Disclosure of one's HIV status to a sexual partner can have significant health implications. From a health promotion point of view, disclosure is seen as a cornerstone for the prevention of HIV transmission between partners. Despite its importance as a strategy for controlling the spread of HIV, there are challenges that inhibit voluntary disclosure.
In exploring factors associated with disclosure of HIV status, the study had two complementary objectives related to: (1) investigation of participants’ views about HIV-positive status disclosure to sexual partners; and (2) a broader identification of factors that influence disclosure of HIV-positive status.
The study explored factors associated with disclosure of the HIV status of people living with HIV to their sexual partners. Purposive sampling was used to select 13 participants living with HIV who attended a wellness clinic. Primary data were collected via an in-depth interview with each of the participants.
The exploration showed that male participants were notably more reluctant to disclose to their sexual partners for fear of rejection; and secrecy was commonly reported around sexual matters. Female participants (who were in the majority) were relatively more willing to disclose their HIV status to their sexual partners. Despite the complexity of disclosure, all participants understood the importance of disclosure to their sexual partners.
There is a need for HIV prevention strategies to focus on men in particular, so as to strengthen disclosure counselling services provided to people living with HIV and to advocate strongly for partner testing.
Disclosure of one's HIV status to a sexual partner can have significant health implications. The first of these is that the negative outcomes of disclosure can be both severe for and detrimental to those affected; and because the second is that low rates of disclosure may lead to increased cases of HIV transmission to others (United States Agency for International Development [USAID]
The Burnet Institute (
Whilst disclosure can be an important strategy for controlling the spread of HIV, because of the protective benefits to both individuals and the health system, there are challenges that inhibit voluntary disclosure (Maman
VHCT provides access to structured therapeutic intervention so that affected individuals and couples can make informed health-promoting choices about being tested for HIV (Shangula
Contemporary literary sources show that there is limited disclosure of one's HIV status to a sexual partner (Almeleh
In 2008, the Northern Cape had a lower prevalence rate of HIV compared with other provinces in South Africa (Department of Health
The purpose of the study was to explore factors associated with disclosure of HIV status by PLWH to their sexual partners with the aim of improving HIV interventions for PLWH.
There were two objectives for this study, namely:
To investigate participants’ views about HIV-positive status disclosure to sexual partners at the Galeshewe Day Hospital Wellness Clinic in Kimberly (in the Northern Cape Province).
To identify factors that influence disclosure of HIV-positive status to sexual partners.
The study purported to answer two research questions as:
What are the participants’ views about HIV-positive status disclosure to sexual partners?
What are the factors that influence disclosure of HIV-positive status to sexual partners?
Factors associated with disclosure of HIV status to sexual partners would assist in improving planning for HIV interventions amongst PLWH. Disclosure of HIV status offers considerable benefits from both an individual and a public health perspective (World Health Organization [WHO]
The burden of guilt and secrecy associated with non-disclosure will be minimised. Disclosure also encourages healthy attitudes as partners come to understand and approach safer practices, such as abstinence, sticking to one sexual partner and using protection, amongst others. The life of both the infected and affected can thus be prolonged, as all of the above factors work synergistically to not only prolong their lives but also to promote both their relevance and productive participation in daily activities, at home amongst their families and in society.
A qualitative study using in-depth interviews was conducted with 13 purposively-selected participants living with HIV. The target population was made of both male and female participants living with HIV, who attended the wellness clinic at Galeshewe Day Hospital in the Northern Cape and who were between the ages of 18 and 45 years. This age group was selected because, according to Avert (
Data were collected over a three-week index period. Community counsellors at the wellness clinic assisted with recruitment of participants following the eligibility criteria, after which the primary researcher contacted participants telephonically to secure appointments. Out of 18 recruited participants, one declined, one did not answer her phone and the other one had left the village by the time of contact. Two more did not show up for the assigned time of the interview. The remaining 13 participants were seen on separate dates, depending on their availability. The principal investigator explained the consent form to each participant before the actual interview. A list of questions was prepared to guide the interview but questions were made open to allow participants the freedom to expand on them.
The interviews were conducted in Tswana because the participants were more familiar and comfortable with the language. Although the consent form was in English, the researcher explained it clearly in Tswana. Each participant was interviewed at the identified private room at the hospital. The interviews lasted between 30 and 45 minutes, depending on the participant.
