MSc (Med), Bioethics and Health Law, Steve Biko Centre for Bioethics, Faculty of Health Sciences, University of the Witwatersrand, 2009 / Disclosure of HIV status has been considered an important public health issue for some 20 years. Yet the ethical issues surrounding the disclosure of positive HIV status have not been examined comprehensively. This report examines the ethics behind the disclosure of HIV-positive status primarily or individuals to their sex partners, and for health care practitioners to a patient’s sex partner when the patient is unwilling to disclose. Relevant rights and ethical principles are analysed, including the rights to: self-preservation; privacy and confidentiality; and the bioethical principles of respect for autonomy, beneficence, non-maleficence, and justice. Historic and contemporary individual rights that people living with HIV (PLHIV) have regarding disclosure are emphasised, especially in adverse circumstances, where ethics can support non-disclosure based on the right to selfpreservation. Rights declarations and current disclosure guidelines for health care practitioners from several international and South Africa medical organisations also are reviewed. Of key importance to disclosure decisions are the specific situations of individuals in climates rife with stigma toward, and discrimination against, PLHIV, existing more or less worldwide. The potential negative impacts of disclosure are the basis for disclosure decisions of PLHIV. Research study results show that the negative impacts of disclosure can be severe for individuals, ranging from divorce or abandonment to community ostracism and even to murder. Relevant current theories of social justice related to HIV disclosure also are discussed. A conclusion is reached that, by decreasing stigma and discrimination against PLHIV and protecting individual rights related to HIV disclosure, prevention behaviours will be practised more widely, including ‘positive prevention’ by PLHIV and higher rates of disclosure. The eventual result will be the longterm public health goal of decreased spread of HIV.

Background: HIV prevalence is increasing and more people are being infected despite the messages and the advertising.1 Namibia has one of the highest HIV/AIDS prevalence rates in the world of 21.3% as at end of 2002. Two hundred and ten thousand people were estimated to be living with HIV/AIDS, more than one in five adults.2 Disclosure is very important for the prevention and control of HIV infection and is an essential part of behaviour modification, access and adherence to treatment. Aim: To determine knowledge, attitudes, and practices of HIV positive patients regarding disclosure of HIV results at Betesda clinic in Namibia. Objectives: To determine the participant profile, reasons for disclosure and non disclosure, to explore attitudes, knowledge and to understand practices of HIV positive patients with regard to disclosure of HIV results. Methods: This was a cross-sectional descriptive study done at Betesda clinic a private clinic in Katutura a high density suburb of Windhoek. Two hundred and sixty three HIV positive patients tested after 2004 were entered into the study. Convenience sampling of all willing HIV positive patients was done. A questionnaire was used; a professional interpreter and a counsellor were available. Permission to conduct the study was obtained from Betesda management; ethical clearance was obtained from the Post Graduate Committee and Human Research Committee of the University of the Witwatersrand. Epi Info statistical software package version 3.4.1 July 3 2007 was used to analyze data. An expert statistician was utilized to assist with analyzing data. Results: Two hundred and sixty three respondents were entered into the study. Sixty four percent were males, 41% were married, 28% were single, and 27% were cohabitating. 68% responded positively to what they thought about disclosure. Reasons for disclosure were 32% needed help, 25% partner to go for testing and 20% to let relatives know. Reasons for non disclosure were mainly fear of gossiping 79%. Seventy three percent had disclosed 60% within one week of knowing the results. Seventy three percent had disclosed to their partners, 23% had disclosed to more than one person. People’s reactions were 43% supportive, 29% understood, 9% accepted and 6% angry. Upon disclosure 40% received help, 24% partners were tested, 23% received psychological support and 5% were stigmatized. Disclosure was found to be higher among the married and cohabitating. Conclusion: Knowledge of disclosure was positive; most thought disclosure was important and good. Attitudes and practices towards disclosure were encouraging; people were disclosing but to trusted individuals in the society and fear of stigma was still there but actual stigma was very low.

