239901 Relationship dynamics and HIV disclosure: A qualitative study in Rakai District, Uganda

Wednesday, November 2, 2011: 10:30 AM

Rebecca Kaarina Wong, MPH , Mailman School of Public Health, Columbia University, New York, NY
Jenny Higgins, PhD, MPH , Mailman School of Public Health, Columbia University, New York, NY
Neema Nakyanjo , Qualitative Research Department, Rakai Health Sciences Program, Kalisizo, Rakai District, Uganda
Fred Nalugoda, S Stat, MHS , Director of Kalisizo Field Station, Rakai Health Sciences Program, Kalisizo, Rakai District, Uganda
Godfrey Kigozi, MBChB, MPH , Medical Officer, Junior Principal Investigator, Rakai Health Sciences Program, Kalisizo, Rakai District, Uganda
David Serwadda, MBChB, MSc, MMed, MPH , Senior Principal Investigator and Director, Rakai Health Sciences Program, Kalisizo, Rakai District, Uganda
Joseph Kagaayi, MBChB, MPH , Medical Officer, Deputy Director of Field Activities, Junior Principal Investigator, Rakai Health Sciences Program, Kalisizo, Rakai District, Uganda
Background: HIV treatment and counseling programs often focus on serostatus disclosure as a way to decrease HIV transmission and increase treatment. Sparse literature addresses the role of relationship dynamics in an individual's decision to disclose to his/her sexual partner. This study explored how partner interaction and gender roles can influence disclosure decisions in order to inform how voluntary counseling and testing (VCT) programs can encourage their clients to disclose. Methods: Qualitative data derive from a public health research and treatment program in southern Uganda. Thirty-seven in-depth interviews conducted with HIV+ individuals ages 16-42 were analyzed using NVivo software. Results: The analysis revealed that partner communication, gender roles within the context of the relationship, and relationship stability were the strongest factors influencing respondents' decisions to disclose. Productive discussion about children, family planning, and seeking treatment was present in relationships where respondents disclosed. However, some respondents who were in relationships that lacked such communication used indirect, non-verbal methods of disclosure. Women and men were motivated to disclose for different reasons. Men did not want to lose their partner's help with household chores and raising the children; women were influenced by their perceived personal risk and whether or not they felt susceptible to violence. Conclusions: The findings reveal that VCT programs must strategically approach the different challenges that men and women face in disclosing to their partner. Namely, productive communication between partners should be facilitated and the role of domestic violence should be addressed in multiple aspects of treatment and counseling services.

Learning Areas:
Assessment of individual and community needs for health education
Public health or related research
Social and behavioral sciences

Learning Objectives:
1. Describe four challenges that HIV+ individuals living in rural east African settings face when trying to disclose their serostatus to their sexual partner. 2. Explain how domestic violence in a relationship can both hinder and facilitate disclosure. 3. Compare the different ways men and women consider three barriers to disclosure - fear of separation, fear of accusations of infidelity, and fear of violence when deciding whether or not to disclose to their partner. 4. Identify three implications of the study for HIV treatment and counseling services.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I was an MPH student intern at the Rakai Health Sciences Program in the summer of 2011 and was asked to analyze the data.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.