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

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ARVs has brought hope for patients and families. Our conversations left the impression that people now discuss HIV/AIDS and the availability of ARVs more openly than they did 10 years ago. Most respondents indicated that their sexual practices and relationships changed after taking the test and disclosing their results to their sexual partners. Sixteen respondents said they have stopped practicing sex altogether, and six respondents stated that they practiced safer sex. Three said they no longer had multiple sex partners. Few respondents said that their sexual relations have continued unchanged after learning of and disclosing their results. Further conversations with such people showed that their sexual partners are also positive, and therefore they do not see the rationale of using condoms when both are in the same situation. Two respondents confirmed that they continued to practice unprotected sex. This calls into question the hope of public health specialists who hold that learning one’s serostatus can by itself make people practice safe sex and therefore control further HIV transmission. These findings also mean that the counsellors need to continue working hard to help individuals with sexual partners who are also positive to understand the dangers of having unprotected sex. In addition to the ones mentioned, two respondents decided to encourage their sexual partners and other close relatives and friends to go and take an HIV test so that they may also learn their serostatus. A 40-year-old man from Iringa explained how he was expecting to disclose his results: Eeh, I knew that my family will not have a problem knowing that I am positive but I was concerned with the reaction from my wife, I think, I should bring her for counselling and testing here instead of telling her at home, probably she might be confused. In the same context, one respondent confirmed that he now speaks more openly about HIV/AIDS than he did before taking the test. Very few respondents declared their status publicly. However, one respondent, a 30-year-old male living with HIV/AIDS, said the following when he was explaining why and how he declared his status to the village and village leaders: I told all of my relatives. Even my community at home knows my status because I have already declared myself; I have declared through a newspaper… it has helped me, because when the community knows the situation there are many benefits. For example, my village knows that I live with HIV/AIDS, and has therefore exempted me from paying any financial contributions for development purposes. Some individuals have disclosed to those who support them to ensure that the support they will receive will include, for example, nursing care. Married couples disclosed to their spouses more frequently than they disclosed to others, and more often than single people disclosed their results to their sexual partners. The majority of these married people took the initiative to practice safe sex, such as using the condom or encouraging their spouses to go for the test as well. The study has also indicated, 68
however, that disclosure is limited among singles or individuals with multiple partners. There are many reasons why single people refrain from disclosing their status to their partners. Moreover, most of the HIV-positive respondents were looking forward to securing medical support, especially ARVs, as we have already shown in Chapters five and six. Disclosure may also lead to support facilities as well as initiation of and adherence to HIV treatment and medication. The MOHSW encourages patients, particularly TB patients, to choose someone reliable from their family or community who will help them adhere to their medication and support them through their illness. The idea behind this is that, by relying on a close family member or friend for medical attention, less will be expected of the hospitals which are already overburdened with the responsibilities of providing for and supporting patients’ medication and treatment. This means of intervention is only possible when patients disclose their results. Without disclosure, patients can garner no social support and are left to fend for themselves. This chapter has demonstrated how the process of disclosing HIV/AIDS test results takes place in Tanzania. Nonetheless, the decision to disclose or conceal one’s serostatus remains an intensely personal one. The decision whether or not to disclose varies among different people, cultures, age groups, marital statuses, types of relationships, and social and personal situations and contexts. Although there are many challenges involved with disclosing serostatus in Tanzania, disclosure rates are high. 69
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SOCIAL CONTEXT OF DISCLOSING HIV TE
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Cover photo: Iringa bus station (Jo
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5.4 Benefits of VCT ...............
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ACKNOWLEDGEMENTS Many institutions
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Study Objectives EXECUTIVE SUMMARY
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HIV Counselling The respondents wer
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discrimination than are women. In a
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1.2 Statement of the Problem It is
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1.5 Significance of the Study The s
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Major Lakes HIV prevalance (THIS 20
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Stigma tends to affect men and wome
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The other challenge that VCT facili
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to their sexual partner or did not
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Disclosure to significant others ca
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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
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: 7.6 Disclosure and HIV Prevention R
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
Page 97 and 98: Klitzman, R.L., S.B. Kirshenbaum, B
Page 99: 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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