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

7.5.1 Disclosure among Married Respondents
In African countries confronted with an HIV/AIDS pandemic, cases of sexual
transmission of HIV often occur within stable relationships. Therefore, prevention within
the couple is of primary importance (Brou et al., 2007). For HIV prevention to occur
within stable relationships, it must begin with the testing of both partners, followed by
disclosure of test results to one another.
Some married individuals disclosed their HIV test results to their spouses, and
some did not. The majority of married men (55 percent) showed the results to their wives,
and a minority of women disclosed their results to their husbands (34 percent). Women
were much less likely to show the test results to their spouses than were men. Also,
women tended to have someone else with whom they shared information about their
testing and results. For instance, most women had someone to accompany them when
they went to take an HIV test, usually a close female relative such as a sister and/or
mother.
Although most of the respondents disclosed to their blood relatives, one widow
from Iringa, age 31 years, disclosed first to her brother-in-law. This was unusual, but they
were on very good terms, and he had been very supportive of her. However, in reality, it
is rare for married women to disclose first to a relative of their husband. Disclosure to a
relative of a spouse risks accusations of infidelity and immoral behaviour.
The above scenario suggests that to understand disclosure well in terms of how it
takes place, we must not ignore the cultural and social context within which people live
and disclosure takes place. We must assess the extent to which the social environment
determines or shapes people’s lives and by so doing influences the process of disclosure.
It is important to recall that those who disclose or do not disclose live not in a vacuum but
rather in a social context. Unfortunately, the behavioural and biomedical models tend to
neglect this reality. The models pay little attention to social context and structural issues,
and as a result, important issues that influence people’s lives, such as gender dynamics
and power relationships between men and women are either forgotten or considered as
not important.
Because of gender inequality in Tanzania, disclosure of HIV test results by a
woman to a husband can potentially harm or destroy a relationship. Women have to think
hard before disclosing their HIV-positive status to their husbands. Some are beaten or
accused of infidelity or of bringing death into the family. Some are simply divorced and
sent away. When asked about the reaction of her husband after showing the results to
him, a 30-year-old woman from Dar es Salaam confirmed such a situation in the
following way:
My husband was furious and blamed me of infidelity and he planned to
call a meeting of relatives to tell them that I had brought a disease in the
family.
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