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

Stigma tends to affect men and women differently. Decades of changes in
economic activity and gender relations have placed women in increasingly difficult
situations, making them vulnerable to HIV/AIDS. Traditionally, women managed
households and acted as primary caregivers; now they must contribute significantly to
their household incomes. Those who lack options to do so have turned in increasing
numbers to sex work—a practice that has facilitated the spread of the epidemic (Thaxton,
2005; Silberschmidt, 2004). At the same time, the traditional norm of virginity for
unmarried girls that exists in many societies paradoxically increases young women’s risk
of infection because it restricts their ability to ask for information about sex out of fear
that they will be thought to be sexually active. In addition, the social construction of
masculinity compromises men’s health by encouraging men to equate a range of risky
behaviours with manliness and to regard health-seeking behaviour as unmanly (Mwaluko
et al., 2003). For instance, images of masculine ideals encourage multiple sexual partners
and more sexual activity, and promote sexual practices that do not include the use of
condoms, or the use of condoms inconsistently (Kapiga and Lugalla, 2002).
2.4 Characteristics of HIV/AIDS Interventions in Tanzania
As the number of people living with HIV/AIDS was increasing in Tanzania,
national and international commitments were put in place to control the further spread of
the epidemic and to assist those who have already been infected. National commitments
included the establishment of the NACP in 1987 under the MOHSW, the Presidential
Declaration of HIV/AIDS as a disaster in 1999, and the establishment in 2000 TACAIDS
with a mandate to provide strategic leadership and coordination of multisectoral
responses, as well as monitoring and evaluation including, research, resource
mobilization, and advocacy (MOHSW, 2004; TACAIDS, 2005).
Besides forming these policy programmes, the government with support from
donors also increased the budget for supplies and other commodities (e.g. condoms) and
educational and advocacy materials; the logistics for their distribution was also put in
place. At present, educational and advocacy materials have been and continue to be
distributed throughout the country to educate people about AIDS. As a result, accurate
knowledge regarding HIV transmission and prevention has increased tremendously in
Tanzania during the last few years.
2.5 Availability of VCT and CTCs
The use of VCT services has been considered as a key component in the
prevention of HIV transmission in many countries. It is believed that knowledge of one’s
own HIV serostatus, combined with effective counselling, can facilitate individual
behaviour changes that reduce the risk of HIV infection and protect sexual partners as
well.
To encourage people to know their HIV serostatus, the government, in
collaboration with nonprofit organizations, has established many sites where individuals
can get tested for HIV. Tanzanians can now get tested in VCT centres, in routine testing
facilities, in PMTCT centres, and in other types of facilities with various types of
8