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

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Patients now wait for equipment or reagents to be delivered to perform tests necessary to begin taking ARVs. Another challenge confronting people wanting to test is the distance they have to travel to access the service. Most of our respondents travelled far to a VCT centre. Another major challenge of VCT is that the use of a stand-alone facility may be stigmatized. Although CTC services are attached to most hospitals, we noted that such services are accommodated in special buildings that are easily identifiable by people as buildings for people with HIV/AIDS. In a country like Tanzania where stigma against HIV/AIDS is still high, isolating VCT services from other health services tends to stigmatize these services. 8.5 Implications of Study Findings to VCT Services in Tanzania The findings of this study help us to understand the nature of social relations that surround and influence not only processes of counselling and testing for HIV/AIDS, but also the process of disclosing HIV test results to others. For example, the findings show that: • It is important to recognize that individuals live in a social context that influences the way they perceive risks, the way they make decisions about HIV testing, and finally whether to disclose their test results to others or not. Understanding this reality can assist counsellors in considering the individual circumstances of their clients and tailor their advice to fit the needs and problems that clients experience. • It is important to treat post-test counselling not as the end process of VCT services, but as an introduction to a system of support. This is only possible if ways of maintaining future contacts between VCT service providers and clients are put in place. Although the national guidelines for VCT encourage follow-up counselling after posttest counselling shows HIV test results, this study did not collect findings about whether this takes place in practice. • Disclosure is not a simple matter of individuals telling one or two persons they are HIV positive or negative. Rather, the person who hears the news must also accept and believe that news and may need help in dealing with the implications. What this means is that most VCT clients need further assistance to negotiate the news of their serostatus. 8.6 Recommendations The observations and findings from this study suggest the following points of emphasis and policy recommendations: • The amount of time and money needed to obtain an HIV test constitutes a barrier to VCT services. It is assumed that if VCT services are more accessible, more people will use the services. Therefore, there is a need to facilitate access to VCT services for the public, particularly in rural areas. 74
• Most respondents who were not married did not disclose their HIV result to their sexual partners. This situation presents a challenge for counsellors to persuade single individuals to share their test results with their partners. • VCT counsellors need to discuss the importance of disclosure with their clients more often and more directly, for this issue receives little attention now. This is especially important for younger single individuals who are sexually active but do not disclose their status to their sexual partners. • A referral system needs to be developed so that clients who get their HIV test in facilities that do not offer care and treatment services can access such services for medical and social support. One way to do this would be to expand care and treatment services in stand-alone VCT facilities. • Links should be created between clients and other community-based support services so that continuous support is available at the local level to assist VCT clients in communicating with their families or friends about their situation. This can work well if there is constant interaction and communication between VCT facilities and organizations that offer social support at the local village level. 75
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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
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4. STUDY DESIGN AND METHODS OF DATA
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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 and 86: 7.6 Disclosure and HIV Prevention R
Page 87: however, that disclosure is limited
Page 90 and 91: 8.2 Respondents’ Views of Counsel
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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