In conclusion, this study documents how the prison context is a social environment in which HIV positive ex – offenders experience the infectious nature of HIV/AIDS, VCT, and their process of HIV disclosure. In addition, HIV disclosure is a process that cannot solely be defined as a single event in the ex-offender‟s experiences. It is cyclical in nature as it involves active decision – making, weighing the costs against the benefits, and dealing with the outcomes of HIV disclosure. Indeed, being an HIV positive individual and an ex-offender has infiltrated through the process of disclosure as both identities are interconnected with other and are not void of meaning. What this implies is that for these participants there is never an endpoint to their process of disclosure. Thus, HIV disclosure is an ongoing process as the HIV positive ex-offender is embedded in various networks and relationships with significant others. It shows that to some extent ex-offenders were able to exercise active decision - making when they disclosed to significant others. What is particularly important is that we can find that the participant‟s experience of disclosure is influenced by the level of support that the participants
received both within and outside of the prison environment. While HIV/AIDS initially leads to debilitating effects on the ex-offender, it later becomes an experience of acceptance, self – motivation and positive role – modeling.
Although ex-offenders were able to exercise agency over their process of HIV disclosure, it is also vital to note that it also occurred where there are imbalances in power. This also highlights that those who control power within the prison context exercise their authority and practice within a politically – structured agenda. In addition, HIV disclosure
amongst ex-offenders takes place at multiple levels such as within prison, community and with significant others. In effect, HIV disclosure is continuous and is complex in nature.
To assume that HIV disclosure is uniform simplifies the process of disclosure. In sum, HIV disclosure is crucial for ex-offenders to gain insight into available prevention interventions.
6.2 Recommendations:
Based on this study, these are some of the recommendations:
6.2.1 Prison Conditions and VCT:
More research needs to be conducted on the extent to which South African prisons have played a role in the proliferation of HIV/AIDS. There also needs to be more efficient services provided at Government level as the government cannot ignore the crisis that is currently affecting South African prisons. Wellness programmes need to also be
implemented in order to identify which prisoners are in need for ARV treatment and care.
Government needs to acknowledge that prison should be the entry point for curbing HIV infection rates. In addition, South African prisons need to do regular HIV and CD4 count testing as well as tests for opportunistic infections. This implies that there needs to be a drastic change to the prison infrastructure.
6.2.2 Re - integration into the community and HIV disclosure
South African prisons also lack programmes which can assist offenders with developing skills in order to re-integrate themselves into the community as well as promote HIV disclosure. Upon release, offenders are merely placed into the community without appropriate skills on how to adapt to their new environment and progress in this environment. Offenders should be empowered so that they will be able to deal with stigma and discrimination when they are released from prison. Offenders also need to be provided with skills on how to disclose, when, as well as the possible benefits of
disclosure upon release from prison.
6.2.3 Access to ARV treatment and Care, employment opportunities
Future research also needs to look at whether ex-offenders have access to ARV treatment and should also alert ex-offenders on how they can promote their care as well as their physical, psychological and emotional well – being. Moreover, programmes should be implemented on how ex-offenders can take advantage of employment opportunities.
6.2.4 Significant other’s perspective
Although it is important to gain insight from the HIV positive ex-offender, it is also valuable to understand how significant others are managing the HIV disclosure as well as the status of an ex-offender. This was not within the scope of this study which needs to be explored further.
6.2.5 Policy
It is recommended that policy should be implemented within prison that addresses issues around HIV disclosure. More importantly, guidelines should be established on how prisons can protect the offender‟s HIV status. This implies that all the necessary prison authorities as well as relevant stakeholders should be involved in maintaining
confidentiality of testing for HIV in prisons. It can be suggested that all offenders should be given a nutritional diet irrespective of their status. In addition, the roll – out of ARV‟s within prison should be done more systematically and this can be addressed by more efficient healthcare staff within prison. This can be made possible by involving stakeholders such as non – governmental organizations, prison authorities, DCS.
6.3 Limitations:
The extent to which participants did disclose their HIV status to their partners and effectively negotiate safe sex is unknown as participants may have stated they were able to negotiate safe sex based on being part of the TAC and being positive role-models within their communities. In addition, being an Indian female could have also been problematic as participants may have felt discomfort when exploring issues around safe sex, intimacy, and prison life. Furthermore, if permission had been granted the research
could have taken place within the prison setting but at the time of the study it was not possible.
Research has also indicated that there is no evidence of a specific theory – related to HIV disclosure. This poses many limitations with the model of HIV disclosure decision – making. Firstly, it has ignored how VCT influences the process of disclosure. Secondly, it has ignored the socio-political and socio-economical context in which disclosure and the individual are embedded. By doing this, the way in which power influences HIV disclosure is downplayed. Thirdly, it reduces HIV disclosure as a simplistic process how the individual goes about doing a cost – benefit analysis, is ignored. Finally, it can be solely adopted for HIV positive individuals and not marginalized communities such as ex-offenders.