Page 1 of 6 Original Research

Disclosure of HIV status to sexual partners by people

living with HIV
Authors: Background: Disclosure of one’s HIV status to a sexual partner can have significant health
Gloria T. Tshweneagae1
implications. From a health promotion point of view, disclosure is seen as a cornerstone for
Victoria M. Oss1
Tennyson Mgutshini1 the prevention of HIV transmission between partners. Despite its importance as a strategy for
controlling the spread of HIV, there are challenges that inhibit voluntary disclosure.
Affiliations:
1
Department of Health Objectives: In exploring factors associated with disclosure of HIV status, the study had two
Studies, University of South complementary objectives related to: (1) investigation of participants’ views about HIV-
Africa, South Africa positive status disclosure to sexual partners; and (2) a broader identification of factors that
Correspondence to: influence disclosure of HIV-positive status.
Gloria Tshweneagae
Method: The study explored factors associated with disclosure of the HIV status of people
Email: living with HIV to their sexual partners. Purposive sampling was used to select 13 participants
[email protected] living with HIV who attended a wellness clinic. Primary data were collected via an in-depth
interview with each of the participants.
Postal address:
PO Box 392, Pretoria 0003, Results: The exploration showed that male participants were notably more reluctant to disclose
South Africa
to their sexual partners for fear of rejection; and secrecy was commonly reported around
Dates: sexual matters. Female participants (who were in the majority) were relatively more willing
Received: 30 Apr. 2013 to disclose their HIV status to their sexual partners. Despite the complexity of disclosure, all
Accepted: 16 Dec. 2014 participants understood the importance of disclosure to their sexual partners.
Published: 23 Mar. 2015
Conclusion: There is a need for HIV prevention strategies to focus on men in particular, so
How to cite this article:
as to strengthen disclosure counselling services provided to people living with HIV and to
Tshweneagae, G.T., Oss,
V.M. & Mgutshini, T., 2015, advocate strongly for partner testing.
‘Disclosure of HIV status to
sexual partners by people
living with HIV’, Curationis Introduction
38(1), Art. #1174, 6 pages.
http://dx.doi.org/10.4102/ Disclosure of one’s HIV status to a sexual partner can have significant health implications. The
curationis.v38i1.1174 first of these is that the negative outcomes of disclosure can be both severe for and detrimental to
those affected; and because the second is that low rates of disclosure may lead to increased cases
Copyright:
© 2015. The Authors. of HIV transmission to others (United States Agency for International Development [USAID]
Licensee: AOSIS 2006:10–11). In South Africa, new infections are reported every day despite the interventions and
OpenJournals. This work is efforts put in place to fight the pandemic. Given this trend, strategies to increase disclosure may
licensed under the Creative
Commons Attribution
be a way of reducing new infections.
License.
The Burnet Institute (2010:17) states that HIV infections continue to spread each year. New
infections mean that infected people have sex with those who were not previously infected and
they then become infected. Ignorance of the sexual partner status has also been shown as the
main reason for the spread of HIV.

Whilst disclosure can be an important strategy for controlling the spread of HIV, because of the
protective benefits to both individuals and the health system, there are challenges that inhibit
voluntary disclosure (Maman et al. 2001); these challenges require measures to help people
living with HIV (PLWH) to deal with them (Adedimeji 2010:17). Voluntary HIV counselling and
Testing (VHCT) has also proved to be helpful in assisting PLWH to disclose their HIV status to
their significant other persons (Gatta & Thupayagale-Tshweneagae 2012).

VHCT provides access to structured therapeutic intervention so that affected individuals and
couples can make informed health-promoting choices about being tested for HIV (Shangula
Read online: 2006:23). Along with testing, HIV counselling plays an important role as a prevention
Scan this QR intervention. Initial awareness about one’s status serves as an important first step that allows
code with your
smart phone or affected individuals a chance to better understand the health implications of their HIV status and
mobile device make informed choices for the future. To this end, the development of affordable and effective
to read online.
medical care for people living with HIV is urgently needed to improve access and quality of