Interviews were tape recorded with the permission of the participants and field notes were also made during the interview.
Data from each component of the study were analysed using Joubert and Ehrlich’ s (
Two major themes emerged from the study, namely, support and sexuality. The support theme had two categories – partner reaction to disclosure and partner support – and the sexuality theme had one category, namely, the desire to have children.
The findings are presented as demographic data and as themes that emerged from the study.
In the present study, the most represented age group (
Demographic data of participants.
Demographic variables | Number | Percentage |
---|---|---|
20–25 | 1 | 7 |
26–30 | 3 | 24 |
31–35 | 2 | 15 |
36–40 | 5 | 39 |
41–45 | 2 | 15 |
Female | 10 | 77 |
Male | 3 | 23 |
Single | 9 | 69 |
Customary marriage | 1 | 8 |
Civil marriage | 1 | 8 |
Cohabiting | 2 | 15 |
Never attended school | 0 | 0 |
Up to Grade 7 | 1 | 8 |
Grade 8 to 10 | 1 | 8 |
Grade 11 to 12 | 11 | 84 |
Unemployed | 12 | 92 |
Employed | 1 | 8 |
0 | 3 | 23 |
1–2 | 8 | 62 |
3 | 2 | 15 |
6 or more | 0 | 0 |
The sample confirms Avert’ s (
The majority of the sampled participants (
The majority of participants in the study were unemployed (
The majority of the participants (
The majority of participants (
Two themes, one of which had two categories, emerged from the qualitative data. Each of the themes will be discussed and the participants’ narratives will be presented in order to support the findings. The themes and categories generated from the data are displayed in
Themes and categories generated from the study.
Themes | Categories |
---|---|
Support | Partner reaction to disclosure. |
Sexuality | Desire to have children. |
The first theme that emerged was ‘support’, which emerged as two discernable categories, namely, ‘partner reaction to disclosure’ and ‘partner support’.
Partner reaction to disclosure.
Partner reaction | Participants’ narratives |
Fear | ‘I feel that informing a new partner about my status will scare them away. One partner freaked after I informed her about my status and she stopped contacting me, I later told her I was joking and then she came back.’ (P1, Male, 28 years old) |
Ignorance | ‘When I told him, he just took it lightly. He would sometimes bribe me into not using a condom. The day I informed him, we did not have condoms but he insisted on having unprotected sex.’ (P2, Female, 42 years old) |
Anger | ‘He was furious with me at first after I informed him about my status. He deserted me for one month but later accepted and started supporting me and reminding me to take treatment.’ (P6, Female, 35 years old) |
Secrecy | ‘When I told him, he said he is HIV-positive. He did not inform me before that he was HIV-positive.’ (P3, Female, 32 years old) |
Rejection | ‘He did not support the child after I informed him about my status until I applied for maintenance and took a DNA test and we are no more together.’ (P5, Female, 32 years old). |
Silence | ‘We went for couple testing, and he tested negative. He was quite after testing and later he started to be supportive and confessed that he had a relationship with a partner who died of AIDS.’ (P6, Female, 41 years old) |
Acceptance | ‘When I disclose to him, I said, “you will be sitting on a mattress next year”, and he said the same thing.’ (P7, Female, 41 years old) |
Two of the participants were rejected after disclosing their status. Silence, acceptance and secrecy about the status were also experienced. This study supports Deribe
In general, the study showed some willingness for partners to inform their partners of their status. This finding is well supported in literature. For instance, the Third South African National HIV Communication Survey (John Hopkins Health and Education in South Africa
Few participants argued that the fear of being rejected by their partners hindered them from disclosing their status. This is also reported in literature such as the study from USAID/Synergy (
No participant mentioned any form of discrimination, which was indicated by their willingness to disclose their status. This is reinforced by the findings of the Third South African National HIV Communication Survey (John Hopkins Health and Education in South Africa
Although few participants feared disclosure, they were in agreement in their acknowledgement that it was a difficult process. They communicated the need to disclose in order to protect their partners from contracting the disease. This was seen as a way of ensuring more mutually supportive relationships between partners.
