Relationship dynamics and HIV disclosure: A qualitative study in 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.