. The study collected information about the type of individuals to whom respondents did not wish to disclose their test results. The study also wanted to find out the type of people who would take care of the respondent when he/she became sick. For those who did not show their test results, it is most important to understand the consequences of disclosure that individuals thought or feared, to understand why such people opted to remain silent. 2
In brief, the following were the research questions: • How did respondents learn their HIV status? • What form of the social relations did individuals maintain? • What family and friends do persons interact with most often? And how did these relations determine patterns of disclosure of HIV test results? • How did people decide to show their HIV test results to others? • What was the response of others who learned of a person’s test results? • What circumstances keep a person from showing HIV test results? These research questions and associated assumptions were examined and revised through discussions with stakeholders during the preparation for training field workers, and then again during the training for field workers. Because we knew that the individual assumptions of field workers collecting data through guided conversations would affect how they actually guided the conversations, the training gave the field workers the same understandings of the research strategy and of our expectations from respondents. Regarding disclosure, we assumed that individuals who were HIV negative were more likely to discuss their test results with others than those who were found to be HIV positive. Similarly, we also assumed that married people were more likely to disclose test results to their sexual partners than unmarried persons. 1.4 Study Objectives The overall objective of this study was to understand peoples’ experiences in showing their own HIV test results to others or not, to discover the pattern of disclosure (whether or not, to whom, how it was done, after how long) among individuals tested, and to discover the role of social relations in facilitating disclosure to others. Very little is known about factors related to disclosure of test results or the ways to encourage individuals to discuss HIV test results with others. A better understanding of factors that facilitate disclosure can be useful to programmes that promote disclosure of HIV test results. 3
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 and 14: Study Objectives EXECUTIVE SUMMARY
Page 15 and 16: HIV Counselling The respondents wer
Page 17: discrimination than are women. In a
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
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To understand the effects of ARVs o
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7.1 Introduction 7. DISCLOSURE AND
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Respondent: People differ. Research
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Researcher: Do you have other reaso
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…eeh since I became sick, I had t
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Female respondents were often afrai
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lose the job as well as be chased a
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7.6 Disclosure and HIV Prevention R
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however, that disclosure is limited
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8.2 Respondents’ Views of Counsel
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Patients now wait for equipment or
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REFERENCES AMREF. 2008. Angaza HIV
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Klitzman, R.L., S.B. Kirshenbaum, B
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Skogmar, S., D. Shakely, M. Lans, J
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Questions: What kind of work do you
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Questions: What thoughts have you h
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social context of disclosing hiv test results: hiv testing in tanzania

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