The other interesting finding of the study was the reluctance of men to disclose their status to their sexual partners. Men remained silent about their status until their partner(s) tested positive – and that is the only time when they admitted that they had suspected something regarding their own status all along. This was supported by Seid
An interesting finding from the study was that participants used cultural explanations to disclose their HIV status to their partners. Culture pervades all areas of life, including the explanation for HIV and its disclosure to partners. The statements from participants that could only be understood by persons of the same culture are:
Laying on the mattress.
Let's allow it to happen.
Lighting the candle.
The three statements can only be understood to mean ‘death’ by the Tswana ethnic groups and are an indirect way of saying, ‘I am HIV positive’. Literature calls it cultural diversity (Turan
‘He was furious with me at first. He deserted me for one month but later accepted and started to support me and even reminded me to take treatment.’ (P6, Female, 35 years old)
‘We went for couples testing and he tested negative. He was quiet afterwards, but he later started to be supportive and confessed that he had a relationship with a partner who had died because of AIDS.’ (P3, Female, 41 years old)
The observations within the current study support the findings by Gari
Sexuality is defined by Zimmerman and Dahlberg (
Three of the participants had difficulties in having sexual relationships as supported by the following quotes:
Fear of relationships: ‘I thought when you are HIV positive you cannot be involved in sexual relationships.’ (P9, Female, 38 years old)
Experience of rape: ‘I tried to pursue relationships when I was in Grade 11 but it was difficult for me to engage in sexual activities because of that experience.’ (P5, Female, 28 years old)
Failure to obtain interest from potential partners: ‘At first, they would give me promises but the next day they would suddenly change their minds. I have given up hope, but next time I will try to pursue people of the same HIV status.’ (P8, Male, 39 years old)
Adherence to sound ethical principles including the unequivocal protection of respondents was maintained throughout this study. In advance of study commencement, ethical clearance was applied for and obtained from Research and Ethics Committee of the Department of Health Studies at the University of South Africa (HSDC 60/2011). Site-access approval was obtained from Galeshewe Day Hospital Wellness Clinic after communicating through a formal letter from University of South Africa (UNISA). Participants signed the consent form after a thorough explanation of the study was given. The principle of beneficence was adhered to in this study – the researcher ensured that participants were comfortable and were interviewed in a private room away from noise and prying eyes. Confidentiality, privacy and anonymity were also maintained throughout the study. Participants were reassured that the information they provided would not be traceable to them and that their names would not be mentioned in any document or manuscript emanating from the study. All the transcripts were kept under lock and key in the second author's office. The participants were further informed that they had the right to refuse to participate in the study and that they could withdraw from it at any time during the course of the study.
To facilitate trustworthiness of data, a close adherence to the strategies established by Lincoln and Guba (
The limitations of this study include sampling and dissemination issues. The sample was very small and dominated by more women than men, which makes generalisation of the findings difficult. Although not generalisable, our findings reflect those of others in settings such as Botswana and Zimbabwe. Data collection was completed approximately two years ago and dissemination of this finding will only be done this year, which could be a potential problem as a lot of things might have changed in the intervening years.
HIV counsellors should be encouraged to discuss the importance of disclosure to their patients. From the findings of this study, it is evident that disclosure comes as a shock to those on the receiving end. Men should also be encouraged to take an active part in HIV issues so that their voices could be heard. There is a need for more research on disclosure of HIV status to sexual partners. The envisaged study should include more men and have more participants.
The purpose of the study was to explore factors associated with disclosure of HIV status by PLWH to their sexual partners. In-depth interviews were conducted with 13 PLWH men and women between the ages of 18 and 45. This study has shown an increase in percentage of disclosure, as well as a willingness to disclose on the part of those who have not yet disclosed their HIV-positive status to their sexual partners. The benefits of disclosure, as recognised in this study, were support and acceptance.
Gender role is a key aspect in dealing with disclosure of HIV-positive statuses. Women in this study have shown great involvement in disclosure as compared to their male counterparts. Greater involvement on the part of men is still needed.
The authors declare that they have no financial or personal relationship(s) that may have inappropriately influenced them in writing this article.
G.T.T. (University of South Africa) was responsible for the conceptualisation of the manuscript, literature review, data analysis, decision regarding journal submission and revision of the article. V.M.O. (University of South Africa) was responsible for data collection, data analysis, report writing and drafting of the manuscript. T.M. (University of South Africa) was responsible for partially conducting the literature review and also assisted in manuscript preparation.