HIV/AIDS status disclosure increases support, behavioural change and, HIV prevention in the long term: a case for an Urban Clinic, Kampala, Uganda

Abstract

BackgroundDisclosure of HIV status supports risk reduction and facilitates access to prevention and care services, but can be inhibited by the fear of negative repercussions. We explored the short and long-term outcomes of disclosure among clients attending an urban HIV clinic in Uganda.MethodsQualitative semi-structured interviews were administered to a purposeful sample of 40 adult HIV clients that was stratified by gender. The information elicited included their lived experiences and outcomes of disclosure in the short and long term. A text data management software (ATLAS.ti) was used for data analysis. Codes were exported to MS Excel and pivot tables, and code counts made to generate statistical data.ResultsOf the 134 short-term responses elicited during the interview regarding disclosure events, most responses were supportive including encouragement, advice and support regarding HIV care and treatment. The results show on-disclosing to spouse, there was more trust, and use of condoms for HIV prevention. Only one third were negative responses, like emotional shock and feeling of distress. The negative reactions to the spouses included rejection, shock and distress in the short term. Even then, none of these events led to drastic change such as divorce. Other responses reflected HIV prevention and call for behavioural change and advice to change sexual behaviour, recipient seeking HIV testing or care. Women reported more responses of encouragement compared to men. Men reported more preventive behaviour compared to women. Of the 137 long-term outcomes elicited during disclosure, three quarters were positive followed by behavioral change and prevention, and then negative responses. Men reported increased care and support when they disclosed to fellow men compared to when women disclosed to women. There was better or not change in relationship when women disclosed to women than when women disclosed to men.ConclusionsThere is overwhelming support to individuals that disclose their HIV status, especially in the long term. Besides, gender appears to influence responses to HIV disclosure, highlighting the need for gender specific disclosure support strategies.

“How can I tell?” Consequences of HIV status disclosure among couples in eastern African communities in the context of an ongoing HIV “test-and-treat” trial

“…Studies in both rural and urban settings across sub-Saharan Africa have shown disclosure of HIV-positivity to be associated with positive outcomes including increased social support (Maman et al, 2003; Ogoina et al, 2015), reduced internalized stigma (Geary et al, 2014), improved mental health (King et al, 2008), and safer sexual behaviors (Rujumba et al, 2012). Other research in the region associates disclosure to sexual partners with increased understanding and support (Medley, Garcia-Moreno, McGill, & Maman, 2004; Obermeyer et al, 2011), trust (Atuyambe et al, 2014; King et al, 2008), and HIV care uptake (Deribe, Woldemichael, Wondafrash, Haile, & Amberbir, 2008; King et al, 2008). …”

Types and predictors of partner reactions to HIV status disclosure among HIVinfected adult Nigerians in a tertiary hospital in the Niger Delta

“…12 Failure to disclose has been attributed to fear of abandonment, broken relationships, physical and emotional abuse, discrimination and loss of economic support. 2 Despite these disclosure-related fears, studies from both developed and developing countries [2][3][4][5][6][7] , Nigeria inclusive [8][9][10][11][12][13] , have revealed predominant positive or supportive reactions to disclosure, with 50-100% of sexual partners eliciting positive reactions following disclosure. The few reports of negative reactions such as disruption of relationships, violence and discrimination were more commonly reported among unmarried sexual partners and sero-discordant couples, as well as among people from low economic status and in those with history of violence in their relationships.…”

HIV/AIDS-Related Stigma and Discrimination in Workplaces in Tanzania

“…This is largely because stigma hinders uptake of HIV testing, a critical requirement for access to HIV treatment. In a study conducted in an urban clinic in Kampala, Uganda, authors showed that HIV status disclosure increase support, behavioural change and, HIV prevention in the long term (Atuyambe, Ssegujja, Ssali, Tumwine, Nekesa, Nannungi, Ryan & Wagner, 2014). The major reasons for termination of employment among HIV infected people were psychological one, not physical or symptoms-associated conditions (Vitry-Henry, Pénalba, Beguinot, & Deschamps, 1999).…”