AGPAHI tackles partners’ HIV infection disclosure dilemma

If there is a challenge people face after discovering that they have contracted HIV, it is how to tell their sexual partners that they have been diagnosed with the virus. This dilemma often leads to such people not revealing their HIV status for fear of either being rejected or subjected to violence. As a result, unprotected sexual contact between such couples is likely to continue, leading to infection of the uninfected partners and putting their unborn children at risk of mother-to-child HIV transmission.

Anastazia, 29, a resident of Musoma, Mara Region, is among people who faced this dilemma. She says she married a man who was divorced from his first wife. While Anastazia was in the early stages of her first pregnancy, she was sent to Buhemba Village in Mara Region to look after her husband’s farms.

Seventh month

Until the seventh month of her pregnancy, Anastazia had never attended prenatal clinic because it did not exist in the village. During the seventh month, her husband called instructing her to return to Musoma to attend prenatal clinic. “The strange thing is that almost every night at 9pm my husband took some medication. When I asked him what the drugs were for, he told me that he had a chronic headache,” says Anastazia.

Her husband also prohibited her from opening one of the drawers that were in their bedroom. “One day while he was away I decided to open the drawer which I was told not to open. I was curious, and wanted to know what was inside. I opened it and saw a small black plastic bag. I opened the bag and inside was a card and one of the words on it was ‘CD4’, which reminded me of AIDS. I was devastated. I knew I was as good as dead,” says Anastazia.

Brother-in-law

She summoned the courage to alert her brother-in-law who was in the living room. “My brother-in-law was surprised to see my mood had changed suddenly because I seemed very happy only a few minutes earlier. I showed him the card, and asked him if he knew whether his brother had HIV. He told me that he was not aware. I called my mother-in-law and asked her what the tablets his son took daily were for. She told me that he had asthma.”

When the husband came back home she asked him about the card, and he admitted that he was living with HIV. “He told me that he did not want to tell me for fear that I would have left him because two women had previously left him after he told them that he had HIV. I was downcast, and the following day, September 12, 2016, I went to the clinic to be tested. I was diagnosed with HIV and was put on treatment. However, the delay soon took its toll. I gave birth on December 26, 2016, but the baby died after only one week,” she says.

Had Anastazia’s husband told her that he was living with HIV, it would have been possible to protect her and their first child like they have managed to protect their second child from HIV infection from the mother. Knowing their HIV-positive statuses, Anastazia attended prevention of HIV transmission from mother to child services, and gave birth to an HIV-free child on March 30, 2018.

In addressing the partner HIV-positive disclosure problem, Ariel Glaser Pediatric AIDS Healthcare Initiative (AGPAHI) has launched a campaign to help PLHIVs break the silence around their HIV-positive status to their spouses or sexual partners and notify them that they are exposed to HIV infection and therefore it is important that they too get tested.

With support from the US President’s Emergency Plan For AIDS Relief (PEPFAR) through Centers for Disease Control and Prevention (CDC), AGPAHI has oriented a total of 457 healthcare workers in partner notification processes. The partner HIV disclosure orientation sessions for health providers carried in Tanga, Mara, Geita, Mwanza, Shinyanga and Simiyu regions are aimed at building the capacity of healthcare providers in providing HIV index testing and partner notification services to PLHIVs so that they can scale up these services at their facilities.

The campaign aimed at reaching 221 health facilities will be a big boost to the HIV/AIDS fight by making it possible for more people to know their HIV status so that they can be put on antiretroviral therapy (ART) early if they are infected. Those found to be uninfected will be advised on HIV prevention.

Commenting on the campaign being carried out through the Boresha project, AGPAHI’s HIV Index Testing Program Coordinator, Ms Olympia Laswai, says the exercise entails that oriented service providers enquire from PLHIVs if their untested sexual partners, biological children below 15 years and/or drug injecting partners are willing to be tested. “With the consent of the PLHIVs, service providers assist these clients in notifying their partners about their HIV status and the fact that they are exposed to HIV infection. Ultimately, they provide them with HIV testing services,” she says.

Ms Laswai says the exercise does not intend to humiliate anybody or invade their privacy, but aims to break the chain of HIV transmission by offering HIV testing to persons who have been exposed to HIV and linking them to HIV treatment, if positive, or prevention services if negative. “All the information about PLHIVs, their contacts and HIV status is strictly confidential,” Ms Laswai says.

“Traditionally, PLHIVs were regarded as the sole persons responsible for notifying their partners, but after it was established that most of those diagnosed with HIV don’t inform their partners it was decided that such people should be helped to do so. If their partners are not infected, they are advised on how to avoid infection, and if they have contracted HIV, they are given access to HIV treatment to reduce HIV-related diseases and mortality,” she adds.

HIV-exposed partners

Sexual partner/children notification maximizes the proportion of partners and/or children who are notified of their exposure to HIV and this allows HIV-exposed partners and children to get tested for HIV. “If children are exposed to HIV and go without treatment, most of them will die by the time they are five years old. ART initiation upon diagnosis can reduce mortality among HIV-infected infants by up to 75 per cent. That is why it is critically important to identify children who were exposed to HIV during pregnancy, delivery, or breastfeeding and ensure that they get an HIV test,” Ms Laswai says.

Talking about eligibility to HIV index testing, Ms Laswai says all biological children less than 15 years of age of an HIV-positive woman, sexual and drug injecting partners are eligible.

In this campaign, healthcare workers introduce to PLHIVs various ways to assist them in notifying their partners that they may have been exposed to HIV and arrange for their testing. “One of the approaches is contract referrals. With this approach, service providers will notify the sexual partners if client’s efforts to notify the partners fail,” Ms Lswai says. She also mentioned the provider referral approach whereby, with the consent of the client, service providers will directly notify sexual partners and arrange for HIV testing. “Another approach is dual referral. Here, service providers and the client will jointly notify the partners and ultimately offer HIV testing,” says Ms Laswai.

Other countries

With index HIV testing and partner notification campaign having been successful in other countries such as Mozambique and Kenya, AGPAHI will certainly contribute to the global goal of ensuring that 95 per cent of those living with HIV know their status, and 95 per cent of those diagnosed with HIV are put on ART to suppress the virus and 95 per cent are suppressed.