Barriers to sexual behaviour change after an HIV diagnosis in sub-Saharan Africa

This longitudinal, in-depth study of sexual behaviour of 96 HIV-positive individuals in a sub-Saharan country where HIV is heavily stigmatized, showed that even with counselling and free condoms, most people with HIV did not succeed in maintaining long-term, consistent condom use. Their condom use depended on fluctuations in their health status, and the anticipated or actual reaction of their social environment. People with HIV encountered the same barriers to safer sex as the community in general: women's lack of sexual decision-making power; men's dislike of condoms; denial of HIV, especially in men; and child-wish. In addition, HIV-positive people who did not disclose their HIV status feared that proposing to use condoms would raise partners' suspicions, and lead to social rejection and stigma. Results suggest that HIV testing and counselling programs will only achieve prevention of secondary HIV spread when they are preceded and supported by strong measures promoting acceptance and openness with regard to HIV. HIV testing, with or without counselling, is promoted as a means to prevent the spread of HIV in developed and developing counties. The underlying assumption is that knowing their HIV status will enable individuals to take measures to reduce or eliminate HIV risk to others. This study provided an opportunity to investigate this assumption. Between 1991 and 1993, 96 persons diagnosed HIV-positive at a counselling clinic in Bulawayo, Zimbabwe, were asked to participate in a program of continuing counselling and support. The study aimed to increase understanding and information about the medical, social, economic, and psychological problems of people with HIV in order to strengthen support services. The study was conducted in collaboration with the Ministry of Health and the Matabeleland AIDS Council, a non-Government AIDS service organization located in Bulawayo which provides information, care and support in Matabeleland. A full report of the study can be found in Meursing (1997). Context of the study Zimbabwe has one of the most severe AIDS epidemics recorded. Between 1991 and 1993, seroprevalence among pregnant women in Bulawayo rose from 17 to 27 per cent, and it continued to rise in subsequent years. Because there is good transport infrastructure, seroprevalence in rural Zimbabwe is often not much lower than in urban areas. In 1995, seroprevalence figures in some urban and rural sites in Masvingo province exceeded 70 per cent of pregnant women. Heterosexual spread is the main risk factor, so that many children born to HIV-positive parents are born with the virus or face an uncertain future as orphans.