Factors affecting disclosure of HIV sero-status to immediate family members: a case study of TASO Kampala clients

Abstract

This study sought to identify and document factors that either motivate or inhibit people living with HIV and AIDS (PLHIV) while disclosing their HIV status to their spouses or long term sexual partners and children. It explored socio-economic factors, choice of person to disclose to, the timing of revealing to specific individuals, and the reactions of those disclosed to. In this exploratory study, data was collected from TASO, Kampala clients, from October 2006 to February 2007, using mainly qualitative methods that included focus group discussions, key informant and in-depth interviews. Results show that people living with HIV disclose their HIV status because of need for care, treatment and prevention, quality of counseling offered, triggers that motivate HIV testing, need to “un-burden” oneself, preventing future crises and the need for self sustenance. Disclosure is easier to friends and other relatives than to sexual partners and children. The level of emotional stability, perceived ability to keep confidentiality, perceived support and the readiness to disclose by the client determine the choice of person and timing of disclosure; while reactions towards the client after disclosure ranged from understanding to rejection. They varied between children and spouses/sexual partners. Amongst children, denial, anger, worry, anxiety and increased closeness were evident; while rejection in cases of discordance; blame, stigma, discrimination and denial were common amongst spouses. Economic status, gender, uncertainty of confidentiality, fear of negative reactions, fear of blame, social dependence and inadequate counseling support were the major barriers of disclosure to sexual partners while perceived fear to hurt feelings related to children. It is imperative that interventions should target practical support to those with HIV to break the cycle of perceived fear to disclose to immediate family and empower especially the women for self-reliance to avoid dependency on men. Enhancement of counseling skills for service providers is also necessary if they are to effectively address disclosure challenges by those infected with HIV.