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 Page 2 of 6 Original Research

service because of increased demand (IPPF South Asia disclosure amongst PLWH to sexual partners, this might
Regional Office and UNFPA 2004:6). contribute to a reduction in the rate of new infections,
because when boyfriends, girlfriends, husbands and wives
know about the status of their partners, they will take
Problem statement
measures to protect themselves at all times. This could then
Contemporary literary sources show that there is limited contribute to a lower mortality rate and could also prolong
disclosure of one’s HIV status to a sexual partner (Almeleh life expectations and productive active participation in daily
2004:139; Gari, Habte & Markos 2010:88). Partners who are life, knowing that significant other people know about one’s
HIV-positive usually disclose their status to other family HIV status.
members, such as parents and siblings, but rarely to their
sexual partners (Harris & Touray 2004:12; Horn 2010:1). The The burden of guilt and secrecy associated with non-
principal investigator, at her place of work in a wellness disclosure will be minimised. Disclosure also encourages
clinic, anecdotally found that patients, especially women healthy attitudes as partners come to understand and
who tested HIV-positive, were reluctant to share their approach safer practices, such as abstinence, sticking to one
diagnosis with their sexual partners, preferring rather to tell sexual partner and using protection, amongst others. The life
their parents or siblings. of both the infected and affected can thus be prolonged, as all
of the above factors work synergistically to not only prolong
In 2008, the Northern Cape had a lower prevalence rate of their lives but also to promote both their relevance and
HIV compared with other provinces in South Africa productive participation in daily activities, at home amongst
(Department of Health 2008). However, a study by Isaacs their families and in society.
and Hara (2008) on mainstreaming of HIV into South African
Fisheries Policy, showed that the population studied in the Research methods and design
Northern Cape were not aware of the underlying contributory
factors for HIV (Isaacs & Hara 2008:8). One of these factors
Design
may be the reluctance to disclose one’s HIV status to sexual A qualitative study using in-depth interviews was conducted
partners. with 13 purposively-selected participants living with HIV.
The target population was made of both male and female
Purpose of the study participants living with HIV, who attended the wellness
clinic at Galeshewe Day Hospital in the Northern Cape and
The purpose of the study was to explore factors associated
who were between the ages of 18 and 45 years. This age
with disclosure of HIV status by PLWH to their sexual
group was selected because, according to Avert (2010:47),
partners with the aim of improving HIV interventions for
almost one in three women aged between 25 and 29 years
PLWH.
is affected and over a quarter of men aged between 30 and
34 years is affected in sub-Saharan Africa. Generally the
Research objectives population most affected globally is between the ages of 15
There were two objectives for this study, namely: and 49 years (UNAIDS 2010:29). The lower limit of the age
• To investigate participants’ views about HIV-positive group for this study was chosen based on the age of consent
status disclosure to sexual partners at the Galeshewe Day in South Africa.
Hospital Wellness Clinic in Kimberly (in the Northern
Cape Province). Data collection method
• To identify factors that influence disclosure of HIV-
Data were collected over a three-week index period.
positive status to sexual partners.
Community counsellors at the wellness clinic assisted with
recruitment of participants following the eligibility criteria,
Research questions after which the primary researcher contacted participants
The study purported to answer two research questions as: telephonically to secure appointments. Out of 18 recruited
• What are the participants’ views about HIV-positive participants, one declined, one did not answer her phone and
status disclosure to sexual partners? the other one had left the village by the time of contact. Two
• What are the factors that influence disclosure of HIV- more did not show up for the assigned time of the interview.
positive status to sexual partners? The remaining 13 participants were seen on separate dates,
depending on their availability. The principal investigator
explained the consent form to each participant before the
Contribution to field actual interview. A list of questions was prepared to guide
Factors associated with disclosure of HIV status to sexual the interview but questions were made open to allow
partners would assist in improving planning for HIV participants the freedom to expand on them.
interventions amongst PLWH. Disclosure of HIV status
offers considerable benefits from both an individual and The interviews were conducted in Tswana because the
a public health perspective (World Health Organization participants were more familiar and comfortable with
[WHO] 2003). If measures are put in place to increase the language. Although the consent form was in English, the

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researcher explained it clearly in Tswana. Each participant TABLE 1: Demographic data of participants.
was interviewed at the identified private room at the hospital. Demographic variables Number Percentage
The interviews lasted between 30 and 45 minutes, depending Age
on the participant. 20–25 1 7
26–30 3 24
31–35 2 15
Interviews were tape recorded with the permission of the
36–40 5 39
participants and field notes were also made during the
41–45 2 15
interview. Gender
Female 10 77