Reports from the World Health Organization (WHO) indicate tremendous advancement in the fight against HIV/AIDS infection through prevention, provision of high-quality treatment options, and psychosocial services to infected and affected individuals and communities. However, there is still a considerable number of new infections occurring among children, especially in sub-Saharan Africa. Researchers highlight the benefits of HIV status disclosure to children. Yet, there is limited research concerning the ways counselors navigate the process of status disclosure to children with an HIV diagnosis. The purpose of this study was to examine the experiences of counselors regarding status disclosure to children living with HIV in Uganda, and to determine their self-identified training needs. I utilized a phenomenological qualitative research method and conducted individual interviews using a semi-structured interview protocol with 10 counselors from three HIV care centers in the central region of Uganda. Findings indicated six overarching themes including: (1) counselors' roles and responsibilities, (2) impact of age in the disclosure process, (3) motivations for disclosure, (4) challenges and barriers, (5) counselor preparations and trainings for disclosure, (6) and post-disclosure interventions. Study results highlight the critical role played by counselors during the HIV status disclosure process and the need for additional training and support to enable counselors to effectively support children and their caregivers. There is a need to further examine the effectiveness of current HIV status disclosure procedures and post-disclosure support interventions utilized by counselors within HIV care centers in Uganda.

Most children born with HIV are maturing into adolescence due to the accessibility of medical support, specifically the availability of antiretroviral drugs. During adolescence, children are faced with critical adolescent developmental tasks in that they develop physically, cognitively and psychosocially, including assuming independence. As the adolescents living with perinatally acquired HIV mature, their care-givers start disclosing the adolescents’ HIV status to them. Attaining the knowledge of living with HIV is encompassed with worries of how to manage the illness as well as other social ills such as taking care of sick loved ones and dealing with losses of loved ones. It is also during this stage of development that adolescents living with HIV begin to form intimate relationships, thus issues of self-disclosing their status become a concern. The aim of this study was to explore and describe the perceptions of adolescents perinatally infected with HIV regarding the self-disclosure of their status to others. Following this, it was hoped that the study would come to conclusions and make recommendations regarding the wellness of and support for adolescents living with perinatally acquired HIV. A qualitative descriptive research approach with an interpretive paradigm was used to explore and describe the perceptions of the adolescents. A multiple case study design was suitable to explore and describe the perceptions of participants as they see it. Ethical approval for the study was obtained from the relevant body. A sample of 10 adolescents perinatally infected with HIV, whose status had been disclosed to them and were receiving clinical care and psychosocial support at a local clinic in Port Elizabeth, were selected through purposive sampling. Consent to undertake the study was provided by the head of the clinic in Port Elizabeth as well as by the adolescents’ caregivers. Assent to partake in the study was also provided by the participants. A deeper understanding of participants perceptions was explored through utilising multiple sources of data collection methods which included reflective journals and semi-structured interviews. Multiple data collection methods were used in order to collect rich data and for crystallisation of the data to take place. After the data was analysed themes were identified and described leading to the findings of the study. The findings of the study confirmed the perceptions of adolescents living with perinatally acquired HIV regarding the self-disclosure of their status. Adolescents perinatally infected with HIV perceive certain conditions as conducive to self-disclose their status against other conditions that were perceived to be unfavourable for the self-disclosure of their HIV status. Conditions permitting self-disclosure included the availability of trusting relationships with people who understand them as well as the need for support which subsequently highlights the benefits of self-disclosure. Benefits included and are not limited to clinical support from healthcare professionals and an understanding from teachers when they are absent from school during their monthly clinical visits. Although adolescents see the benefits of selfdisclosing their status they are however aware of the possible negative effects to self-disclose their status such as stigmatisation and discrimination manifested through isolation from peers and through moral judgement and rejection from the community. Peers living with HIV are perceived to be the closest people providing them with trusting and open relationships that foster self-disclosure. Adolescents also perceived adulthood as a phase were self-disclosing their HIV status could be possible with the belief that they would be more mature when they are adults. Recommendations are made for healthcare professionals and policy makers to formulate and implement guidelines on supporting adolescents living with perinatally acquired HIV regarding the self-disclosure of their status. Providing measures of support for adolescents living with perinatally acquired HIV in their different ecological systems could widen the choice of to whom and when to self-disclose their HIV status. / M (Social Work), North-West University, Potchefstroom Campus, 2015

