Organizational factors influencing non disclosure of HIV status among sexual partners attending Muhimbili national hospital care and treatment clinic in Dar es salaam, Tanzania

Abstract

Background Disclosure of HIV positive sero-status to sexual partners, friends or relatives is useful for prevention and care. Identifying factors associated with disclosure is a research priority as a high proportion of persons living with HIV&AIDS never disclose. HIV counseling and testing programmes as well as post test care services such as of antiretroviral therapy and pre-ART care emphasize HIV status disclosure among persons living with HIV&AIDS. Objective The broad objective of this study was to establish organizational factors influencing non disclosure among sexual partners attending Care and Treatment Clinic at Muhimbili National Hospital Dar es salaam Tanzania. Methods A descriptive cross sectional study was conducted at the Muhimbili National Hospital Care and Treatment Clinic. A total of 215 respondents participated in this study (207 clients, 5 Counselors and 3 Administrators). Non probability purposive sampling technique was used to select counselors and the administrators. Exit interviews were conducted to the clients using a structured questionnaire to get information on organizational factors contributing to non disclosure of HIV status among sexual partners attending Care and Treatment Clinic. A review of various documents/records such as job allocation book, staff attendance book, staff roster and client register book, HIV&AIDS policy and guideline was conducted at the study site to get information on availability of personnel, work schedules, workload per care provider per day, number of clients and attendance and availability of policy and guidelines materials. Observations were conducted throughout the study on the issues like number of clients, client flow, availability of equipments and guidelines, client- provider interaction and emerging issues during the course of data collection. In-depth interviewing was conducted with the MNH administrators and the counselors to generate information on issues like availability of funds, vii staff availability, training, user involvement and their evaluation of the working environment they have at MNH. The questionnaire contained both close and open ended questions to generate data needed. The data was entered into a computer and analysed using Statistical Package for Social Sciences version 16 programmes and output was presented in tables. Results The results showed that 72.8% of the study population disclosed HIV status to their sexual partners, only 27.2% did not disclose. Counselors were seen as a source of disclosure information to the majority of respondents (79.4%) but only few 10.6% got disclosure information from the doctors and only 1.7% got information from other sources. Long time was also reported by the majority of respondents (53.3%). Absence of workers’ involvement was responded by majority of counselors interviewed. Also counselors stated that there was not enough counseling rooms, clients were congested in one room and there was no confidentiality during counseling. Counselors reported working in poor environment, face staff shortage and lacked necessary equipments. Conclusion Poor organizational leadership existing at the MNH strongly influences low level of disclosure among sexual partners attending the Care and Treatment Clinic Muhimbili National Hospital that need to be addressed. Recommendations This study did not cover all organizational factors that would influence disclosing of HIV status among the CTC MNH clients a gap that is recommended for further research. The MNH management should strongly improve the existing CTC conditions making sure that all the organizational factors are well addressed to encourage clients develop HIV status disclosing behaviors.