Population Council Research that makes a difference

Abstract

Exploring the context of HIV testing and disclosure among patients on ARV treatment in Mombasa, Kenya 
Poster presentation at the XVIII International AIDS Conference, Vienna, 19 July
Okal,Jerry; Sarna,Avina; Syengo,Masila; Luchters,Stanley; Chersich,Matthew F.; Rutenberg,Naomi; Temmerman,Marleen
Publication date: 2010


Background
In Kenya about 1.5 million people are living with HIV, and four out of every five HIV-positive Kenyans are unaware of their status. About two-thirds of the country's 37 million people have never been tested for HIV. The purpose of this qualitative study was to understand the reasons PLHA receiving ART provided for undertaking HIV testing and disclosing or not disclosing their status to their sexual partners.

Methods
Stratified purposive sampling was used to randomly select in-depth interview candidates. Twenty-three sexually active adults receiving ART (11 women and 12 men) were recruited from a larger ART adherence study. The median age of participants was 36 years (IQR 33-40). Content analysis was undertaken by two researchers using Atlas t.i 5.0 (Berlin, Germany).

Results
A clear factor structure for testing and disclosure emerged suggesting that underlying health problems, risky sexual behavior, and death of partner or child triggered the need for an HIV test. Knowledge of a positive HIV test caused severe stress and compounded the respondent's already compromised health. The decision to be tested was self-initiated and often made unilaterally. Disclosure of HIV status to partners presented difficulties for both men and women. Anxiety about possible disapproval of past risky behaviours, responsibility for bringing infection into the dyad, and partner's reaction influenced the respondents' decision to disclose. Fear of rejection by partners gave participants little advantage to disclose.

Conclusions
Reasons for disclosure or nondisclosure to sexual partners were varied, and these data provide insights for secondary prevention efforts with people living with HIV and their sexual partners in view of the KNASP III target to increase current testing levels from 36 percent to 80 percent by 2013. More research is needed to better understand salient issues motivating individuals to test and disclose in this setting.