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The duty to disclose in Kenyan health facilities: a qualitative investigation of HIV disclosure in everyday practice.
- Source :
-
SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance [SAHARA J] 2013 Jul; Vol. 10 Suppl 1, pp. S60-72. Date of Electronic Publication: 2013 Jul 04. - Publication Year :
- 2013
-
Abstract
- Disclosure of HIV status is routinely promoted as a public health measure to prevent transmission and enhance treatment adherence support. While studies show a range of positive and negative outcomes associated with disclosure, it has also been documented that disclosing is a challenging and ongoing process. This article aims to describe the role of health-care workers in Central and Nairobi provinces in Kenya in facilitating disclosure in the contexts of voluntary counselling and testing and provider-initiated testing and counselling and includes a discussion on how participants perceive and experience disclosure as a result. We draw on in-depth qualitative research carried out in 2008-2009 among people living with HIV (PLHIV) and the health workers who provide care to them. Our findings suggest that in everyday practice, there are three models of disclosure at work: (1) voluntary-consented disclosure, in alignment with international guidelines; (2) involuntary, non-consensual disclosure, which may be either intentional or accidental; and (3) obligatory disclosure, which occurs when PLHIV are forced to disclose to access services at health facilities. Health-care workers were often caught between the three models and struggled with the competing demands of promoting prevention, adherence, and confidentiality. Findings indicate that as national and global policies shift to normalize HIV testing as routine in a range of clinical settings, greater effort must be made to define suitable best practices that balance the human rights and the public health perspectives in relation to disclosure.
- Subjects :
- AIDS Serodiagnosis
Adolescent
Adult
Antiretroviral Therapy, Highly Active
Child
Confidentiality
Counseling
Culture
Female
Guideline Adherence
Guidelines as Topic
HIV Infections drug therapy
HIV Infections epidemiology
HIV Infections prevention & control
Health Facilities economics
Health Personnel legislation & jurisprudence
Health Personnel psychology
Humans
Kenya epidemiology
Male
Qualitative Research
Self Disclosure
Social Discrimination
Social Stigma
Young Adult
Attitude to Health
Duty to Warn
HIV Infections psychology
Health Facilities standards
Health Personnel ethics
Professional-Patient Relations
Truth Disclosure ethics
Subjects
Details
- Language :
- English
- ISSN :
- 1813-4424
- Volume :
- 10 Suppl 1
- Database :
- MEDLINE
- Journal :
- SAHARA J : journal of Social Aspects of HIV/AIDS Research Alliance
- Publication Type :
- Academic Journal
- Accession number :
- 23826931
- Full Text :
- https://doi.org/10.1080/02664763.2012.755339