title: HIV/AIDS status disclosure increases support, behavioural change and, HIV prevention in the long term: a case for an Urban Clinic, Kampala, Uganda.
abstract: BACKGROUND
  Disclosure of HIV status supports risk reduction and facilitates access to prevention and care services, but can be inhibited by the fear of negative repercussions. We explored the short and long-term outcomes of disclosure among clients attending an urban HIV clinic in Uganda.
  
  
  METHODS
  Qualitative semi-structured interviews were administered to a purposeful sample of 40 adult HIV clients that was stratified by gender. The information elicited included their lived experiences and outcomes of disclosure in the short and long term. A text data management software (ATLAS.ti) was used for data analysis. Codes were exported to MS Excel and pivot tables, and code counts made to generate statistical data.
  
  
  RESULTS
  Of the 134 short-term responses elicited during the interview regarding disclosure events, most responses were supportive including encouragement, advice and support regarding HIV care and treatment. The results show on-disclosing to spouse, there was more trust, and use of condoms for HIV prevention. Only one third were negative responses, like emotional shock and feeling of distress. The negative reactions to the spouses included rejection, shock and distress in the short term. Even then, none of these events led to drastic change such as divorce. Other responses reflected HIV prevention and call for behavioural change and advice to change sexual behaviour, recipient seeking HIV testing or care. Women reported more responses of encouragement compared to men. Men reported more preventive behaviour compared to women. Of the 137 long-term outcomes elicited during disclosure, three quarters were positive followed by behavioral change and prevention, and then negative responses. Men reported increased care and support when they disclosed to fellow men compared to when women disclosed to women. There was better or not change in relationship when women disclosed to women than when women disclosed to men.
  
  
  CONCLUSIONS
  There is overwhelming support to individuals that disclose their HIV status, especially in the long term. Besides, gender appears to influence responses to HIV disclosure, highlighting the need for gender specific disclosure support strategies.
authors.affiliation: Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, P,O,Box 7072, Kampala, Uganda. latuyambe@yahoo.com.
authors.forename: Lynn Muhimbuura
authors.initials: LM
authors.lastname: Atuyambe
authors.forename: Eric
authors.initials: E
authors.lastname: Ssegujja
authors.forename: Sarah
authors.initials: S
authors.lastname: Ssali
authors.forename: Christopher
authors.initials: C
authors.lastname: Tumwine
authors.forename: Nicolate
authors.initials: N
authors.lastname: Nekesa
authors.forename: Annette
authors.initials: A
authors.lastname: Nannungi
authors.forename: Gery
authors.initials: G
authors.lastname: Ryan
authors.forename: Glenn
authors.initials: G
authors.lastname: Wagner
mesh_terms: D000554:Ambulatory Care Facilities; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology; D006801:Humans; D008297:Male; D036301:Qualitative Research; D040242:Risk Reduction Behavior; D012944:Social Support; D011795:Surveys and Questionnaires; D019037:Urban Health Services