Data analysis Male 3 23

Marital status
Data from each component of the study were analysed using Single 9 69
Joubert and Ehrlich’s (2007) principles of content analysis. Customary marriage 1 8
According to Joubert and Ehrlich (2007:324), the first step Civil marriage 1 8
of data analysis entailed the search for broader categories Cohabiting 2 15
from the transcripts from the audiotaped interviews so as to Educational level
Never attended school 0 0
acquire a sense of the way in which participants expressed
Up to Grade 7 1 8
the factors associated with disclosure. Tabulation and
Grade 8 to 10 1 8
frequencies were used to order similar categories and, in Grade 11 to 12 11 84
the final step, thematic strands were woven together into an Employment status
integrated picture of the factors associated with disclosure of Unemployed 12 92
HIV status to sexual partners. Employed 1 8
Number of children

Results and discussion 0

1–2
3
8
23
62
Two major themes emerged from the study, namely, support 3 2 15
and sexuality. The support theme had two categories – 6 or more 0 0
partner reaction to disclosure and partner support – and the
sexuality theme had one category, namely, the desire to have cohabitation was a real problem for most poor women. This
children. did not seem to be the case in the present study as most of
the female participants (n = 10) were unemployed but did
The findings are presented as demographic data and as not opt to cohabit.
themes that emerged from the study.
The majority of participants in the study were unemployed
Demographic data of study participants (n = 12). Two of the participants received social grants and
most were dependent on their parents.
In the present study, the most represented age group (n = 5)
was the 36- to 40-year olds, followed by the 26–30-year age
The majority of the participants (n = 10) were women. Eleven
groups, represented by three participants. There were two
of the participants were literate and had attended school up
participants in the 31–35 and 41–45 age groups and one in
to Grade 12, whereas two of the participants had finished
the 20–25 age group (Table 1).
school with either Grade 7 or Grade 8.

The sample confirms Avert’s (2010: 3) assertion that almost

The majority of participants (n = 8) had one or 2 children, only
one in three women aged 25–29 and more than a quarter of
2 participants had 3 children and 3 out of 13 participants did
men aged 30–34 are affected in sub-Saharan Africa. The not have children because of a fear of being in a relationship.
Third South African National HIV Communication Survey According to the WHO (2010:2), the fertility rate is at 2.5
(John Hopkins Health and Education in South Africa for children born per woman. South Africa has experienced
2012:1) also asserts that HIV prevalence peaks at 32.7% a 40% decline in fertility from pre-transition. It has also
amongst women aged 25–29 years, whilst for men, it peaks emerged in the survey done by the South African Institute
at 25.8% in the 30–34-year age group. This is also supported of Race Relations (2009:51) that South African women are
by the literature, which indicates that generally, the having fewer and fewer children.
population most affected globally are the 15–49 age group
(UNAIDS 2010:5).
Themes and categories generated from the study
The majority of the sampled participants (n = 9) were Two themes, one of which had two categories, emerged from
single. Two were married according to either civil law or the qualitative data. Each of the themes will be discussed
customary (marriage) law and two were cohabiting. This and the participants’ narratives will be presented in order to
is in contrast with the study performed by Budlender, support the findings. The themes and categories generated
Chobokoane and Simelane (2004:5), which found that from the data are displayed in Table 2.

