This article provides a contextualized comparison and analysis of the former Kwazulu and the new Kwazulu-Natal policy documents on HIV confidentiality, the differing practices within the region, and their implications for support and gender. It is based on interviews with key players in the regional NACOSA (National AIDS Convention of South Africa), and participation in meetings between August and November 1995. The main division is between those influenced by other rural African models, especially the Zambian concept of "shared confidentiality' as a way of ensuring support, and who have gone on to develop more community-based practices to destigmatize the disease, in contrast with the stronger emphasis in the new document on individual rights, assuming a more urban constituency, and where "shared confidentiality' is much more circumscribed. One of the difficulties of the new policy in which "confidentiality' is interpreted as "secrecy', is that it would seem to foreclose and neutralize lay and community support, as distinct from the earlier and unacknowledged policy of former Kwazulu. It also seeks to provide an enhanced role for professional counsellors. This psychologizing of the infection and the distancing from "community', and from women's groups, is surprising in a country in whose townships "community' remains a powerful motivating symbol, and where NGOs and peer groups have been identified everywhere as central to effective HIV/AIDS related prevention, care and support for behavior change.
PIP: The former Kwazulu and the new Kwazulu-Natal policies on HIV confidentiality are analyzed and compared, as are the differing practices within the region and their implications for support and gender. Conclusions are based upon interviews with key players in the regional National AIDS Convention of South Africa (NACOSA) and participation in meetings during August-November 1995. A central division is identified between policymakers who are influenced by other rural African models such as the Zambian concept of shared confidentiality as a way of ensuring support, and those who have developed more community-based approaches to destigmatize HIV/AIDS. One difficulty of the new policy in which confidentiality is interpreted as secrecy is that it appears to neutralize lay and community support. The policy also attempts to give a broader role to professional counselors.