Social Context of Disclosing HIV Test Results: HIV Testing in Tanzania

This 105-page study conducted by the Centre for Strategic Research and Development, with assistance from Macro International, examines the circumstances and social contexts in which individuals in Tanzania were tested and counselled for HIV, and patterns of disclosure of test results to partners, family, and friends. The research sought to discover how people experienced these processes based on their own descriptions. The overall objectives of the study were to understand people's experiences in showing their own HIV test results to others, to discover the pattern of disclosure among individuals tested, and to discern the role of social relations in facilitating disclosure to others. Authors say a better understanding of factors that facilitate discloser can be useful to programmes that promote disclosure of HIV test results.

Authors say disclosure of HIV test results is critical to HIV prevention in three ways. First, it allows the individual to garner social support for preventative actions. Second, for those who test positive, disclosure to a spouse or regular partner is essential to prevent HIV transmission. Finally, without disclosure, a person cannot easily access social or medical services. Thus, authors argue that any intervention that increases disclosure can improve prevention, increase the number of spouses and regular partners who are tested and counselled, and increase access to services.

The study relied primarily on open-ended conversations with individuals who had been tested for HIV. The research team interviewed only those who tested positive. In addition, interviews were conducted with voluntary counselling and testing (VCT) counsellors, other health care providers, religious leaders, and community leaders to discuss their views about how people are tested and disclose their results.

The study found the large majority of people interviewed had been chronically ill when they were tested for the first time. Most remaining individuals tested because their spouse or sexual partner had died of symptoms similar to AIDS, or was chronically sick. Although a small number tested without telling anyone, most had discussed testing with someone before visiting a testing centre. One-fourth of married people discussed the idea with their spouse. Authors say the nexus of social relations of family and friends played a direct role in the decision to get tested for many respondents.

Respondents were asked their experiences of pre and post-test counselling. Married couples or partners were given the choice of being counselled together or separately. Pre-test counselling encouraged people to get tested, discussed basic information about HIV, obtained consent, and explained again that the result would be positive or negative. Post-test counselling discussed living positively with HIV, and provided a referral to see a doctor. Some respondents were also urged to disclose. A few respondents suggested ways VCT services could be improved.

Authors say findings indicate that respondents disclosed their HIV status selectively depending on the type of relationship in which the individual was involved. For example, mutual obligation seemed to be an underlying factor in disclosing to a family member and/or partner. The process of disclosure varied. Some respondents disclosed the same day they were tested, and others waited for a period of time. The majority disclosed to close relatives and to those they had a high level of trust, and some did not want to disclose to people outside their closest circle because they were afraid that if news of their status became widespread they would face discrimination.

Women were much less likely to show results to their spouses or sexual partners than were men. Among younger unmarried respondents five out of 11 did not disclose to anyone, fearing discrimination. In all relationships, expected social support and the ability to maintain confidentiality played a key role in influencing someone's decision to disclose. Authors emphasise that the nuclear and extended family tend to be the backbone of community-level social relationships in Tanzanian society.

Based on these findings, the report makes three recommendations for improving HIV testing and counselling:

• VCT counsellors should discuss the importance of disclosure with their clients more often and more directly, this is especially important with young single individuals;
• VCT counsellors should seek ways to tailor their counselling to the needs of their clients rather than provide the same advice to everyone; and
• programmes are needed to train counsellors to address the different fears and social concerns of men and women regarding life with HIV and disclosures of HIV status to others.