Women's barriers to HIV-1 testing and disclosure: challenges for HIV-1 voluntary counselling and testing

In view of the ever-increasing HIV/AIDS epidemic in sub-Saharan Africa, the expansion of HIV-1 voluntary counselling and testing (VCT) as an integral part of prevention strategies and medical research is both a reality and an urgent need. As the availability of HIV-1 VCT grows two limitations need t o be addressed, namely: low rates of HIV-1 serostatus disclosure to sexual partners and negative outcomes of serostatus disclosure. Results from a stu dy among men, women and couples at an HIV-1 VCT clinic in Dar es Salaam, Ta nzania are presented. The individual, relational and environmental factors that influence the decision to test for HIV-1 and to share test results wit h partners are described. The most salient barriers to HIV-1 testing and se rostatus disclosure described by women include fear of partners' reaction, decision-making and communication patterns between partners, and partners' attitudes towards HIV-1 testing. Perception of personal risk for HIV-1 is t he major factor driving women to overcome barriers to HIV-1 testing. The im plications of findings for the promotion of HIV-1 VCT programmes, the imple mentation of partner notification policies and the development of Post-test support services are discussed.