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

to their sexual partner or did not (Antelman et al., 2001). A few have focused on the
reaction of spouses or sexual partners to disclosure (Maman et al., 2003). In east and
southern Africa, one finds more studies of disclosure among pregnant women in antenatal
clinics than studies of the general public (Kilewo et al., 2001; Nsabagasani and Yoder,
2006).
Disclosure studies have found that pregnant women tested in a PMTCT centre are
much less likely to disclose their serostatus to their sexual partners than are women who
use a VCT facility. As Suzanne Maman and colleagues explain, discussing findings from
their study in Dar es Salaam, women who use VCT facilities have thought about getting
tested for quite some time, they often discussed going for a test with their partner, and
they perceived themselves as at high risk for HIV infection (Maman et al., 2003;
Nsabagasani and Yoder, 2006). Pregnant women who are offered an HIV test in PMTCT
centres, on the other hand, may not feel at risk for HIV, they may not have thought much
about getting tested, and they are not likely to have discussed their acceptance of a test
with their partner. Thus, the prospect of telling a partner that they have been tested, no
matter what the outcome, is a very different matter.
3.2 Disclosure as a Social Process
The process of disclosure has been found to be quite complex to describe,
measure, and evaluate. Disclosure may be voluntary or involuntary, direct or indirect, full
or not at all. Most studies of disclosure have examined disclosure that is voluntary and
direct, that is, situations in which an individual voluntarily tells someone else directly of
his or her serostatus (Nsabagasani and Yoder, 2006). Disclosing HIV test results is a
complex, very difficult personal matter that entails communication about a potentially life
threatening, stigmatized, and transmissible infection. The decisions about disclosure vary
across different people, cultures, age groups, types of social relationships, situations, and
contexts. These decisions sometimes change with time and one’s experiences with
HIV/AIDS, and in some cases they also depend on the state of health of the individual.
Disclosure of HIV-positive status may be inhibited if individuals live in
neighbourhoods and/or ethnic communities that stigmatize someone with HIV (Castro et
al., 1998; Mason et al., 1995) or if cultural rules discourage the disclosure of distressful
facts and feelings (Argyle et al., 1986). Communities have “rules and scripts for
appropriate conduct” (Cupach and Metts, 1994) that influence HIV
disclosure/nondisclosure (Derlega et al., 2004).
Viewed in this light, disclosure is a social process that occurs over time with
certain people and not others. As Cusick and Rhodes (1999) have pointed out,
“Disclosure is therefore best envisioned as a social process which is ‘situated’ within
particular social relationships and contexts” (Nsabagasani and Yoder, 2006). Individuals
who have just been tested consider to whom they may want to show their status as well as
people they do not want to tell about the results. The process thus may involve
revelations to some people along with active concealment from others, including people
known to gossip a lot, people who will blame the individual, or those who may react
violently (Nsabagasani and Yoder, 2006). Therefore, to properly understand disclosure,
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