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

and that encouraging disclosure only serves to further stigmatize HIV-positive persons
(Galletly and Pinkerton, 2006).
3.4 Implications for the Study of Disclosure in Tanzania
A better understanding of factors that facilitate disclosure can be useful for
programmes that promote disclosure of HIV test results, yet very little is known about the
factors related to disclosure of test results or ways to enable individuals to discuss HIV
test results with others. Achieving a better understanding presents many methodological
challenges. Longitudinal studies are the most effective, provided they allow respondents
to relate to the circumstances surrounding their acts of disclosure, but they are time
consuming and expensive. One can, of course, ask individuals a few months after testing
if they disclosed to anyone, and to whom, and at what moment, but the usefulness of that
information is quite limited without a social context. A more effective approach for crosssectional
studies would be to conduct loosely structured, extended interviews with
respondents who are free to talk about their own social situation and the circumstances
that have facilitated or hindered the revelation of their HIV status to those around them.
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). There
are also more studies of disclosure among women as opposed to men. This study
therefore was conducted with a sample of individuals who have come to VCT centres and
to routine testing centres rather than with clients of PMTCT centres in order to obtain a
variety of clients: male and female, young and old, those who are well and those who are
ill to discover the pattern of disclosure (whether or not, to whom, how, after how long)
evident among individuals who have recently taken an HIV test, to identify the kinds of
social relations that increase the probability of disclosure, and to describe the role of
gender in the process of disclosure.
AMREF has been implementing the Angaza Project, a VCT programme, during
the last five years. Many VCT centres have been established in different parts of
Tanzania and statistics show that the number of people who use the Angaza services has
increased since the project began in 2001. Similarly, there are many other VCT services
that are being provided by CTCs that are run by the government as well as other NGOs.
However, as we have already argued, VCT can only become an effective intervention if
the VCT clients are encouraged to disclose their HIV test results. The question then is: To
what extent has the increase of VCT services been accompanied by an increase in the
number of people who are willing to disclose their test results to significant others?
Addressing this question was one of the purposes of this study.
Although HIV testing and disclosure of test results is seen to be critical to HIV
prevention, there are few studies on disclosure in Tanzania. Antelman and colleagues
(2001) conducted a study of disclosure among pregnant women in Dar es Salaam from
1995 to 2000 to discover when and to whom HIV serostatus was shown over time. They
found a clear and regular increase in the number of women who showed to their sexual
partner and to a female relative over a period of four years (Antelman et al., 2001). In a
study to investigate how counselling of couples can facilitate HIV disclosure, it was
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