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Disclosure, in the context of our voluntary counselling
and testing (VCT) programmes in the workplace,
may be affected by different dynamics from disclosure
within a family or community context.
In our workplace programmes, we do not have constant
contact with the individuals who choose to test.
They may be more financially secure than members
of the general public, may have medical aid and
may therefore have provision to go to a psychologist
for ongoing counselling, they may be permanent
staff and their circumstances may be quite different
from those who test in a day hospital or a clinic.
In the workplace, if individuals disclose and
are not ready to do so, or if there is a breach
of confidentiality, they have much to lose.
Within our programme the ultimate objective is
for them to disclose within the workplace, but
this is not something we have yet experienced.
We have not had one person coming out and openly
sharing with their colleagues that they
are HIV positive.
There are several types of disclosure: partial,
full, to several family members or only one, to
a spouse, to colleagues or to a supervisor. Legally,
if one discloses to your supervisor, then it has
to be kept confidential.
We are not ready for this kind of disclosure
in South Africa: there is still too much stigma,
too many unvoiced fears, and fear of rejection:
rejection can take lots of different forms within
the workplace. Legally one cannot be discriminated
against. However, while it may not be openly done,
it can often be felt through being excluded, or
through experiencing being alone.
When we talk to our clients we look at the advantages
and disadvantages of disclosure within the workplace.
We tell them it is not necessary to tell your
colleagues, and to make sure when you tell a friend;
it is one you can really rely on; a friend with
whom you have a relationship and with whom you
have survived any kind of crisis together before.
Ensure that the person has adequate time before
telling them. You need to come to terms with the
result yourself before disclosing to others.
It is not an easy process, especially within
the realm of intimacy. When you might be going
home and your husband is asking you to have sex
with him, it puts much more urgency on to that
type of disclosure. How do you bring urgency into
the need for using a condom in that context?
Only disclose if the environment is right, if
you know that the person you disclose to is going
to accept unconditionally whatever the result
is, based on previous conversations that you have
had with that person regarding HIV, and perceptions
around people having HIV. Next time you have a
conversation in your home think about whether
it is inviting and safe for anyone who may need
to disclose.
Once you have disclosed, you cannot go back.
It is out there. And in the communities, people
often take your disclosure out there without your
permission. There is often a sense that the priest,
the cousins and family members, need to know this
news. Eventually everybody knows without your
permission.
It certainly needs to be thought through. Open
disclosure is not for everybody. And it can often
limit relationship opportunities when you disclose
openly.
The role of the counsellor is to point out to
the person what the advantages and disadvantages
are of disclosing. The person with a fully formed
picture needs to make a decision. One needs to
think about the other person’s emotions that one
would need to deal with, but one needs to think
about one’s own needs and emotions first.
Individuals have to accept it themselves first
and work on it. You have to be ready, because
there will be outcomes. You might trust someone
but they might pass the information on to someone
else. It is hurtful when you have disclosed and
then you discover that someone else – that you
didn’t tell and chose not to tell – knows your
news. The gossip can flow everywhere.
It is very difficult with partners and with people
who are married. People are afraid of losing their
marriage. If the wife is not working and the husband
is, she may fear losing her home, etc, and then
if she chooses not to disclose, one wonders how
far the virus will spread.
We still have a long way to go in South Africa.
It is not yet a safe environment in our country
for people to feel they can disclose and be accepted
unconditionally.
It is really an individual decision.
Lolita Cairncross, manager VCT (voluntary counselling
and testing) Programme, LifeLine/Childline Western
Cape Eunice Bidli, manager Guguletu centre, and
co-ordinator in HIV and AIDS Lay Counselling Programme,
LifeLine/Childline Western Cape
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