title: Do support groups members disclose less to their partners? The dynamics of HIV disclosure in four African countries.
abstract: BACKGROUND
  Recent efforts to curtail the HIV epidemic in Africa have emphasised preventing sexual transmission to partners through antiretroviral therapy. A component of current strategies is disclosure to partners, thus understanding its motivations will help maximise results. This study examines the rates, dynamics and consequences of partner disclosure in Burkina Faso, Kenya, Malawi and Uganda, with special attention to the role of support groups and stigma in disclosure.
  
  
  METHODS
  The study employs mixed methods, including a cross-sectional client survey of counselling and testing services, focus groups, and in-depth interviews with HIV-positive individuals in stable partnerships in Burkina Faso, Kenya, Malawi and Uganda, recruited at healthcare facilities offering HIV testing.
  
  
  RESULTS
  Rates of disclosure to partners varied between countries (32.7% - 92.7%). The lowest rate was reported in Malawi. Reasons for disclosure included preventing the transmission of HIV, the need for care, and upholding the integrity of the relationship. Fear of stigma was an important reason for non-disclosure. Women reported experiencing more negative reactions when disclosing to partners. Disclosure was positively associated with living in urban areas, higher education levels, and being male, while being negatively associated with membership to support groups.
  
  
  CONCLUSIONS
  Understanding of reasons for disclosure and recognition of the role of support groups in the process can help improve current prevention efforts, that increasingly focus on treatment as prevention as a way to halt new infections. Support groups can help spread secondary prevention messages, by explaining to their members that antiretroviral treatment has benefits for HIV positive individuals and their partners. Home-based testing can further facilitate partner disclosure, as couples can test together and be counselled jointly.
authors.affiliation: Amsterdam Institute for Social Science Research, University of Amsterdam, Kloveniersburgwal 48, 1012 CX, Amsterdam, The Netherlands. a.p.hardon@uva.nl
authors.forename: Anita
authors.initials: A
authors.lastname: Hardon
authors.forename: Gabriela B
authors.initials: GB
authors.lastname: Gomez
authors.forename: Eva
authors.initials: E
authors.lastname: Vernooij
authors.forename: Alice
authors.initials: A
authors.lastname: Desclaux
authors.forename: Rhoda K
authors.initials: RK
authors.lastname: Wanyenze
authors.forename: Odette
authors.initials: O
authors.lastname: Ky-Zerbo
authors.forename: Emmy
authors.initials: E
authors.lastname: Kageha
authors.forename: Ireen
authors.initials: I
authors.lastname: Namakhoma
authors.forename: John
authors.initials: J
authors.lastname: Kinsman
authors.forename: Clare
authors.initials: C
authors.lastname: Spronk
authors.forename: Edgar
authors.initials: E
authors.lastname: Meij
authors.forename: Melissa
authors.initials: M
authors.lastname: Neuman
authors.forename: Carla Makhlouf
authors.initials: CM
authors.lastname: Obermeyer
mesh_terms: D000328:Adult; D002050:Burkina Faso; D003430:Cross-Sectional Studies; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology*; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007630:Kenya; D008295:Malawi; D008297:Male; D012657:Self-Help Groups; D012747:Sexual Partners / Q000523:psychology*; D057545:Social Stigma; D014342:Truth Disclosure; D014454:Uganda; D055815:Young Adult