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TABLE 2: Themes and categories generated from the study. and Education in South Africa 2012:5) reveals that amongst
Themes Categories those who have ever been tested and who know their status,
Support Partner reaction to disclosure. 86% were willing to share their HIV status during the
Partner support.
Sexuality Desire to have children.
interview. In another study, Iwuagwu (2009:56) reported that
all his participants had disclosed their status to their
husbands or partners; and Seid et al. (2012:100) reported
TABLE 3: Partner reaction to disclosure. 93.1% disclosure to sexual partners. This finding supports a
Partner reaction Participants’ narratives number of reviewed studies which reported high rates of
Fear ‘I feel that informing a new partner about my status will scare disclosure amongst females. (Iwuagwu 2009:56; Seid et al.
them away. One partner freaked after I informed her about
my status and she stopped contacting me, I later told her I 2012:100; UNAIDS 2010:5).
was joking and then she came back.’ (P1, Male, 28 years old)
Ignorance ‘When I told him, he just took it lightly. He would sometimes
bribe me into not using a condom. The day I informed Few participants argued that the fear of being rejected by their
him, we did not have condoms but he insisted on having
unprotected sex.’ (P2, Female, 42 years old) partners hindered them from disclosing their status. This is
Anger ‘He was furious with me at first after I informed him about my also reported in literature such as the study from USAID/
status. He deserted me for one month but later accepted and
started supporting me and reminding me to take treatment.’ Synergy (2006), which argues that perceived negative
(P6, Female, 35 years old) reactions discourage people from disclosing their status.
Secrecy ‘When I told him, he said he is HIV-positive. He did not inform
me before that he was HIV-positive.’ (P3, Female, 32 years old)
‘We did couple testing. He remained quiet for some time No participant mentioned any form of discrimination, which
after receiving the result and later he began to be supportive was indicated by their willingness to disclose their status.
and confessed that he had a relationship with a partner who
had died because of AIDS.’ (P4, Female, 41 years old) This is reinforced by the findings of the Third South African
Rejection ‘He did not support the child after I informed him about my National HIV Communication Survey (John Hopkins Health
status until I applied for maintenance and took a DNA test
and we are no more together.’ (P5, Female, 32 years old). and Education in South Africa 2012:5), which alluded
‘My partner left me when the child was one year old after to the fact that social stigma is gradually disappearing,
I informed him about my status.’ (P9, Female, 38 years old)
Silence ‘We went for couple testing, and he tested negative. He was
largely because of HIV communication programmes and a
quite after testing and later he started to be supportive and cumulative behaviour change in South Africa over the last
confessed that he had a relationship with a partner who died
of AIDS.’ (P6, Female, 41 years old) 10 years. Factors that the participants felt would disable their
Acceptance ‘When I disclose to him, I said, “you will be sitting on a disclosure included not knowing where to start, difficult
mattress next year”, and he said the same thing.’
(P7, Female, 41 years old) partners and fear of rejection.

Although few participants feared disclosure, they were in

Theme 1: Support
agreement in their acknowledgement that it was a difficult
The first theme that emerged was ‘support’, which emerged
process. They communicated the need to disclose in order
as two discernable categories, namely, ‘partner reaction to
to protect their partners from contracting the disease. This
disclosure’ and ‘partner support’.
was seen as a way of ensuring more mutually supportive
relationships between partners.
Category 1: Partner reaction to disclosure: The majority of
the participants (n = 9) had disclosed their status to their
The other interesting finding of the study was the reluctance
sexual partners. Three participants had not disclosed because
of men to disclose their status to their sexual partners. Men
they were not involved in relationships at the time of the
remained silent about their status until their partner(s) tested
study. However, these participants maintained that if they
positive – and that is the only time when they admitted that
were in relationships, they would tell their partners. One
they had suspected something regarding their own status
participant did not disclose his status because he feared
all along. This was supported by Seid et al. (2012:102) who
rejection. The variety of partner reactions, covering fear,
also state that silence in male partners could be indicative
ignorance, anger, secrecy, rejection, silence and acceptance, is
of the fact that they were already infected. This assertion
displayed in Table 3.
is consistent with the findings at Jima University Hospital
Two of the participants were rejected after disclosing their in Ethiopia, where it emerged from the study that couples
status. Silence, acceptance and secrecy about the status were testing helps to facilitate disclosure (Erku, Megabiaw &
also experienced. This study supports Deribe et al. (2008:81) Wubshet 2012:86).
and Greeff et al.’s (2008:311) findings, which highlighted
that although positive effects of disclosure have been An interesting finding from the study was that participants
identified, such as acceptance and support, there are also used cultural explanations to disclose their HIV status to
potential consequences associated with disclosure, such as their partners. Culture pervades all areas of life, including
abandonment and discrimination. the explanation for HIV and its disclosure to partners. The
statements from participants that could only be understood
In general, the study showed some willingness for partners by persons of the same culture are:
to inform their partners of their status. This finding is well • Laying on the mattress.
supported in literature. For instance, the Third South African • Let’s allow it to happen.
National HIV Communication Survey (John Hopkins Health • Lighting the candle.

