Confidentiality and HIV status in Kwazulu-Natal, South Africa: implications, resistances and challenge

Abstract

This article provides a contextualized comparison and analysis of the former Kwazulu and the new Kwazulu-Natal policy documents on HIV confidentiality, the differing practices within the region, and their implications for support and gender. It is based on interviews with key players in the regional NACOSA (National AIDS Convention of South Africa), and participation in meetings between August and November 1995. The main division is between those influenced by other rural African models, especially the Zambian concept of "shared confidentiality' as a way of ensuring support, and who have gone on to develop more community-based practices to destigmatize the disease, in contrast with the stronger emphasis in the new document on individual rights, assuming a more urban constituency, and where "shared confidentiality' is much more circumscribed. One of the difficulties of the new policy in which "confidentiality' is interpreted as "secrecy', is that it would seem to foreclose and neutralize lay and community support, as distinct from the earlier and unacknowledged policy of former Kwazulu. It also seeks to provide an enhanced role for professional counsellors. This psychologizing of the infection and the distancing from "community', and from women's groups, is surprising in a country in whose townships "community' remains a powerful motivating symbol, and where NGOs and peer groups have been identified everywhere as central to effective HIV/AIDS related prevention, care and support for behavior change.

Assessment of HIV-related stigma and determinants among people living with HIV/AIDS in Abeokuta, Nigeria: A cross-sectional study

“…32 Health workers may sometimes be trapped between these conflicting values, and they may feel the need to disclose their patients’ status to their loved ones, either to rally support for them or because of their responsibility to protect those around PLWHA if the patients refuse to disclose their status themselves. 32…”

“…Disclosure of HIV status is not always with the permission of those involved, 30 and studies have shown that HIV status had been disclosed without the consent of PLWHA by family, friends and even health workers. 31,32 Disclosure of the status of PLWHA without their consent by health workers has been linked to the difficulty in balancing the medical confidentiality of PLWHA with the necessity to assist and protect people around them. 32 Health workers may sometimes be trapped between these conflicting values, and they may feel the need to disclose their patients' status to their loved ones, either to rally support for them or because of their responsibility to protect those around PLWHA if the patients refuse to disclose their status themselves.…”

High acceptability for cell phone text messages to improve communication of laboratory results with HIV-infected patients in rural Uganda: a cross-sectional survey study

“…Published literature contains little guidance on these variations. One report from the Kwazulu region of South Africa described a patient-driven practice of “shared confidentiality,” or acceptability of disclosure by providers of HIV-status to close relatives [23]. For those participants in our study who did express concerns about confidentiality, there was interest in use of both coded messages and PIN codes to protect confidentiality.…”

Theoretical models of parental HIV disclosure: A critical review

“…How should health professionals deal with the dilemma between respecting HIV-positive’ privacy and protecting people around patients (Seidel, 1996)? How should primary health care providers deal with the conflicts between local social norms and national guidance on HIV disclosure (Datye et al, 2006)?…”