Acceptance of referral for partners by clients testing positive for human immunodeficiency virus

Figures & data

Figure 1 Semistructured questionnaire for new HIV-positive clients.

Figure 2 Semistructured questionnaire for service providers on partner notification after HIV-positive test.

Table 1 Theme results and comments from a qualitative study conducted on HIV referral acceptance by partners of clients testing HIV-positive, Addis Ababa, Ethiopia, 2012

Theme	Findings	Comments
1. Disclosure preference of HIV-positive clients.	Seven preferred to notify their partner(s) directly, while five preferred to disclose through close relatives rather than themselves. Four clients could not tell either.	Clients who prefer to disclose HIV-positive results to close relatives need to be encouraged and supported to disclose results to their partners.
2. HIV-positive clients’ knowledge about partner notification and referral.	Twelve clients knew the importance of partner notification and referral.	Knowledge of clients testing positive about partner notification and referral may not necessarily be linked with the actual practices which help partners to be referred and tested.
3. HIV-positive clients’ pretest discussion with partners.	Ten newly positively tested clients did not know the HIV status of their partners, and eight did not discuss with their partners that they planned to have an HIV test.	Failure to have a pretest discussion with partner(s) about having an HIV test may encourage clients to hold back an HIV-positive result from their partners.
4. HIV-positive clients’ desire for partner notification.	Twelve participants did not want to disclose their positive status immediately.	Fear of separation and bearing the burden of infidelity is a common reason for not wanting immediate disclosure.
5. Referral card acceptance by clients testing positive.	All clients testing positive agreed and took the referral card, but only eight were willing to provide the card to their partners.	Willingness to accept a referral card from counselors does not necessarily mean that HIV-positive clients are willing to provide the cards to their partners. This is the time when contractual referral and outreach assistance might be essential.
6. Referral acceptance by partners of HIV-positive clients.	Five of eight partners of clients testing positive who were provided with referral cards accepted referral and tested for HIV.	There is a high HIV test rate among partners who accept referral cards.
7. Getting partner locator information.	Nine of 11 counselors did not agree about seeking partner locator information from HIV-positive clients for contractual referral and/or outreach assistance.	HIV counselors do not fully comprehend the recommendations made by the International Guidelines on HIV/AIDS and Human Rights for service providers on making the decision to inform partners of patients testing HIV-positive.
8. Challenges to HIV-positive clients concerning partner notification and referral.	Fear of separation and divorce, stigma and discrimination, financial dependence on partners, and fear of the burden of infidelity in the relationship were mentioned as barriers to partner notification and referral.	HIV counselors need to identify specific challenges to HIV-positive clients and actively assist in the partner notification and disclosure process.
9. Recommendation by HIV counselors to improve HIV-positive partner notification and referral.	Improving access to HIV counseling and testing, providing thorough post-test counseling, and customizing partner notification based on clients’ context.	A comprehensive and client-contextualized partner notification and referral strategy has to be implemented.

Figure 3 Conceptual framework for comprehensive, integrated and active involvement of HIV counselors in partner notification and referral.