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

Many clients come to us with many reasons of wanting to know their HIV
serostatus. Some come because they are very sick and their bodies are
showing openly symptoms of full blown AIDS patients. Others come
because they have lost an intimate romantic partner from a mysterious
disease. Others are here because they are planning for marriage or are
entering into new sexual relationships. Since the needs/reasons for our
clients vary, we always use different counselling approaches.
One counsellor asserted that the counselling process was usually a major
challenge. Most of the counsellors said that pretest counselling was less cumbersome
than posttest counselling. The latter was particularly problematic in a situation where the
results were positive. One counsellor from Dar es Salaam had this to say:
Since most of the people come to the VCT facility of their own will, pretest
counselling that aims at informing them of the advantages of testing
and the implication of the test results is actually an easy process. What is
usually a difficult task is when the results are out and they are positive.
Most clients become shocked, some cry and you can sense fear, and
sometimes denial in their minds. We are required to deal with their
psychosocial emotions and to help them live positively with the results. We
are supposed to convince them that being HIV positive does not
necessarily mean death. And this is not easy because most of the people
equate HIV and AIDS with death. Another daunting task is convincing
those who test positive to disclose the test results to significant others.
While few agree, and some deny, others simply remain silent and promise
us that they will think about it. We can understand that, due to the fear of
stigma, people who test positive find it difficult to disclose their positive
results; those who opt to disclose do so only to a few people whom they
trust.
In our informal discussions with individuals knowledgeable about VCT, we
discovered that some individuals who discover they are HIV positive contact a religious
leader for advice or comfort. Therefore, we interviewed five religious leaders in Dar es
Salaam and in Iringa to understand why some people sought their services and what kinds
of advice or counsel these leaders provided.
The religious leaders we spoke with confirmed that people do come to them to
disclose their HIV-positive status and most are individuals who are in poor health.
According to the religious leaders, some of them have repented from their “sins” and
have become strong believers of religious teachings. The religious leaders provide
spiritual counselling that helps the clients to understand that God has not rejected them
and is with them, and will be with them even in case of death. While post-test counselling
from VCT helps the clients to accept the results and live with them, spiritual counselling
helps them to believe that, even when they die, they have nothing to fear. The kind of
counselling that the clients get from their pastors, priests, or Imams helps them to accept
their destiny. A Lutheran pastor in Iringa had this to say:
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