The Role of Disclosure in Enhancing Behavioural Change Among Young People Living Positively with HIV and AIDS:

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. The study explored the role of disclosure in enhancing behavioral change among young people living positively with HIV/AIDS. The study was conducted among young people clients attending an urban HIV clinic in Kampala.

Methodology: The study was a cross sectional study designed to cover a total sample of 138 respondents. Qualitative semi-structured questionnaires were administered to a purposeful sample of 138 young HIV clients that was stratified by gender. The information collected included their lived experiences, factors influencing disclosure, and outcomes of disclosure on behavior change among young people living positively with HIV. The study also established the relationship between disclosure and behavior change among HIV positive young people. Data collected was cleaned, edited, categorized, coded and summarized. The researcher analyzed quantitative data using SPSS computer package, and then generated, frequencies and tables. Qualitative data was coded and divided into various themes and sub-themes and then presented in narratives.

Results: A total of 138 respondents were interviewed. Of these, 60% were females and 40% were males. Results indicated that over 68.8% had disclosed their sero-status to other people, excluding the health care professionals, as compared to the 31% who had never disclosed. The results indicated that the rate of disclosure was higher among the female (40%) as compared to their male (22%) counterparts. The majority of respondents (31%) had disclosed to a health practitioner, followed by 19% who had disclosed to the family member, while only 2% had disclosed to a casual partner. This indicates that very few individual disclose their sero-status to the casual partners. The major barrier disclosure to sexual partners was fear of rejection or discrimination as indicated by the majority of respondents (72%). There was however no significant differences between males and females in other barriers to status disclosure. Sensitization was revealed as the most motivating factors (85%) for disclosure of HIV status to sexual partners. The study found out that there is a strong significant positive relationship between impact of non-disclosure and behavioral change (Chi-square = 13.389, P = 0.010) among the young people which is 95% confidence level. This means that if the young people don't disclose, they are not most likely not to change behavior.

Conclusions: There is overwhelming support to individuals that disclose their HIV status, especially in the long term. Besides, gender influence responses to HIV disclosure, highlighting the need for gender specific disclosure support strategies.

The decision to disclose one's HIV diagnosis is a difficult and often stressful process because of the potential costs of disclosure, such as social stigma and burden on others. In the study, these costs were weighed against potential benefits, such as social support and reduced risky sexual behavior. The findings indicate that HIV disclosure mediates reduced HIV risk and the further someone discloses he or her HIV status to the most significant ones, the more behavioral change is realized.