Do support groups members disclose less to their partners? The dynamics of HIV disclosure in four African countries
1 Amsterdam Institute for Social Science Research, University of Amsterdam, Kloveniersburgwal 48, 1012 CX, Amsterdam, The Netherlands
2 Department of Global Health, Academic Medical Centre, University of Amsterdam and Amsterdam Institute for Global Health and Development, Pietersbergweg 17, PO Box 22700, 1100 DE, Amsterdam, The Netherlands
3 Institut de Recherche pour le Développement, TRANSVIHMI, Dakar, Senegal
4 Makerere University School of Public Health, New Mulago Hospital Complex, PO Box 7072, Kampala, Uganda
5 Programme d’Appui au Monde Associatif & Communautaire de Lutte Contre le VIH/SIDA (PAMAC), 11 BP 1023 CMS 11, Ouagadougou, Burkina Faso
6 Research for Equity and Community Health (REACH) Trust, Paul Kagame Highway, 6/28, PO Box 1597, Lilongwe, Malawi
7 Umeå Centre for Global Health Research, Umeå University, Umeå, SE-901 85, Sweden
8 Intelligent Systems Lab Amsterdam, University of Amsterdam, Science Park 904, 1098 XH, Amsterdam, The Netherlands
9 Institute for Global Health, University College London, Guilford Street 30, WC1N 1EH, London, UK
10 Faculty of Health Sciences, American University of Beirut, PO Box 11-0236, Riad El-Solh, Beirut, Lebanon
BMC Public Health 2013, 13:589 doi:10.1186/1471-2458-13-589Published: 17 June 2013
Recent efforts to curtail the HIV epidemic in Africa have emphasised preventing sexual transmission to partners through antiretroviral therapy. A component of current strategies is disclosure to partners, thus understanding its motivations will help maximise results. This study examines the rates, dynamics and consequences of partner disclosure in Burkina Faso, Kenya, Malawi and Uganda, with special attention to the role of support groups and stigma in disclosure.
The study employs mixed methods, including a cross-sectional client survey of counselling and testing services, focus groups, and in-depth interviews with HIV-positive individuals in stable partnerships in Burkina Faso, Kenya, Malawi and Uganda, recruited at healthcare facilities offering HIV testing.
Rates of disclosure to partners varied between countries (32.7% – 92.7%). The lowest rate was reported in Malawi. Reasons for disclosure included preventing the transmission of HIV, the need for care, and upholding the integrity of the relationship. Fear of stigma was an important reason for non-disclosure. Women reported experiencing more negative reactions when disclosing to partners. Disclosure was positively associated with living in urban areas, higher education levels, and being male, while being negatively associated with membership to support groups.
Understanding of reasons for disclosure and recognition of the role of support groups in the process can help improve current prevention efforts, that increasingly focus on treatment as prevention as a way to halt new infections. Support groups can help spread secondary prevention messages, by explaining to their members that antiretroviral treatment has benefits for HIV positive individuals and their partners. Home-based testing can further facilitate partner disclosure, as couples can test together and be counselled jointly.