Most children born with HIV are maturing into adolescence due to the accessibility of medical support, specifically the availability of antiretroviral drugs. During adolescence, children are faced with critical adolescent developmental tasks in that they develop physically, cognitively and psychosocially, including assuming independence. As the adolescents living with perinatally acquired HIV mature, their care-givers start disclosing the adolescents’ HIV status to them. Attaining the knowledge of living with HIV is encompassed with worries of how to manage the illness as well as other social ills such as taking care of sick loved ones and dealing with losses of loved ones. It is also during this stage of development that adolescents living with HIV begin to form intimate relationships, thus issues of self-disclosing their status become a concern. The aim of this study was to explore and describe the perceptions of adolescents perinatally infected with HIV regarding the self-disclosure of their status to others. Following this, it was hoped that the study would come to conclusions and make recommendations regarding the wellness of and support for adolescents living with perinatally acquired HIV. A qualitative descriptive research approach with an interpretive paradigm was used to explore and describe the perceptions of the adolescents. A multiple case study design was suitable to explore and describe the perceptions of participants as they see it. Ethical approval for the study was obtained from the relevant body. A sample of 10 adolescents perinatally infected with HIV, whose status had been disclosed to them and were receiving clinical care and psychosocial support at a local clinic in Port Elizabeth, were selected through purposive sampling. Consent to undertake the study was provided by the head of the clinic in Port Elizabeth as well as by the adolescents’ caregivers. Assent to partake in the study was also provided by the participants. A deeper understanding of participants perceptions was explored through utilising multiple sources of data collection methods which included reflective journals and semi-structured interviews. Multiple data collection methods were used in order to collect rich data and for crystallisation of the data to take place. After the data was analysed themes were identified and described leading to the findings of the study. The findings of the study confirmed the perceptions of adolescents living with perinatally acquired HIV regarding the self-disclosure of their status. Adolescents perinatally infected with HIV perceive certain conditions as conducive to self-disclose their status against other conditions that were perceived to be unfavourable for the self-disclosure of their HIV status. Conditions permitting self-disclosure included the availability of trusting relationships with people who understand them as well as the need for support which subsequently highlights the benefits of self-disclosure. Benefits included and are not limited to clinical support from healthcare professionals and an understanding from teachers when they are absent from school during their monthly clinical visits. Although adolescents see the benefits of selfdisclosing their status they are however aware of the possible negative effects to self-disclose their status such as stigmatisation and discrimination manifested through isolation from peers and through moral judgement and rejection from the community. Peers living with HIV are perceived to be the closest people providing them with trusting and open relationships that foster self-disclosure. Adolescents also perceived adulthood as a phase were self-disclosing their HIV status could be possible with the belief that they would be more mature when they are adults. Recommendations are made for healthcare professionals and policy makers to formulate and implement guidelines on supporting adolescents living with perinatally acquired HIV regarding the self-disclosure of their status. Providing measures of support for adolescents living with perinatally acquired HIV in their different ecological systems could widen the choice of to whom and when to self-disclose their HIV status. / M (Social Work), North-West University, Potchefstroom Campus, 2015

<p><font size="4" face="TrebuchetMS,BoldItalic"><font size="4" face="TrebuchetMS,BoldItalic"> <p>The study used a qualitative approach. Fourteen (14) in-depth interviews were conducted with English and Luganda speaking adult male and female clients on antiretroviral treatment (ART), in TASO Mulago. A focus group discussion (FGD) was conducted with 8 purposively selected ART clients who were considered to be &lsquo / expert&rsquo / clients in TASO Mulago. These participants were expert clients/ peer educators, who were open about their HIV status and have been involved in HIV/AIDS education and advocacy. The individual interviews and the focus group discussion were transcribed verbatim, and subjected to thematic and content analysis. Male and female participants who were married (primary relationship) disclosed their sero-status to their sexual partners, while few of those cohabiting or in steady relationship (only one) disclosed to their partners. Enabling factors to disclose to current sexual partners included: desire for partner to get treatment, need for the partner&rsquo / s support, having prior knowledge of partner&rsquo / s HIV status, out of anger, and having anxiety about the future. Some of the barriers to disclosure included: fear of blame and disappointing the partner, fear of abandonment, fear of stigma and discrimination. Participants suggested that couple counselling and testing, economic independence, peer support and involvement of the TASO staff in disclosure should be considered to facilitate or promote disclosure to sexual partners.</p> </font></font></p>

<p><font size="4" face="TrebuchetMS,BoldItalic"><font size="4" face="TrebuchetMS,BoldItalic"> <p>The study used a qualitative approach. Fourteen (14) in-depth interviews were conducted with English and Luganda speaking adult male and female clients on antiretroviral treatment (ART), in TASO Mulago. A focus group discussion (FGD) was conducted with 8 purposively selected ART clients who were considered to be &lsquo / expert&rsquo / clients in TASO Mulago. These participants were expert clients/ peer educators, who were open about their HIV status and have been involved in HIV/AIDS education and advocacy. The individual interviews and the focus group discussion were transcribed verbatim, and subjected to thematic and content analysis. Male and female participants who were married (primary relationship) disclosed their sero-status to their sexual partners, while few of those cohabiting or in steady relationship (only one) disclosed to their partners. Enabling factors to disclose to current sexual partners included: desire for partner to get treatment, need for the partner&rsquo / s support, having prior knowledge of partner&rsquo / s HIV status, out of anger, and having anxiety about the future. Some of the barriers to disclosure included: fear of blame and disappointing the partner, fear of abandonment, fear of stigma and discrimination. Participants suggested that couple counselling and testing, economic independence, peer support and involvement of the TASO staff in disclosure should be considered to facilitate or promote disclosure to sexual partners.</p> </font></font></p>

