Disclosure of Hiv status to sexual partners among people who ...

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on ART therefore need to be prioritized. A study in South Africa (Eisele, Mathews, Chopra, Lurie, Brown, Dewing & Kendall, 2008) found that not disclosing one’s HIV status to a sexual partner increased the risk of having unprotected sex among both men and women after their first year of ART. Currently in Uganda, the fear is that the availability of ART for patients with advanced HIV disease may lead to a false sense of security, laxity and complacency among individuals and communities, which could result in new HIV infections thus high costs in HIV prevention (UAC, 2007). Furthermore, Gray, Gange, Serwadda and Sewankambo (2003) assert that the current gains in prevention could be threatened by increased risk behaviour associated with widespread of ART. The government policy of openness and political commitment to HIV/AIDS control has created high levels of awareness in the population about the dangers of the epidemic and possible means of prevention (UAC, 2006). Government policies promote HIV testing, access to treatment for people living with HIV and safer sex practices. Disclosure of HIV status in this context is important because it enables the sexual partners to be included in the decision making process as far as safe sex behaviour is concerned as well as receiving appropriate support towards ART adherence. 1.5 Study Setting This study was conducted amongst clients of The AIDS Support Organisation (TASO) who are on ART. TASO is a non-governmental organization founded in 1987 by a group of 16 volunteers who were either HIV positive or had their family members or friends living with HIV. TASO is the largest HIV/AIDS agency serving Uganda and the Great Lakes Region. TASO’s mission is to contribute to the process of HIV prevention, restoring hope and improve the quality of life of individuals and families affected by HIV/AIDS. TASO fills a counselling, care and support gap that has been largely neglected in the health service delivery and has become critical with the HIV/AIDS epidemic and the increase in psychosocial needs in the health sector. People diagnosed with HIV by various HIV counselling and testing (HCT) providers are referred to TASO to get registered as TASO clients. TASO provides free HIV counselling, treatment of 5
opportunistic infections and ART, in addition to food support to over 80,000 people living with HIV/AIDS (TASO clients) and education support to the clients’ children in 11 TASO service centres across the country. TASO Uganda provides ART to 20,000 of the 90,000 patients, nation-wide (TASO, 2008). TASO ART programme is a subcomponent of the national ART scale-up. TASO’s counselling service is provided to individuals, couples and groups; home-based counselling for clients’ families is also offered. TASO’s counselling empowers individuals and couples to make informed decisions and to; accept diagnosis, seek medical care and adhere to treatment, access counselling, take responsibility to prevent HIV transmission to others by disclosing serostatus to partners, using of condoms, family planning and PMTCT which are some of the aspects of positive living. TASO provides sexuality counselling to clients including discordant couples, and its emphasis on sexuality issues faced by HIV-positive people (clients) shows its understanding of the importance of and need to address sexuality in the context of HIV prevention. TASO’s couple counselling aims at strengthening couples’ relationships and promote mutual understanding as well as promote behaviour change strategies amongst sexual partners. Clients’reports in TASO reveal that couple counselling is vital in terms of drug adherence, risk reduction, facilitating disclosure, countering stigma and is key to positive living. TASO Mulago in Kampala has been in operation since the beginning of the organization. By the end of 2007 the centre had provided services to over 34450 cumulative (20254 female &10043 male). HIV positive clients from seven surrounding districts. Kampala District hosts 57% of the clients; Wakiso has 19%, Mukono 11% and the rest of the other districts only 13%. (TASO, 2008). Of the registered clients at TASO Mulago 2,104 were receiving ART by end of 2007 (TASO, 2008). The numbers of clients on ART increase each year (Table 1). When TASO clients were enrolled on ART, their health improved and many became sexually active and had increased desire to give birth to children. Table 2 shows changes in sexual behaviour among 992 TASO clients in Tororo six months after commencing ART, with significant increase in sexual desire among male and 6
Page 1 and 2: DISCLOSURE OF HIV STATUS TO SEXUAL
Page 3 and 4: ABBREVIATIONS AND ACRONYMS AIDS - A
Page 5 and 6: While strategies like HBHCT and cou
Page 7 and 8: ACKNOWLEDGEMENTS I am grateful to t
Page 9 and 10: 4.5.2 Fear of abandonment .........
Page 11 and 12: partners, behavioural dis-inhibitio
Page 13: engage in preventive behaviours as
Page 17 and 18: Mulago centre had registered 270 di
Page 19 and 20: 1.6 Problem Statement With the evid
Page 21 and 22: 2.2 Benefits of HIV Status Disclosu
Page 23 and 24: approaches including suggesting tha
Page 25 and 26: that people selectively disclose in
Page 27 and 28: Length of time after testing Women
Page 29 and 30: clients who are on antiretroviral t
Page 31 and 32: Stigma and discrimination The stigm
Page 33 and 34: 2001) had fear of the partners’re
Page 35 and 36: gender based violence as well as du
Page 37 and 38: & Ezzy, 2005). This was relevant fo
Page 39 and 40: the personal experiences but also g
Page 41 and 42: participants was raised to the grou
Page 43 and 44: methods besides the data recorded,
Page 45 and 46: CHAPTER 4: RESULTS 4.1 Description
Page 47 and 48: The other common reason for taking
Page 49 and 50: Although most of the participants w
Page 51 and 52: 4.3.2 Timing of disclosure Disclosu
Page 53 and 54: I thought he would probably blame m
Page 55 and 56: 4.4.1. Desire for partner to get tr
Page 57 and 58: In the FGD a female participant who
Page 59 and 60: Some men particularly are afraid to
Page 61 and 62: Some male participants commented th
Page 63 and 64: so that she too could come and they
Page 65 and 66:
[Female, 36 years, has a steady par
Page 67 and 68:
[Female, 42 years, married] Even th
Page 69 and 70:
consequences of disclosure among se
Page 71 and 72:
esults (Maman et al., 2003; Kassaye
Page 73 and 74:
fear of stigma and discrimination.
Page 75 and 76:
them and emulate the good examples.
Page 77 and 78:
• Couples should be encouraged to
Page 79 and 80:
Brou, H., Djohan, G., Becquet, R. A
Page 81 and 82:
Greene, K., Derlega, V. J., Yep, G.
Page 83 and 84:
Kitzinger, J. (1994). The Methodolo
Page 85 and 86:
Mugenyi, K., Kabasinguzi, R., & Ali
Page 87 and 88:
Prevention with Positives Committee
Page 89 and 90:
Annual Report, 2007. Kampala, Ugand
Page 91 and 92:
choose not to. The research is tryi
Page 93 and 94:
Appendix 2 UNIVERSITY OF THE WESTER
Page 95 and 96:
A3. Date of interview: ____________
Page 97 and 98:
A2. Interviewee Identification Numb
Page 99:
The counsellors at the different TA
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