Atuyambe Lynn Muhimbuura, Ssegujja Eric, Ssali Sarah, Tumwine Christopher, Nekesa Nicolate, Nannungi Annette, Ryan Gery, Wagner Glenn
Department of Community Health and Behavioral Sciences, Makerere University School of Public Health, P,O,Box 7072, Kampala, Uganda.
BMC Health Serv Res. 2014 Jun 21;14:276. doi: 10.1186/1472-6963-14-276.
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.
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.
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.
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.
披露艾滋病毒感染状况有助于降低风险并促进获得预防和护理服务，但可能因担心负面后果而受到抑制。我们探讨了乌干达一家城市艾滋病毒诊所的就诊者披露感染状况的短期和长期结果。
对40名成年艾滋病毒感染者进行了定性半结构化访谈，样本按性别分层。收集的信息包括他们的生活经历以及短期和长期披露感染状况的结果。使用文本数据管理软件（ATLAS.ti）进行数据分析。代码导出到MS Excel并制作数据透视表，并进行代码计数以生成统计数据。
在访谈中就披露事件引发的134条短期反馈中，大多数反馈是支持性的，包括对艾滋病毒护理和治疗的鼓励、建议和支持。结果显示，向配偶披露感染状况后，信任度增加，且在艾滋病毒预防中使用避孕套。只有三分之一的反馈是负面的，如情绪冲击和痛苦感。对配偶的负面反应包括短期内的拒绝、震惊和痛苦。即便如此，这些事件均未导致诸如离婚等剧烈变化。其他反馈反映了艾滋病毒预防以及对行为改变的呼吁和改变性行为的建议、接受者寻求艾滋病毒检测或护理。与男性相比，女性报告的鼓励性反馈更多。与女性相比，男性报告的预防行为更多。在披露感染状况引发的137条长期结果中，四分之三是积极的，其次是行为改变和预防，然后是负面反馈。与女性向女性披露相比，男性向男性披露时报告获得了更多的护理和支持。女性向女性披露时关系改善或无变化的情况比向男性披露时更好。
对于披露艾滋病毒感染状况的个人，尤其是从长期来看，存在压倒性的支持。此外，性别似乎会影响对艾滋病毒披露的反应，凸显了制定针对性别差异的披露支持策略的必要性。
