title: Disclosure of HIV results among discordant couples in Rakai, Uganda: a facilitated couple counselling approach.
abstract: Disclosure of HIV sero-positive results among HIV-discordant couples in sub-Saharan Africa is generally low. We describe a facilitated couple counselling approach to enhance disclosure among HIV-discordant couples. Using unique identifiers, 293 HIV-discordant couples were identified through retrospective linkage of married or cohabiting consenting adults individually enrolled into a cohort study and into two randomised trials of male circumcision in Rakai, Uganda. HIV-discordant couples and a random sample of HIV-infected concordant and HIV-negative concordant couples (to mask HIV status) were invited to sensitisation meetings to discuss the benefits of disclosure and couple counselling. HIV-infected partners were subsequently contacted to encourage HIV disclosure to their HIV-uninfected partners. If the index positive partner agreed, the counsellor facilitated the disclosure of HIV results, and provided ongoing support. The proportion of disclosure was determined. Eighty-one per cent of HIV-positive partners in discordant relationships disclosed their status to their HIV-uninfected partners in the presence of the counsellor. The rates of disclosure were 81.3% in male HIV-positive and 80.2% in female HIV-positive discordant couples. Disclosure did not vary by age, education or occupation. In summary, disclosure of HIV-positive results in discordant couples using facilitated couple counselling approach is high, but requires a stepwise process of sensitisation and agreement by the infected partner.
authors.affiliation: Uganda Virus Research Institute, Entebbe, Uganda.
authors.forename: Robert
authors.initials: R
authors.lastname: Kairania
authors.forename: Ronald H
authors.initials: RH
authors.lastname: Gray
authors.forename: Noah
authors.initials: N
authors.lastname: Kiwanuka
authors.forename: Fredrick
authors.initials: F
authors.lastname: Makumbi
authors.forename: Nelson K
authors.initials: NK
authors.lastname: Sewankambo
authors.forename: David
authors.initials: D
authors.lastname: Serwadda
authors.forename: Fred
authors.initials: F
authors.lastname: Nalugoda
authors.forename: Godfrey
authors.initials: G
authors.lastname: Kigozi
authors.forename: John
authors.initials: J
authors.lastname: Semanda
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Wawer
mesh_terms: D015492:AIDS Serodiagnosis; D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D003376:Counseling / Q000379:methods*; D005260:Female; D018023:HIV Seronegativity; D006679:HIV Seropositivity / Q000175:diagnosis*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012737:Sex Factors; D012747:Sexual Partners; D014342:Truth Disclosure; D014454:Uganda; D055815:Young Adult
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