Advancing methodology in the study of HIV status disclosure: The importance of considering disclosure target and intent

Abstract

Advancing methodology in the study of HIV status disclosure: The importance of considering disclosure target and intent Dima, A.L.; Stutterheim, S.E.; Lyimo, R.; de Bruin, M. General rightsIt is not permitted to download or to forward/distribute the text or part of it without the consent of the author(s) and/or copyright holder(s), other than for strictly personal, individual use, unless the work is under an open content license (like Creative Commons). Disclaimer/Complaints regulationsIf you believe that digital publication of certain material infringes any of your rights or (privacy) interests, please let the Library know, stating your reasons. In case of a legitimate complaint, the Library will make the material inaccessible and/or remove it from the website. Please Ask the Library: http://uba.uva.nl/en/contact, or a letter to: Library of the University of Amsterdam, Secretariat, Singel 425, 1012 WP Amsterdam, The Netherlands. You will be contacted as soon as possible. Acknowledgements:The authors appreciatively acknowledge the financial assistance from RVVZ from the Netherlands, the participation of PLWH in our target group, and the cooperation of the management in the ART clinics where we conducted the study. Abstract:