Magister Public Health - MPH / The increased number of new infections in Uganda necessitates HIV prevention programmes that address risky behaviours especially among heterosexual populations. The AIDS Support Organisation (TASO) is the largest indigenous HIV/AIDS agency serving Uganda and the Great Lakes Region. TASO endeavours to empower sexually active clients to disclose their sero-status to their sexual partners and promotes partner testing for HIV. In spite of these efforts, only 12% of 2,071 sexually active clients in Mulago centre had disclosed by the end of 2006. This study aimed to explore the factors that influence clients’ decisions to disclose their HIV status to their partners in TASO Mulago, Kampala, Uganda. The study used a qualitative approach. Fourteen (14) in-depth interviews were conducted with English and Luganda speaking adult male and female clients on antiretroviral treatment (ART), in TASO Mulago. A focus group discussion (FGD) was conducted with 8 purposively selected ART clients who were considered to be ‘expert’ clients in TASO Mulago. These participants were expert clients/ peer educators, who were open about their HIV status and have been involved in HIV/AIDS education and advocacy. The individual interviews and the focus group discussion were transcribed verbatim, and subjected to thematic and content analysis. Male and female participants who were married (primary relationship) disclosed their sero-status to their sexual partners, while few of those cohabiting or in steady relationship (only one) disclosed to their partners. Enabling factors to disclose to current sexual partners included: desire for partner to get treatment, need for the partner’s support, having prior knowledge of partner’s HIV status, out of anger, and having anxiety about the future. Some of the barriers to disclosure included: fear of blame and disappointing the partner, fear of abandonment, fear of stigma and discrimination Participants suggested that couple counselling and testing, economic independence, peer support and involvement of the TASO staff in disclosure should be considered to facilitate or promote disclosure to sexual partners.While strategies like HBHCT and couple counselling have enhanced disclosure among sexual partners on ART living together in stable married relationships (primary), the partners in secondary relationships (cohabiting and steady) especially women, continue to face challenges in disclosure yet their sexual partners are at risk of HIV infection. The study has re-affirmed the fact that while some people living with HIV/AIDS wish to disclose their HIV status to their partners, there are compound factors that make it difficult to disclose. This calls for effective strategies by government, TASO and other agencies to ensure that sexual partners especially in cohabiting and steady relationships are disclosed to in order to reduce their vulnerability to HIV infection.

In the past twenty years a global trend has emerged illustrating increasing rates of violence against women, with HIV rates among this population also steadily on the rise. Despite the burden of the problem, there is scant corpus of literature exploring the influence of domestic violence on HIV. Therefore, this study examined the association between domestic violence and women’s decision to consent to HIV testing, and their HIV status. Using the 2007 Zambia Demographic and Health Survey, it was found that Zambian women who have experienced domestic violence are 13% more likely to consent to an HIV test. After adjusting for residence as a confounder, women who had experienced domestic violence were 11% more likely to test positive for HIV. Studies similar to this one could provide the basis for future policy and program planning that would have significant implications on violence against women in HIV prevalent populations.

The current report was an exploratory case study that utilsed a mixed mehtodology to consider the HIV and Aids wellness context of a South African small to Medium Enterprise (SME), hereafter called company A. This study aimed to investigate company A by observing the knowledge. Attitude and practices (KAP) of emmployees, as well as their reported behaviours on disclosure of HIV status. HIV and AIDS are critical issues, with South Africa, having the highest rate in the world (UNAIDS, 2010). While various projects are in place to promote prevention and decrease infection rate, infection statistics plateaued at a high leve. The situation in South Africa thus needs to be examined from a different perspective, approaching the epidemic as a case study, rather than through the systematic models and interventions used in the past. A KAP survey and open ended questionnaire were used, as they formed the forefront of the assumptions usally in interventions that look at behaviour change model such as the Health belief model (HBM) and social cognitive theory (SCT) and the relationship between knowledge, attitude and practices and dissclosure of HIV status. The research observed that while no clear cut relationships can be found between knowwledge, attitude, practices, and the decisin of whether to dissclose the HIV status, the context and experience of the epidemic is far from straightforward, and needs to be tackled in it`s entiriety. While the intention of policies and interventions may be good, without the requisite investigation of the context, the attempts may not be as successfull as they could be.