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

Disclosure to significant others can help increase support for HIV-positive persons. A
study of Latino gay men found that disclosure was related to greater quality of social
support, greater self-esteem, and lower levels of depression (Zea et al., 2005).
Disclosure also can lead to support that facilitates initiation of, and adherence to,
HIV treatment and medications (Stirrat et al., 2006; Klitzman et al., 2004). According to
some studies, disclosure generally becomes easier the longer someone has been living
with HIV, as she/he becomes more comfortable with an HIV-positive status. Disclosure
to sexual partners is more likely in longer-term, romantic relationships than in casual
relationships like-one-night stands, anonymous partners, group scenes, etc. (Duru et al.,
2006). Disclosure also varies depending on perceived HIV status of partners, level of
HIV risk of sex activities, sense of responsibility to protect partners (personal or shared
responsibility), and alcohol or drug use (ibid).
The relationship between disclosure, sexual risk behaviours, and potential
transmission of HIV varies widely. Different studies have ended up with different results.
Parsons and his team argue that increased disclosure is indeed associated with a reduction
in sexual risk behaviour (Parsons et al., 2003), but Crepaz and Marks (2003) have shown
that disclosure does not always alter risk-taking behaviours. According to them, even
with disclosure, unsafe sex sometimes occurs. Some people engage in safer sex
behaviours even without discussion of HIV status (Klitzman et al., 2007). Some studies
have also shown that disclosure tends to provide some psychological benefits. A study
carried out by Parsons and colleagues (2004) observed that HIV-positive injection drug
users who disclosed their status experienced increased intimacy with partners and
reaffirmation of their sense of self. It is believed that many people who are HIV positive
who disclose their status find that it reduces anxiety about transmission, so sex can be
much more comfortable and relaxed.
Other studies have focused on particular persons disclosed to: sexual partners,
family, and friends. For studies that look at the social context of disclosure, the family
context is seen as an important factor because surveillance, treatment, and care are seen
to be family oriented issues, and hence HIV is seen as a family infection (DeMatteo et al.,
2002). Disclosure has been characterized not as a yes or no event, but rather a process of
steps, with concealment, limited retractions for fear of rejection, and admission.
Varga and colleagues (2005) report on several patterns of disclosure to a sexual
partner in their summary of disclosure studies among mothers. Some reports have found
that sexual partners are the most likely target for showing serostatus. For reasons easy to
understand, disclosure rates appear higher among HIV-negative than HIV-positive
individuals. Rates of disclosure to sexual partners vary from 20 percent to about 80
percent, which may indicate wide variation in the samples and methods of measurement.
Disclosure may be influenced by disease progression when it involves family members,
but it may not when it involves sexual partners (Serovich, 2001).
A recent study by Linda Niccolai and colleagues (2006) has suggested a strategy
that uses a survey questionnaire to measure disclosure to one’s sexual partners. Survey
respondents were asked if they disclosed their HIV status to their sexual partner and if
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