"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

September 2016 - Combination Prevention

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Maeri, I., El Ayadi, A., Getahun, M., et al. AIDS Care (2016), 28: S3, 59–66, doi: 10.1080/09540121.2016.1168917.

This qualitative study examined disclosure experiences among couples in Kenya and Uganda. Through semi-structured interviews with 50 HIV providers, 32 community leaders, and 112 residents (HIV-positive and -negative) in 8 communities, the authors examined experiences with disclosure to close partners; customs, opinions, and actions related to HIV testing; and practices for accessing HIV care. Barriers to disclosure varied by sex. HIV-positive women feared their partner leaving them or behaving violently, whereas HIV-positive men feared marital conflicts over infidelity. To maintain secrecy, partners reported accessing HIV services at remote facilities, hiding medication, and falling out of care, resulting in loss to follow-up and poor adherence to medication. Positive disclosure experiences led respondents to improve their care-seeking behaviors, encourage others to test, begin treatment, and use protection with serodiscordant partners. Negative experiences included partner desertion, blocking access to care, and physical violence. Couples testing at health facilities facilitated positive disclosure experiences, as facility staff were able to offer assistance with disclosure and helped minimize partners placing blame when both tested positive. The authors recommended exploring such approaches as addressing male and female partners' concerns, supporting providers to offer disclosure services, exploring alternative testing locations to increase male uptake, and developing community disclosure support services.

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