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

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Cover photo: Iringa bus station (Joe L.P. Lugalla) This report presents the findings from a qualitative research study conducted by the Centre for Strategic Research and Development in Dar es Salaam, with technical assistance from Macro International Inc. This publication was made possible through support provided by the United States Agency for International Development (USAID) under the terms of Award No. GPO-C-00-03-00002-00 and the President’s Emergency Plan for AIDS Relief (PEPFAR). The opinions expressed in this report are those of the authors and do not necessarily reflect the views of the Government of Tanzania or USAID. Additional information about the Centre for Strategic Research and Development is available at: 2 nd Floor, Nakiete House, Ali Hassan Mwinyi Road, Mwenge Area P.O. Box 33335, Dar es Salaam, Tanzania Tel: +255 222 772 816, Fax: +255 222 772 814 Internet: www.cestre.org Suggested citation: Lugalla, Joe L.P., Charles Mlwande Madihi, Huruma L. Sigalla, Nipael E. Mrutu, and P. Stanley Yoder. 2008. Social Context of Disclosing HIV Test Results: HIV Testing in Tanzania. Dar es Salaam, Tanzania: Centre for Strategic Research and Development and Calverton, Maryland, USA: Macro International Inc.
CONTENTS Contents ............................................................................................................................. iii List of Tables and Figures................................................................................................... v Acknowledgements ........................................................................................................... vii Acronyms ........................................................................................................................... ix Executive Summary ........................................................................................................... xi 1. Introduction and Setting of the Study ........................................................................... 1 1.1 Introduction .......................................................................................................... 1 1.2 Statement of the Problem ..................................................................................... 2 1.3 Major Research Questions ................................................................................... 2 1.4 Study Objectives .................................................................................................. 3 1.5 Significance of the Study ..................................................................................... 4 2. The Social Context of HIV/AIDS in Tanzania ............................................................. 5 2.1 Introduction .......................................................................................................... 5 2.2 The Prevalence of HIV/AIDS in Tanzania .......................................................... 5 2.3 Social and Cultural Construction of HIV/AIDS in Tanzania ............................... 7 2.4 Characteristics of HIV/AIDS Interventions in Tanzania ..................................... 8 2.5 Availability of VCT and CTCs ............................................................................ 8 2.6 HIV/AIDS Testing and Counselling in Tanzania ................................................ 9 2.7 VCT: Problems and Challenges ........................................................................... 9 3. Studies of Disclosure: A Brief Review of Literature .................................................. 11 3.1 An Overview of Studies of Disclosure ............................................................... 11 3.2 Disclosure as a Social Process ........................................................................... 12 3.3 Disclosure and Social Relationships .................................................................. 13 3.4 Implications for the Study of Disclosure in Tanzania ........................................ 16 4. Study Design and Methods of Data Collection ........................................................... 19 4.1 Study Design and Methodology ......................................................................... 19 4.2 The Nature and Type of Study Sites .................................................................. 20 4.3 Demographic Characteristics of VCT Respondents (Dar es Salaam and Iringa Sites) ........................................................................................................ 24 4.4 Sampling of the Study Population (Inclusion and Exclusion Criteria) .............. 25 4.5 Development of Instruments and the Training of the Research Assistants ........ 25 4.6 Methods of Data Collection ............................................................................... 26 4.7 Organization of the Fieldwork ........................................................................... 28 4.8 Data Processing and Analysis ............................................................................ 28 4.9 Informed Consent and Ethical Clearance ........................................................... 29 5. HIV Testing as a Social Process ................................................................................. 31 5.1 Introduction ........................................................................................................ 31 5.2 Conditions under Which People Seek an HIV Test ........................................... 32 5.3 Social Relations and HIV Testing ...................................................................... 40 iii
Page 1: SOCIAL CONTEXT OF DISCLOSING HIV TE
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 20 and 21: 1.2 Statement of the Problem It is
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
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There is no doubt that such a perso
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some respondents told us that those
Page 71 and 72:
To understand the effects of ARVs o
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7.1 Introduction 7. DISCLOSURE AND
Page 75 and 76:
Respondent: People differ. Research
Page 77 and 78:
Researcher: Do you have other reaso
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…eeh since I became sick, I had t
Page 81 and 82:
Female respondents were often afrai
Page 83 and 84:
lose the job as well as be chased a
Page 85 and 86:
7.6 Disclosure and HIV Prevention R
Page 87:
however, that disclosure is limited
Page 90 and 91:
8.2 Respondents’ Views of Counsel
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Patients now wait for equipment or
Page 95 and 96:
REFERENCES AMREF. 2008. Angaza HIV
Page 97 and 98:
Klitzman, R.L., S.B. Kirshenbaum, B
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Skogmar, S., D. Shakely, M. Lans, J
Page 102 and 103:
Questions: What kind of work do you
Page 104 and 105:
Questions: What thoughts have you h
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