Serostatus disclosure
Ncama BP. Acceptance and disclosure of HIV status through an integrated community/home-based care program in South Africa. Int Nurs Rev 2007;54(4):391-7.
This was a comparative study of acceptance and disclosure of the HIV status among people living with HIV (PLHIV) served by an integrated community/home-based care programme and those who are not in any home-based care programme. One of the major challenges in HIV care in developing countries is acceptance and disclosure of a positive HIV status by PLHIV. Denial and non-disclosure of HIV status hinders prevention efforts as well as access to treatment, care and support for these people. Quantitative data were collected in 2004 from a group of PLHIV served by the integrated community/home-based care programme and a group that was not receiving any community/home-based care. Data were compared between the two groups in terms of acceptance and disclosure of HIV status. The integrated community/home-based care programme was effective in improving acceptance and disclosure of the HIV-positive status by PLHIV. People living with HIV in the integrated community/home-based care programme did not find disclosure of their status difficult, and had disclosed their positive HIV status to more people than those who were not in any programme. PLHIV in the integrated community/home-based care programme not only disclosed their positive HIV status within their family network and households, but also disclosed to the community in general, sports group, religious groups and other social networks. Ncama and colleagues conclude that community/home-based care programmes can serve as catalysts for acceptance and disclosure of a positive HIV status by people living with HIV.
Editors’ note: Home-based care services such as this one can foster an individual’s acceptance of his/her HIV status. Disclosure of one’s HIV status, which is linked to acceptance of an HIV-positive diagnosis, is the first step in accessing family and community support. The more that people can come to terms with and disclose their HIV status, the more likely it is that their community’s awareness, openness, and understanding about HIV will increase, particularly in the context of access to care and treatment for those in need.
De Baets AJ, Sifovo S, Parsons R, Pazvakavambwa IE. HIV disclosure and discussions about grief with Shona children: A comparison between health care workers and community members in Eastern Zimbabwe. Soc Sci Med 2008; 66: 479-491.
Research in HIV-related counselling for African children has concentrated on urban tertiary hospitals, but most children have their first health care encounter at a rural primary health care centre. This study investigated perceptions about the acceptability of disclosing the parents’ or child’s HIV status to a child and talking about grief with children, as well as the preferred time, type, and setting for HIV disclosure. An anonymous survey was taken from 64 primary health care workers and 131 community members from rural Eastern Zimbabwe. The results expressed a high need and desire for such communications and should be interpreted against a background of high perceived confidence to talk about grief with adults and a high degree of familiarity with child bereavement and foster care. The participants preferred that partial disclosure occurs from the age of 10.8 (+/-4.2) years and full disclosure from the age of 14.4 (+/-4.5) years. Compared to community members, health care workers were significantly more open to full disclosure and disclosure at a younger age but were slightly less open to discussing grief. The different preferred combinations of persons to initiate such communications included a health care worker in up to 56% of the responses and a family member in up to 52%. The most commonly preferred family members were father’s sister (up to 37%) and grandmother (up to 40%) rather than the partner (up to 15%). Southern African family dynamics may hinder a mother initiating HIV disclosure and discussions about grief, even though she is traditionally present during HIV diagnosis, counselling, and health education. A more culturally adapted approach than the standard Western ‘couple approach’ may thus be required. Consequently, counselling training models may need to be adapted. Further research into empowering mothers to involve significant members from the extended family may be highly beneficial.
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