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 Page 5 of 6 Original Research

The three statements can only be understood to mean formal letter from University of South Africa (UNISA).
‘death’ by the Tswana ethnic groups and are an indirect Participants signed the consent form after a thorough
way of saying, ‘I am HIV positive’. Literature calls it cultural explanation of the study was given. The principle of
diversity (Turan et al. 2014:3) and it is a clear demonstration beneficence was adhered to in this study – the researcher
that in every culture there are basic standards of social ensured that participants were comfortable and were
interaction. interviewed in a private room away from noise and prying
eyes. Confidentiality, privacy and anonymity were also
Category 2: Partner support: Six of the participants received maintained throughout the study. Participants were
support from partners after disclosure. Although the reassured that the information they provided would not be
partners had an initial negative reaction to the news, they traceable to them and that their names would not be
later accepted the information and offered their partners mentioned in any document or manuscript emanating from
support. Quotes that supported this category are as follows: the study. All the transcripts were kept under lock and key
‘He was furious with me at first. He deserted me for one month in the second author’s office. The participants were further
but later accepted and started to support me and even reminded informed that they had the right to refuse to participate in
me to take treatment.’ (P6, Female, 35 years old) the study and that they could withdraw from it at any time
‘We went for couples testing and he tested negative. He was quiet during the course of the study.
afterwards, but he later started to be supportive and confessed
that he had a relationship with a partner who had died because Trustworthiness
of AIDS.’ (P3, Female, 41 years old)
To facilitate trustworthiness of data, a close adherence to
the strategies established by Lincoln and Guba (1985:112),
The observations within the current study support the
was ensured. Member and peer checking were utilised as
findings by Gari et al. (2010:86), who concluded that
the primary interventions to ensure credibility of the data.
disclosure of HIV status to sexual partners is beneficial in that
With regard to the former that is, ‘member checking’, a
it may motivate the other partner to seek HIV counselling
précis of data collated from the interview was discussed
and testing. It may contribute towards the reduction of risky with each participant so as to elicit their views about the
behaviour and is associated with increased mutual partner accuracy of collected data. With respect to ‘peer checking’,
support and adherence to antiretroviral therapy (ART). the coder and the researchers coded data independently and
later compared their themes for agreement. Disagreements
Theme 2: Sexuality were discussed and clarified until consensus was
Sexuality is defined by Zimmerman and Dahlberg (2008:71) reached. In order to achieve dependability for the study,
as a unique (individual) expression of our sexual side which the researcher developed an audit trial. The findings
is based on our values, beliefs, experiences and feelings about were made open to scrutiny by the study supervisor.
ourselves in relation to sex. Nominated samples and dense descriptions were provided
to ensure transferability. The researchers visited the study
Three of the participants had difficulties in having sexual site three times before data collection so as to acquaint
relationships as supported by the following quotes: themselves with the prospective participants and develop
a trusting relationship. Visits to the study site were also
Fear of relationships: ‘I thought when you are HIV positive
done frequently by the first author in order to maintain
you cannot be involved in sexual relationships.’ (P9, Female,
contact with the participants. The first author works in the
38 years old)
area, thus prolonged engagement with the field and the
Experience of rape: ‘I tried to pursue relationships when I was in participants occurred automatically.
Grade 11 but it was difficult for me to engage in sexual activities
because of that experience.’ (P5, Female, 28 years old)
Failure to obtain interest from potential partners: ‘At first,
Limitations of the study
they would give me promises but the next day they would The limitations of this study include sampling and
suddenly change their minds. I have given up hope, but dissemination issues. The sample was very small and
next time I will try to pursue people of the same HIV status.’ dominated by more women than men, which makes
(P8, Male, 39 years old) generalisation of the findings difficult. Although not
generalisable, our findings reflect those of others in settings
Ethical considerations such as Botswana and Zimbabwe. Data collection was
completed approximately two years ago and dissemination
Adherence to sound ethical principles including the of this finding will only be done this year, which could be a
unequivocal protection of respondents was maintained potential problem as a lot of things might have changed in
throughout this study. In advance of study commencement, the intervening years.
ethical clearance was applied for and obtained from
Research and Ethics Committee of the Department of Health
Studies at the University of South Africa (HSDC 60/2011). Recommendations
Site-access approval was obtained from Galeshewe Day HIV counsellors should be encouraged to discuss the
Hospital Wellness Clinic after communicating through a importance of disclosure to their patients. From the findings

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 Page 6 of 6 Original Research

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