The duty to disclose in Kenyan health facilities: a qualitative investigation of HIV disclosure in everyday practice

Abstract

Disclosure of HIV status is routinely promoted as a public health measure to prevent transmission and enhance treatment adherence support. While studies show a range of positive and negative outcomes associated with disclosure, it has also been documented that disclosing is a challenging and ongoing process. This article aims to describe the role of health-care workers in Central and Nairobi provinces in Kenya in facilitating disclosure in the contexts of voluntary counselling and testing and provider-initiated testing and counselling and includes a discussion on how participants perceive and experience disclosure as a result. We draw on in-depth qualitative research carried out in 2008-2009 among people living with HIV (PLHIV) and the health workers who provide care to them. Our findings suggest that in everyday practice, there are three models of disclosure at work: (1) voluntary-consented disclosure, in alignment with international guidelines; (2) involuntary, non-consensual disclosure, which may be either intentional or accidental; and (3) obligatory disclosure, which occurs when PLHIV are forced to disclose to access services at health facilities. Health-care workers were often caught between the three models and struggled with the competing demands of promoting prevention, adherence, and confidentiality. Findings indicate that as national and global policies shift to normalize HIV testing as routine in a range of clinical settings, greater effort must be made to define suitable best practices that balance the human rights and the public health perspectives in relation to disclosure.Keywords: HIV/AIDS, Kenya, disclosure, consent, confidentiality, HIV support groups RésuméLe partage du statut VIH+ est systématiquement présenté comme une mesure de santé publique visant à prévenir la transmission du VIH et à améliorer l'appui à l'observance du traitement. Des études ont mis au jour une variété d'effets positifs et négatifs du partage; il a aussi été montré que l'annonce du statut VIH est un processus difficile et étalé dans le temps. Cet article vise à décrire le rôle joué par le personnel de santé pour faciliter le partage par les personnes atteintes, dans le cadre du conseil et dépistage volontaire et du dépistage et conseil à l'initiative du soignant, dans les provinces du Centre et de Nairobi au Kenya. Il discute aussi la manière dont les participants perçoivent et vivent le partage. Nous nous appuyons sur une recherche qualitative approfondie réalisée en 2008-2009 auprès de personnes vivant avec le VIH et des professionnels de santé qui leur fournissent des soins. Nos résultats suggèrent que, dans la pratique quotidienne, il existe trois modèles de partage du statut VIH : 1) la divulgation volontaire et consentie, suivant les directives internationales, 2) le partage involontaire, non-consensuel, qui peut être intentionnel ou accidentel, et 3) le partage obligatoire, lorsque les PVVIH sont tenues de divulguer leur statut pour accéder à des services dans les établissements de santé. Les agents de s...

Perceptions of Stigma and Discrimination in Health Care Settings Towards Sub-Saharan African Migrant Women Living With Hiv/Aids in Belgium: A Qualitative Study

“…Furthermore, it was found that, with the exception of a very few, most participants could not indicate whether the feelings of stigma and experienced discrimination were based on their origins as migrants or of being HIV positive. Similar results have been reported in other studies (Thomas et al, 2010;Obermeyer et al, 2011;Moyer et al, 2013).…”

Fertility Problems and Fertility Care in Sub-Saharan Africa: The Case of Kenya

“…2 in this volume). Many researchers have emphasized the importance of support groups for patients with particular health issues, such as HIV/AIDS, in sub-Saharan African context (Gillett & Parr 2010;Moyer, Igonya, Both, Hardon, & Cherutich, 2013). Little is known about the importance of support groups for people with fertility problems in these contexts, while they are known to play an important role in many Western countries (e.g., Van Uden-Kraan, Drossaert, Taal, Seydel, & Van de Laar, 2009) and lately have been set up in a number of Sub-Saharan African countries such as in Ghana (Gerrits, 2015(Gerrits, , 2016.…”

Peer mentors, mobile phone and pills: collective monitoring and adherence in Kenyatta National Hospital's HIV treatment programme

“…When Kenya revised its national HIV testing and treatment guidelines in 2008 to encourage more people to get tested, it was widely assumed, both in Kenya and globally, that once tested, those needing treatment would seek it out (Moyer et al. 2013 ). It has become increasingly apparent, however, that that follow up routinely does not occur after people test HIV positive (lost to follow-up), especially in contexts where counselling services and referral systems are weak (Rosen and Fox 2011 ).…”

“…The author has been the lead research coordinator on three HIV-related anthropological studies conducted at Kenyatta National Hospital since 2008. See, for example, Moyer and Igonya in this issue; Igonya and Moyer ( 2013 ); Moyer et al ( 2013 ). 4.…”