HIV-serostatus disclosure in the context of free antiretroviral therapy and socio-economic dependency: experiences among women living with HIV in Tanzania

  • Leah F Bohle
  • Hansjörg Dilger
  • Uwe Groß


The worldwide implementation of free antiretroviral therapy (ART) raised great hopes among policy makers and health organisations about the positive changes it would bring about in attitudes and behaviours towards HIV and AIDS, as well as for infected people’s lives. A change in illness perception was anticipated, leading to the hypothesis of a possible change in disclosure rates, patterns and the choice of significant others to inform. In the era of free treatment availability in the United Republic of Tanzania, we examined reasons for disclosure and non-disclosure among HIV-seropositive women enrolled on ART and their choice of significant others to inform. In so doing, we contribute to the necessary yet neglected debate about the social impact of ART on the lives of infected women. The study, for which an ethnographic cross-sectional pilot approach was chosen, was conducted at the Care and Treatment Center (CTC) at Bombo Regional Hospital (BRH) in Tanga city, Tanzania. Data presented here derive from participant observation, questionnaires and semi-structured interviews conducted with 59 HIV-seropositive women on ART. Interestingly, and despite treatment availability, the choice of significant others to inform, as well as reasons for disclosure and non-disclosure, mirror findings from previous studies conducted before the introduction of free ART. The main reason for non-disclosure was fear of discrimination. The hope for social, economic or health support was the main motivation for disclosure, followed by the need for a ‘clinic companion’ in order to receive ART, as requested by hospital staff. Nevertheless, healthcare staff were not unanimous in thinking that disclosure is always beneficial, thus the recommended extent of disclosure varied. ART and concomitant factors were raised as an entirely new and significant reason for disclosure by interviewees. Finally, findings confirm that despite ART, disclosure remains a highly stressful event for women.

Keywords: AIDS, HAART, living with antiretroviral therapy, qualitative, multi-method approach, HIV/AIDS policy, gender, East Africa

African Journal of AIDS Research 2014, 13(3): 215–227

Author Biographies

Leah F Bohle
Institute for Medical Microbiology, Göttingen University Medical School, University of Göttingen, Kreuzbergring 57, 37075 Göttingen, Lower Saxony, Germany; Swiss Tropical and Public Health Institute (Swiss TPH), Swiss Centre for International Health (SCIH), Socinstrasse 57, PO Box 4002, Basel, Switzerland; associated Institute of the University of Basel
Hansjörg Dilger
Institute of Social and Cultural Anthropology, Freie Universität Berlin, Landoltweg 9-11, 14195 Berlin, Germany
Uwe Groß
Institute for Medical Microbiology, Göttingen University Medical School, University of Göttingen, Kreuzbergring 57, 37075 Göttingen, Lower Saxony, Germany

Journal Identifiers

eISSN: 1608-5906
print ISSN: 1727-9445