HIV This Week

Wong LH, Rooyen HV, Modiba P, Richter L, Gray G, McIntyre JA, Schetter CD, Coates T. Test and Tell: Correlates and Consequences of Testing and Disclosure of HIV Status in South Africa (HPTN 043 Project Accept). J Acquir Immune Defic Syndr. 2009;50(2):215-22.

As the numbers of HIV-positive diagnoses rise in South Africa, it is important to understand the determinants and consequences of HIV disclosure. Wong and colleagues conducted a cross-sectional survey from random community samples of men and women in urban and rural South Africa (n = 217 HIV-positive individuals, 89% female). Two thirds of all known HIV-infected adults in these communities had disclosed their status to sexual partner(s). On average, individuals who disclosed were 2 years older, higher in socioeconomic assets, and had known their HIV status 7 months longer than those who had not told their sexual partner(s). The “ need for privacy” was the most cited reason (45%) for nondisclosure among those who had never disclosed. People who eventually disclosed their HIV status to sexual partner(s) were significantly more likely to report always or more frequently using condoms, reducing their number of sexual partners, and/or becoming monogamous. Among individuals who disclosed their HIV status, 77% reported increases in social support, with families providing the most support. The authors concluded that disclosure is associated with reports of consequent safer sexual behaviour and greater social support. Interventions might be informed by the costs and benefits of disclosure and differences in disclosure to sexual partner compared to one’s social network.

Editors’ note: While most studies of disclosure to date have been clinic-based, this is the first community study to examine HIV disclosure in South Africa. Conducted in 2003, the study found that, although 87% of HIV-positive individuals had disclosed their status to at least one person, more than a third did not disclose to sex partners. Since both sexual behaviour change and receiving more social support were associated with disclosure, further study of the barriers and facilitators of disclosure can help design programmes to assist people in making decisions about revealing their serostatus.

Ndebele P, Mfutso-Bengo J, Masiye F. HIV/AIDS reduces the relevance of the principle of individual medical confidentiality among the Bantu people of Southern Africa . Theor Med Bioeth. 2008;29(5):331-40.

The principle of individual medical confidentiality is one of the moral principles that Africa inherited unquestioningly from the West as part of Western medicine. The HIV pandemic in Southern Africa has reduced the relevance of the principle of individual medical confidentiality. Individual medical confidentiality has especially presented challenges for practitioners among the Bantu communities that are well known for their social inter-connectedness and the way they value their extended family relations. Individual confidentiality has raised several unforeseen problems for persons living with HIV, ranging from stigma and isolation to feelings of dejection as it drives them away from their families as a way of trying to keep information about their conditions confidential. The involvement of family members in treatment decisions is in line with the philosophy of Ubuntu and serves to respect patients’ and families’ autonomy while at the same time benefiting the individual patient.

Editors’ note: Regardless of location worldwide, respect for patients and for their cultural context should translate into careful consultation with them to obtain their consent for the involvement of family members. For rural Bantu-speaking people in Central, Eastern and Southern Africa where communitarian values are still dominant, the prevailing philosophy of Ubuntu represents group solidarity, compassion and mutual support that people living with HIV can draw down on and contribute to once they decide to share knowledge of their HIV infection.