title: The risks of partner violence following HIV status disclosure, and health service responses: narratives of women attending reproductive health services in Kenya.
abstract: BACKGROUND
  For many women living with HIV (WLWH), the disclosure of positive status can lead to either an extension of former violence or new conflict specifically associated with HIV status disclosure. This study aims to explore the following about WLWH: 1. the women's experiences of intimate partner violence (IPV) risks following disclosure to their partners; 2. an analysis of the women's views on the role of health providers in preventing and addressing IPV, especially following HIV disclosure.
  
  
  METHODS
  Thirty qualitative interviews were conducted with purposively selected WLWH attending clinics in Kenya. Data were coded using NVivo 9 and analyzed thematically.
  
  
  RESULTS
  Nearly one third of the respondents reported experiencing physical and/or emotional violence inflicted by their partners following the sero-disclosure, suggesting that HIV status disclosure can be a period of heightened risk for partner stigma and abuse, and financial withdrawal, and thus should be handled with caution. Sero-concordance was protective for emotional and verbal abuse once the partner knew his positive status, or knew the woman knew his status. Our results show acceptance of the role of the health services in helping prevent and reduce anticipated fear of partner stigma and violence as barriers to HIV disclosure. Some of the approaches suggested by our respondents included couple counselling, separate counselling sessions for men, and facilitated disclosure. The women's narratives illustrate the importance of integrating discussions on risks for partner violence and fear of disclosure into HIV counselling and testing, helping women develop communication skills in how to disclose their status, and reducing fear about marital separation and break-up. Women in our study also confirmed the key role of preventive health services in reducing blame for HIV transmission and raising awareness on HIV as a chronic disease. However, several women reported receiving no counselling on safe disclosure of HIV status.
  
  
  CONCLUSIONS
  Integration of partner violence identification and care into sexual, reproductive and HIV services for WLWH could be a way forward. The health sector can play a preventive role by sensitizing providers to the potential risks for partner violence following disclosure and ensuring that the women's decision to disclose is fully informed and voluntary.
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK; manuela.colombini@lshtm.ac.uk.
authors.forename: Manuela
authors.initials: M
authors.lastname: Colombini
authors.affiliation: Youth Programme, Save the Children US, London, UK.
authors.forename: Courtney
authors.initials: C
authors.lastname: James
authors.affiliation: Reproductive Health Program, Population Council, Nairobi, Kenya.
authors.forename: Charity
authors.initials: C
authors.lastname: Ndwiga
authors.affiliation: Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Susannah H
authors.initials: SH
authors.lastname: Mayhew
mesh_terms: D000328:Adult; D003376:Counseling; D030881:Disclosure; D005260:Female; D015658:HIV Infections / Q000523:psychology*; D006801:Humans; D000066511:Intimate Partner Violence; D007630:Kenya; D008297:Male; D034121:Reproductive Health Services; D012747:Sexual Partners / Q000523:psychology; D057545:Social Stigma; D011795:Surveys and Questionnaires
keywords: HIV disclosure; HIV-positive women; intimate partner violence; violence against women; women living with HIV