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

8. CONCLUSION AND RECOMMENDATIONS
8.1 The Process of Voluntary Counselling and Testing
Interventions in countries with a generalized HIV epidemic have focused on
promotion of individual behaviour change and getting people tested for HIV, often in
VCT centres. Once people know their HIV status, they may reduce their risky behaviour
and thus slow the spread of HIV/AIDS. For this intervention to succeed, however, those
who are tested and know their HIV serostatus must disclose their results to others,
particularly their sexual partners, so their sexual relations can be safe. This study was
designed and implemented with these background principles in mind.
This study interviewed only respondents who had tested positive for HIV. The
large majority of persons interviewed, both those recently tested (60 percent) and those
living with HIV for some time (68 percent), had been chronically ill when they were
tested for HIV the first time. Most of the remaining cases came for testing because their
spouse or sexual partner had died of symptoms similar to AIDS, or was also chronically
sick. Thus, more than 90 percent of those interviewed were tested because they or their
sexual partner were ill or had been ill. Their own situation or that of their sexual partner
suggested to them that they might be infected with HIV, and they had come to check on
that possibility.
Despite these indications of vulnerability to HIV, many respondents were shocked
to hear they were, in fact, infected. Some were shocked at the results, or frightened or
fearful, but others seemed to have expected such an outcome and were not surprised.
Although these latter responses were few in number, an analysis of their circumstances
shows that most of these were widows who had lost a spouse some time ago from a
mysterious illness, and now they were also suffering from chronic illnesses. In this case,
it was probably easy for them to expect that they would be HIV positive.
The social relations and living situation of respondents varied widely: some were
married with children, others were widowed or separated, and others were not married
but had sexual partners. Marital status and having a sexual partner or not should affect a
person’s reaction to being told they were HIV positive. Those who were widows or who
did not have regular sexual partners found themselves in a different social situation than
those who had spouses or regular sexual partners. The latter may have been
contemplating how to communicate their test results to their partners.
These differences in social relations and individual situations are important in
considering how services might be improved in VCT facilities. Clients who are married
or have regular sexual partners need counselling that is different from the counselling
given to those without regular sexual partners. Advice about whether to have children or
not, and about the use of contraception, should also be different according to the nature of
sexual partnerships.
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