Article

The dimensionality of disclosure of HIV status amongst post-partum women in Cape Town, South Africa

Published in: African Journal of AIDS Research
Volume 16, issue 2, 2017 , pages: 101–107
DOI: 10.2989/16085906.2017.1311932
Author(s): Jo Hunter-AdamsHealth Economics Unit, Public Health and Family Medicine, South Africa, Allison ZerbeICAP, USA, Tamsin PhilipsCentre for Infectious Diseases Epidemiology & Research, Public Health and Family Medicine, South Africa, Zanele RiniCentre for Infectious Diseases Epidemiology & Research, Public Health and Family Medicine, South Africa, Landon MyerCentre for Infectious Diseases Epidemiology & Research, Public Health and Family Medicine, South Africa, Greg PetroDepartment of Obstetrics & Gynaecology, South Africa, Elaine AbramsICAP, Mailman School of Public Health and College of Physicians and Surgeons, USA

Abstract

Disclosure of HIV status to sexual partners and others has been presented as positive health behaviour and is widely encouraged by antiretroviral treatment (ART) programmes, providers and policies. However, disclosure is also highly contextual and its positive effects are not universal. We explore the dimensions of disclosure amongst post-partum women who initiated ART during pregnancy in Cape Town, South Africa. Forty-seven semi-structured interviews with post-partum women were conducted as part of the Maternal Child Health-Antiretroviral Therapy (MCH-ART) study. Primary elements of disclosure were coded and interpreted according to dominant themes and subthemes. Disclosure was commonplace in the sample, ranging from widely disclosing status (rare); to disclosing to some family, friends and partners; to tacit disclosure, where participants took medication in front of others without explicitly discussing their status. Women described reasons for non-disclosure in terms of not being ready, fear of negative reactions (including violence and loss of financial support), and fear of their status being widely known. Self-reported adherence was uniformly high throughout the range of disclosure. Even those who made special efforts to avoid disclosure, such as attending clinics distant from their homes, reported good adherence. Those who disclosed experienced a range of responses to their disclosure, from support to shunning. Despite access to ART, stigma remained a persistent feature in descriptions of disclosure, particularly in relation to partner disclosure. Our findings suggest that disclosure is not always positive and adherence can be maintained within a wide range of disclosure behaviours. It is important that clinic settings allow women to retain control over their disclosure process.

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