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

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they can use to prepare their clients for disclosure. For instance Simoni and Pentalone (2004) suggest that role playing the likely scenarios on disclosure may be useful to help develop the confidence and communication skills clients need to share their results. This can facilitate successful disclosure in reality. 5. 6 Conducive Conditions for Disclosure Some of the participants had various suggestions to improve disclosure such as couple counselling and testing, empowering women for economic independence, peer support and involvement of the TASO staff in disclosure. These findings affirm the current strategy of some HIV related campaigns of encouraging spouses of sexual partners to test together for HIV (Marum, Odoyo, Furnivall, Kamau & Ng’ang’a, 2004). Several participants interviewed wanted to use this approach even when they already knew their own HIV status and in that way they would avoid face to face disclosure. Counsellors should therefore assist clients to improve their interpersonal communication skills and encourage couple counselling and testing as a way to facilitate increased communication and disclosure amongst couples. As the couple gets services together this improves access to prevention messages and methods. Studies from other Sub –Saharan African countries suggest that behaviour change such as increased condom use may be greatest among couples who are counselled together (Allen et al., 1992; Heyward, Batter & Malulu, 1993; Kamenga et al., 1991). The results confirm that couple counselling should be promoted and open communication and dialogue amongst couples should be encouraged to enable them to discuss sexuality issues. Increasing opportunities for couples to know their serostatus through HBHCT and supporting those who already know their serostatus to disclose, should be implemented. Counsellors should effectively handle sexuality counselling among cohabiting couples as well as those who have steady partners. They should seek to provide supported disclosure to individuals who access ART services and have not disclosed their serostatus. People living with HIV also need Peer role models to support them in disclosure. If these role models share their own personal experiences, those who have not disclosed will learn from 65
them and emulate the good examples. This can be possible through encouraging the clients to join the established peer support groups of PLHIV in their communities. 5.7 Conclusion While strategies like HBHCT and couple counselling have enhanced disclosure among sexual partners on ART living together in stable married relationships (primary), the partners in secondary relationships (cohabiting and steady) especially women, continue to face challenges in disclosure yet their sexual partners are at risk of HIV infection. The study has re-affirmed the fact that while some people living with HIV/AIDS wish to disclose their HIV status to their partners, there are compound factors that make it difficult to disclose. This calls for effective strategies by government, TASO and other care agencies to ensure disclosure that will protect the individuals from negative consequences as well as ensure that sexual partners are disclosed to in order to reduce their vulnerability to HIV infection. In TASO where 60% of positive couples are in discordant relationships, disclosure is very important for curbing new infections. HIV prevention strategies in Uganda should therefore strengthen couple counselling and testing, and design strategies that ensure HIV status disclosure to sexual partners particularly those cohabiting and in steady relationships, and promote positive behaviour changes. 5.8 Recommendations The following recommendations can be made based on the findings drawn from the study: • For Policy makers and managersMost participants were in agreement with more sensitisation and undertaking of wider community education so that more couples are persuaded to go for couple counselling and testing which would enhance disclosure to sexual partner. • Strengthen community outreach programmes for counselling and testing. This includes door to door HIV testing with emphasis on couples counselling and testing and community education 66
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DISCLOSURE OF HIV STATUS TO SEXUAL
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ABBREVIATIONS AND ACRONYMS AIDS - A
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While strategies like HBHCT and cou
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ACKNOWLEDGEMENTS I am grateful to t
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4.5.2 Fear of abandonment .........
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partners, behavioural dis-inhibitio
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engage in preventive behaviours as
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opportunistic infections and ART, i
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Mulago centre had registered 270 di
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1.6 Problem Statement With the evid
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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: fear of stigma and discrimination.
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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