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

8.2 Respondents’ Views of Counselling
Respondents were asked to comment on the process of counselling and any
benefits they received from the process. They generally spoke in very positive terms,
saying they learned many things in both pre- and posttest counselling sessions. Those
things included the importance of knowing their HIV serostatus, a greater knowledge and
understanding about HIV/AIDS and its modes of transmission, the significance of the
window period, and the rationale of testing and retesting if the results are negative. The
respondents indicated that their counsellor gave them caring advice, assisted them
psychologically, and reassured them that they were not alone and that being positive did
not mean death. Some counsellors also referred them to care and treatment clinics and
encouraged them to adhere to treatment.
Our conversations showed that the counsellors emphasized confidentiality of the
results and rarely spoke about showing the test results to others, particularly to sexual
partners. None of the respondents said that the counsellors told him/her to disclose test
results to others, but they did say that their counsellors encouraged them to bring their
partners in for testing. This emphasis on confidentiality but not on disclosure may well
stem from the national guidelines for VCT that were prepared by the MOHSW (2005). In
these guidelines, more emphasis is put on confidentiality of the results than on disclosure.
Another aspect of counselling that may be linked to the training is that the advice
given to all people who have tested positive is the same, regardless of whether or not they
are married, single, widowed, sick, or healthy. The social situation and need for
assistance of a single woman who is not yet ill compared with a married man with
symptoms of AIDS are quite different, and they should be given rather different advice.
Counsellors seem to have adopted standardized messages for clients who are positive,
and they recite these messages to their clients without taking into consideration their
situation. Such counselling by rote does not consider the social context and concerns of
the client. Opportunities to provide useful advice to individuals who need assistance to
live with HIV are missed.
8.3 Social Relations and Patterns of Disclosure
This study has indicated that reasons for disclosure or nondisclosure tend to be
linked to the type of close relationship that individuals have with their significant others
to whom they decide to disclose or not to disclose. Benefits include acquired
psychosocial support, active coping, and improved wellbeing. Most of the respondents
who disclosed their test results did so to their blood relatives. Most respondents disclosed
to their female relatives and/or partners such as a wife, mother, sister, sister-in-law, aunt,
and cousin before and more frequently than they did to their male relatives such as a
father, brother, uncle, nephew, and/or brother-in-law. Most of the married clients,
particularly men, disclosed their test results to their spouses. Most single people disclosed
the results to their parents and relatives, but not to their sexual partners. Widows
disclosed to their close blood relatives as well as their children. This was the case with
the divorcées as well, who disclosed their results to blood relatives, children, and friends.
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