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

There were only two cases where respondents disclosed to their religious and political
leaders.
Finally, very few (five) of the respondents had not disclosed their test results to
any one at all. For these few, it was their fear of being stigmatized and discriminated
against that made them keep quiet. After assessing their situation, people decide to
disclose or not to disclose, likely little by little. If they decide to disclose, they do it
selectively. That is, they usually identify the people whom they think should know about
their HIV-positive status and those who do not deserve to know.
Expected social support and the ability to maintain confidentiality also played a
key role in influencing someone’s decision to disclose. Most respondents disclosed to
their family members because of their close and mutual relationship as well as the social
support they expected to gain. It must be emphasized that the nuclear as well as the
extended family tend to be the backbone of social relationships at the community level in
Tanzanian society.
We have also found that there is a gender dimension to the process of disclosure
related to both disclosure to spouses and to the identity of the persons in whom to
confide. Overall, men were more likely to disclose to their spouses than were women (55
percent vs. 34 percent). In considering only the responses from people living with
HIV/AIDS that were interviewed in Iringa, more men (57 percent) disclosed to their
spouses than did women (22 percent). Although there was no significant difference
between men and women in terms of disclosing to their sisters, more men tended to
disclose to their brothers than women did to their brothers. More than half of the female
respondents (56 percent) disclosed their test results to their sisters and only 11 percent to
their brothers, whereas 24 percent of the male respondents disclosed their results to their
sisters. On the other hand, about 33 percent of the male respondents disclosed their
results to their brothers.
These differences by sex can be attributed to the gender inequality that exists in
Tanzania. Men simply have more social and economic power than women generally.
Because men are socially more powerful, they disclose their HIV-positive status to their
spouses with less fear of being rejected or fear of violence. On the other hand, women are
vulnerable to accusations of infidelity in case they test positive and are blamed for
bringing HIV into the family. At the same time, it is the women who shoulder the
responsibility of taking care of the sick and providing for all the necessary services they
need at home. Therefore, people feel obliged to disclose their HIV-positive status to them
because they anticipate support and care from them once they fall ill.
8.4 Challenges to Getting Tested
Although most respondents were happy with individual counselling, those few
who participated in group counselling indicated that group counselling neither paid
attention to individual problems and circumstances, nor maintained confidentiality.
Second, the respondents as well as the counsellors mentioned the lack of easy access to
referral services that could provide other necessary tests required for beginning ART.
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