Difficulties of Disclosure of HIV Status to Sexual Partners among Expectant Women in Selected Clinics in Lusaka Urban

Abstract

HIV disclosure and nondisclosure may have positive and negative impact on HIV positive clients and their sexual partners, family, and friends but very little was known in Zambia on the types of disclosure and its determinants. This study sought to answer two research questions; what risks or rewards do expectant mothers anticipate when considering disclosing their HIV status to their male partners? And why do they choose a particular pattern of disclosure? Research design: A cross sectional explorative descriptive and mixed study was employed driven by the deductive and abductive strategies based on the philosophy of realism and interpretivism. The study was done in four clinics in Lusaka urban. A simple random sampling (lottery) method was used to select the four clinics and a disproportionate sample of 260 women was primarily sampled. A survey questionnaire and 22 one-to-one in-depth interviews were the main source of the data. Qualitative data was coded and analysed using content analysis and quantitative data was analysed using SPSS software version 14.The findings showed that decision making to disclose is a selective process and it consists of several steps, including adjusting to the diagnosis, to disclose or not to disclose, when and to whom. It was evident that just after counseling, the participants were willing to disclose mostly to their partners irrespective of what risks there were. Disclosure is more unlikely to take place within distant, casual, uncommitted, and short-term sexual relationships but with husbands or within close family and/or friends in nonsexual relationships. Disclosures were done on the first day after being diagnosed with HIV infection. This study supports past research that has argued that women’s concern about stigma, rejection and violence related to disclosing their HIV-seropositive status are unwarranted. However, negative reactions to disclosure were common, including betrayed confidence and abandonment but we did not find it to be significant in this study.It is recommended that nurses and other primary health care workers need to be open and supportive in caring for the HIV+ client, discussing the advantages of disclosing one’s HIV status to sex partners, but, at the same time, respecting the rights of clients to make their own decision about disclosure. Nurse midwives will need to have greater knowledge of what factors and situations tend to influence disclosing and not disclosing one’s HIV+ status, especially to sexual partners. There is need to develop intervention strategies that could include support and open discussions with HIV+ clients, even role-playing disclosure conversations-assuming that clients are interested in disclosing. As for HIV research, various types of social relationships associated with HIV disclosure are under-explored and future research may have to explore this. Researchers need to continue to actively pursue clues as to what facilitates HIV disclosure to sex partners, because disclosure has the potential to improve well-being, provide informed choice, and protect life.