According to WHO (2004) disclosure is a situation where information about one’s HIV status is shared with one or more people (spouse, children, parents, friends, caregiver, employer etc). This entails making decisions about whom, how, and when to tell. Disclosure is an act or process of revealing or uncovering what has previously been confidential. Harrison, Colvin, Kuo, Swartz and Lurie (2015) stipulate that disclosure is a crucial element of adherence to any treatment.
Therefore it has to be carefully done strictly observing the personality of the individual disclosing. Harrison et al. (2015) emphasise that disclosure for any illness has to be done as one of the coping strategies employed not only in support groups but also in a hospice, where elderly people are kept each with their own traumatic chronic illness and therefore disclosure acts as a coping mechanism requiring a lot of appropriate care. Tompkins (2007) indicates that adherence to ART in Kenya, Uganda and Zambia had been high because it was implemented alongside forced disclosure to the next of kin.
43 WHO (2004) points out that many HIV infected people who have lost hope for survival live longer when they have disclosed their HIV positive status. Disclosure motivates people to adhere and improve their independency towards self-management and self-care. It increases the sources of support for a client. Namwamba-Ntombela (2010) comments that higher levels of disclosure in the population are important from an individual point of view as disclosure has positive implications for prevention, testing and treatment. Namwamba-Ntombela indicates that lack of disclosure is a major barrier to adherence of antiretroviral therapy and therefore support groups are entrusted to empower members to unleash their bravery and disclose for improved adherence over time. GOL (2008) emphasises that disclosure serves as a silent plea for family and friends support and involvement in risk reduction programmes and encouragement for positive living.
GOL (2008) emphasises that disclosing is a necessary process that will help save favourable relationships and instill behaviour change strategies.
Coates, Richter and Caceres (2008) indicate that support group meetings allow discussion on impact mitigating programmes and home-based care. These include rehabilitative programmes, strategies to reduce HIV transmission, preparing members for individual decision–making and great dedication in providing unpaid nursing and welfare assistance to its members. Coates et al.
(2008) further indicate that rehabilitation programmes target individuals who had disclosed to Village Health Workers or support group members entrusted to observe confidentiality. Mosuoe (2016) indicates that the significance of disclosure is seen where improved adherence to ART depends on the sexual partner testing for HIV because one had disclosed his or her HIV status.
Therefore, Mosuoe sees disclosure as a motivating factor for family and friends to take up an HIV test without fear of being discriminated against.
Namwamba-Ntombela (2010) argues that fear of disclosure results in some individuals being reluctant to join support groups due to fear of the consequences of their disclosure. In many cases individuals fear people finding out about their status even though they are potentially important avenues of support (such as family, friends and the community). Therefore, it is obvious, according to Namwamba-Ntombela, that reasons contributing to delay of disclosure must be recognised and it takes time to convince an individual that there will be no far-reaching detrimental effects. The overall impact of encouraging disclosure as an intervention strategy
44 would seem to be relatively long term, but ultimately beneficial. Mosuoe (2016) sees the benefits of disclosure as: a) Enabling a client to begin dealing with transmission reduction and obtaining support; b) Access to care, support and treatment; c) Ability of the client to protect his /her partner; and d) Avoidance of rumours and suspicion. It may be necessary to help the client to take time to make a decision.
Coates et al. (2008) encourage support groups to share skills and techniques relating to disclosure because disclosure is what most clients want to do if they are given skills and techniques. Such techniques include being assisted to choose which people to disclose to, and helping them practice what they will say in supportive rehearsal situations. Clients need to think about the response and plan the answers. It is wise for a client to choose a suitable place for disclosure and be reminded to speak calmly and clearly but at the same time be prepared for a shock or hostile reaction. Support groups need to allay clients’ fears by role playing disclosure in a group setting to allow for more comments and assistance. The Centre for Disease Control and Prevention (CDC, 2018) advocates for the need to consider barriers to disclosure and discusses the following: fear of stigma; discrimination and rejection from people being disclosed to; fear of possible conflicts; ignorance about HIV infection and disclosure; fear of shame and public opinion; fear of blame and the possible breakdown of relationships. CDC emphasises that non- disclosure is ultimately more harmful than disclosure: ‘non-disclosure has shown ruthless consequences to families and the entire communities’ (CDC, 2018, p. 41). These consequences range from lack of support, risk taking behaviour, re-infection, defaulting treatment and missing appointments, and lack of care to suspicion from friends and families.
Mosuoe (2016), Coates (2008) and CDC (2018) all share the same opinion that disclosure bears positive results on the patient’s health because it paves the way for appropriate support from close friends and relatives. Lack of disclosure allows room for suspicious members of the community to gossip instead of being supportive. Disclosure is a medical discourse which the three support group members in this study wanted to gain a better insight into through group discussions. This study sought to find if these authors’ opinions were also the case in Lesotho. In other words, if disclosure is timely, do patients gain positive relationships from people they have disclosed to?
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