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

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show that disclosure was often associated with less anxiety, fewer symptoms of depression and increased social support among women. In a community health advisory information network (CHAIN) survey among a sample of PLHIV in New York city , individuals who disclosed their results have better adherence to ART outcomes than those who did not disclose ( Wadell & Messeri, 2006). 2.3 Content of Disclosure Describing the content of the disclosure is important. There is evidence of varied understanding of what is disclosed, as indicated in a cross-sectional study conducted in India (Chandra, Deepthivarma & Manjula, 2003). It was reported that even though 52% of the subjects chose to reveal the true nature of the illness, for 34% of the subjects disclosure was partial or disguised as a less stigmatising disease. A qualitative study in Nairobi (Miller & Rubin, 2007) found that one participant had simply told his wife that the doctor had prescribed for him some type of medicine that required them to use a condom while another, simply told the wife that he was dying. On the other hand, a descriptive study in Southern USA found that 12.5% of the 265 women categorised under full disclosure were able to meet someone and at introduction disclose to the person that they are HIV positive or simply mention their names and say how they have AIDS and how they are not ashamed of the disease (Sowell, Seals, Phillips & Julious, 2003).. Notably, a study amongst HIV positive gay men found that the sense of responsibility motivates people living with HIV to disclose while feeling shame for having HIV hinders disclosure (Serovich & Mosack, 2003). 2.4 Process of Disclosure The process of disclosure seems to vary depending on the context and gender. In a study conducted in a VCT clinic in Tanzania, it was found that for most men the process of disclosing their results to their sexual partners was not difficult and to some it was like having a normal conversation (Maman, Mbwambo, Hogan, Kilonzo & Sweat, 2001). Another study in Nairobi, Kenya however, found that some men spent time considering how to reveal the devastating news to their wives and used a variety of indirect 13
approaches including suggesting that they should both go for VCT, without revealing that they already knew their own sero-status while others still hesitated knowing that such news would be devastating to the partner (Miller & Rubin, 2007). Disclosure should be viewed as a process and not a one-time event. This process involves a series of decisions that include when the individual may disclose, to whom, how to disclose and under what circumstances to disclose. Maman et al. (2001) suggest to counsellors that providing a one-time counselling may not suffice for some women that might need to weigh the consequences and rewards of disclosure as well as develop a disclosure plan. Kimberly (1995) suggests a six-step process in decision making for disclosure that includes: (i) Acceptance of sero-status - which involves the individual who has received the HIV positive results after being counselled adjusting to the diagnosis and accepting to live with this condition; (ii) Assessing one’s disclosure skills - which includes what one wants to tell based on how much one has learnt about HIV and their HIV status and how one will communicate this to the people they choose; (iii) Deciding whom to tell - which involves assessing and making a decision whom one should disclose to at a particular time; (iv) Evaluating the recipient’s circumstances- this may include considering when to tell this person , where to tell them from and whether the persons are capable of handling disclosed information ; (v) Anticipating likely reactions -which involves what the best is that one can hope for or the worst one would have to deal with; and (vi) Considering one’s motivation for disclosure- which enables one to reflect on why one wants to tell the people they are telling basing on what one expects from them. 14
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 and 14: engage in preventive behaviours as
Page 15 and 16: opportunistic infections and ART, i
Page 17 and 18: Mulago centre had registered 270 di
Page 19 and 20: 1.6 Problem Statement With the evid
Page 21: 2.2 Benefits of HIV Status Disclosu
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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