Disclosure of HIV results among discordant couples in Rakai, Uganda: a facilitated couple counselling approach.
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.
Kairania
Robert
R
Uganda Virus Research Institute, Entebbe, Uganda.
Gray
Ronald H
RH
Kiwanuka
Noah
N
Makumbi
Fredrick
F
Sewankambo
Nelson K
NK
Serwadda
David
D
Nalugoda
Fred
F
Kigozi
Godfrey
G
Semanda
John
J
Wawer
Maria J
MJ
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
AIDS Care. 2001 Oct;13(5):595-603
11571006
AIDS Behav. 2003 Dec;7(4):373-82
14707534
AIDS. 2000 Oct 20;14(15):2371-81
11089626
AIDS Care. 2003 Jun;15(3):379-87
12745398
BMJ. 1992 Jun 20;304(6842):1605-9
1628088
AIDS Care. 2008 Jan;20(1):80-92
18278618
J Acquir Immune Defic Syndr. 2002 May 1;30(1):73-80
12048366
J Acquir Immune Defic Syndr. 2000 Feb 1;23(2):194-202
10737435
AIDS. 1997 Sep;11 Suppl 1:S103-10
9376093
Int J STD AIDS. 1997 Apr;8(4):243-50
9147157
AIDS. 2003 Oct 17;17(15):2245-52
14523282
AIDS. 1995 Jul;9(7):745-50
7546420
AIDS. 2008 Mar 12;22(5):617-24
18317003
AIDS. 2005 Mar 24;19(6):603-9
15802979
J Assoc Nurses AIDS Care. 2005 Nov-Dec;16(6):33-47
16536263
Bull World Health Organ. 2004 Apr;82(4):299-307
15259260
Curr HIV Res. 2007 Jul;5(4):416-29
17627505
AIDS. 1999 Jun 18;13(9):1083-9
10397539
Lancet. 2001 Apr 14;357(9263):1149-53
11323041
AIDS Behav. 2007 Sep;11(5):698-705
17082982
N Engl J Med. 2000 Mar 30;342(13):921-9
10738050