A Test Of Two HIV Disclosure Theories

Abstract

The purpose of this study was to examine two theories of HIV disclosure. The first is a disease progression theory and the second is the theory of competing consequences. Participants were 138 HIV-positive gay men involved in a larger study of HIV disclosure. Structural equation modeling was used to analyze each model, with the root mean square error of approximation (RMSEA) and the nonnormed fit index (NNFI) used to evaluate goodness of fit. The RMSEA for the disease progression model was .031 and the NNFI was .932. The RMSEA for the consequences model was . 018 and NNFI was .978. Both indices are considered to be a close fit; however, the parameter estimates for disease progression to disclosure in the disease model and disease progression to consequences in the consequences model were nonsignificant, suggesting that disease progression may not play a role in the decision to disclose an HIV diagnosis. Researchers may want to focus on the intentions and possible outcomes from disclosure as predictive factors.

Why do People Disclose their HIV Status? Qualitative Evidence from a Group of Activist Women in Khayelitsha

“…Positive motivations for disclosure include: access to social support, prevention and education, succession planning, seeking appropriate medical treatment and care, lower risk behaviours, stress relief, relational benefits (Ibid. Serovich, 2000Serovich, , 2001. Negative factors include fear of ostracism by community or household, moral judgement and blame, relationship termination, discrimination and in some cases verbal and physical abuse (Almeleh 2004;Chandra et al 2003).…”

“…As the immune system becomes increasingly compromised, the individual experiences more and more opportunistic infections, is less able to hide his or her disease from others, and is more in need of care and support. Thus, as the biophysical trajectory plays out, the individual's social relationships change (Serovich 2001;Petronio 2002, Holt et al 1995. Alonzo and Reynolds (1995) have thus conceptualised living with HIV as a bio-psychosocial experience, a dynamic movement between a biophysical disease trajectory and a 'psychosocial stigma trajectory'.…”

“…As illustrated by the narratives discussed in this paper, the social context affects the decision to disclose, but it is in turn, reconstituted by it. Serovich (2001) compared two disclosure theories that focus on the impact of disease progression on the decision to disclose: the disease progression theory; and the competing consequences theory (see Figure 1). The disease progression theory provides a model of disclosure whereby the HIV-positive person discloses his or her HIV status when HIV progresses to AIDS thereby making it impossible to keep his or her status a secret any longer (Babcock, 1998& Kalichman, 1995cited in Serovich 2001.…”

“…The competing consequences model was found to be more flexible as it gives more volition on the part of PLWHA and can accommodate a wider range of disclosure experiences (Ibid.). In testing the two theories using 138 HIV-positive MSM, Serovich (2001) found that neither theory provided an adequate global understanding of disclosure. Rather, the theories may explain disclosure to family or friends, but not to sexual partners.…”

A Couple’s Marital Disharmony and its Psychological Effects on their Children during the HIV Disclosure Process in Kenya

“…To ease disclosure facilitation and delivery, healthcare professionals working with HIV-affected families should receive training on HIV disclosure models so that they are able to assess each married/cohabiting couple's family circumstances, their willingness to perform disclosure to their children, and the stage of disclosure of each child within the family. Additional useful models that can be used to facilitate and ease disclosure from parent to child include the Four Phase Model (Gachanja et al, 2014b;Tasker, 1992;Qiao et al, 2013), the Disease Progression Theory and Consequences Theory of HIV Disclosure (Gachanja et al, 2014a;Serovich, 2001), The Stress and Coping Theory (Gachanja, 2015;Lazarus, 1993), and the Disclosure Decision-Making Model (Omarzu, 2000;Qiao et al, 2013).…”