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

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training was directed by Dr. P. Stanley Yoder of Macro International and assisted by Prof. Joe L.P. Lugalla from the Centre for Strategic Research and Development (CESTRE). Also participating in this training was Mr. Charles Mlwande Madihi from the Dar es Salaam Institute of Social Work (sociologist and demographer); Dr. Huruma L. Sigalla from the Department of Sociology at the University of Dar es Salaam; and Nipael E. Mrutu from CESTRE (medical anthropologist). The last three were also responsible for field supervision in both sites. The training focused on the principles and usefulness of qualitative research, the general approach of the study, and the important research questions being pursued. The trainees were exposed to different methods of interviewing, how to motivate respondents to talk, and the skills of running a good conversation that motivates the respondent to talk about issues that are of great importance to the study. They were trained how to introduce themselves to the respondent, how to establish a personal connection, and how to carefully listen throughout the conversation. During the training the topics and questions were revised in group discussions. The topics and questions were arranged to begin first with general issues such as demographic characteristics, family ties, hobbies, and social relationships, followed by more specific questions about knowledge and practices related to HIV/AIDS. Because the original interview guidelines were in English, translation of topics and questions into Swahili was done during the training so research assistants could participate in finalizing the instruments. All interviews were to be conducted in Swahili. The English version of the interview guidelines can be found in Appendix 1. 4.6 Methods of Data Collection The conversation guides developed were structured and open-ended so the interviews would follow normal styles of conversation more than a question-and-answer sequence. These conversation guides made it possible to listen to narratives and accounts about social relations, the taking of an HIV test, and thoughts about showing or concealing their test results. The guides were sufficiently flexible for the interviewers to encourage interviewees to discuss questions in any order that they desired. Although they all followed a similar form, three types of conversation guides were developed to direct discussions with three groups of respondents: • A conversation guideline for respondents who had just recently taken an HIV test (new cases). • A conversation guideline for people living with HIV/AIDS. • A conversation guideline for health workers, particularly counsellors working in VCT centres that were included in this study. 26
4.6.1 Conversation Guide for Respondents Who Had a Recent HIV Test This guideline was divided into two parts because two interviews were needed. The first interview took place at the VCT facility immediately after the respondent had taken an HIV test and had been given the results of the test. The first interview dealt with social and demographic information and work experience to understand the social context and social interactions, and with the process of how the respondent went for an HIV test and how that occurred, including counselling. In other words, it dealt with the circumstances that led the respondent to undertake an HIV test. The second interview took place after four to eight weeks and the venue was either the home of the respondent or a neutral place agreed upon by the respondent and the research assistant. This interview focused mostly on their overall impression of the VCT services, their views about pre and post-test counselling, their recent experiences in talking to others about their HIV test results, activities taken to conceal their test results, and how those people reacted when told about the respondent’s HIV status. 4.6.2 Conversation Guide for PLWHAs PLWHAs were included in the study because some of them had six months or much longer to have disclosed their test results to others. This conversation guide followed the guide used for recent testers for several sections: social and demographic information, getting tested the first time, and changes in their health status over time. Another section focused more in depth on the extended period of time living with HIV infection including the process of showing their situation to others over time, particularly to a sexual partner. For those who were on ARVs, we asked about their experience in taking medication and the effect that it had on their health. Finally, we invited them to talk about their participation in activities for PLWHAs, the process of becoming a member, the kind of activities they did, the advantage of being a member of PLWHA groups and activities in the community to prevent HIV transmission. 4.6.3 Conversation Guide for VCT Counsellors The conversation guide for counsellors encouraged them to talk about the reasons clients come for testing, the different kinds of clients they serve, the advice they give to those who test positive and those who test negative, and the referral they give to those who are HIV positive. Also of interest were their descriptions of pre- and post-test counselling and any discussion they might have related to showing test results to others. 4.6.4 Observation at Health Facilities Data collection also included some observations of interactions at health care facilities and households, a study of records and reports of client consultations at testing facilities, and participation in meetings among VCT clients and members of PLWHA organizations. These observations proved valuable in establishing the context of interactions related to HIV/AIDS. 27
Page 1: SOCIAL CONTEXT OF DISCLOSING HIV TE
Page 4 and 5: Cover photo: Iringa bus station (Jo
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: Twenty-five of the respondents (44
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
Page 67 and 68: There is no doubt that such a perso
Page 69 and 70: some respondents told us that those
Page 71 and 72: To understand the effects of ARVs o
Page 73 and 74: 7.1 Introduction 7. DISCLOSURE AND
Page 75 and 76: Respondent: People differ. Research
Page 77 and 78: Researcher: Do you have other reaso
Page 79 and 80: …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
Page 92 and 93: Patients now wait for equipment or
Page 95 and 96:
REFERENCES AMREF. 2008. Angaza HIV
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Klitzman, R.L., S.B. Kirshenbaum, B
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Skogmar, S., D. Shakely, M. Lans, J
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Questions: What kind of work do you
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Questions: What thoughts have you h
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