Disclosure of HIV results among discordant couples in Rakai, Uganda: a facilitated couple counselling approach

Abstract

Disclosure of HIV sero-positive results among HIV-discordant couples in sub-Saharan Africa is generally low. We describe a facilitated couple counselling approach to enhance disclosure among HIV-discordant couples. Using unique identifiers, 293 HIV-discordant couples were identified through retrospective linkage of married or cohabiting consenting adults individually enrolled into a cohort study and into two randomised trials of male circumcision in Rakai, Uganda. HIV-discordant couples and a random sample of HIV-infected concordant and HIV-negative concordant couples (to mask HIV status) were invited to sensitisation meetings to discuss the benefits of disclosure and couple counselling. HIV-infected partners were subsequently contacted to encourage HIV disclosure to their HIV-uninfected partners. If the index positive partner agreed, the counsellor facilitated the disclosure of HIV results, and provided ongoing support. The proportion of disclosure was determined. Eighty-one per cent of HIV-positive partners in discordant relationships disclosed their status to their HIV-uninfected partners in the presence of the counsellor. The rates of disclosure were 81.3% in male HIV-positive and 80.2% in female HIV-positive discordant couples. Disclosure did not vary by age, education or occupation. In summary, disclosure of HIV-positive results in discordant couples using facilitated couple counselling approach is high, but requires a stepwise process of sensitisation and agreement by the infected partner.

Keywords:

• HIV disclosure
• facilitated couple counselling
• discordant couples

Acknowledgements

This study was funded by the National Institutes of Health (#U1AI51171), the Bill and Melinda Gates Foundation (#22006.02) and the Fogarty International Centre (#5D43TW001508 and #D43TW00015). This study was also supported by the Intramural Research Program of the National Institute of Allergy and Infectious Diseases, NIH. The authors would like to thank the study participants whose commitment and cooperation to disclosure made this study a success. We also thank the field counsellors for their continuous endurance and effort in locating, counselling and mobilising these couples without whom this study would have not proceeded. Finally, we thank Rakai Health Sciences Programme management for all the support in developing this paper.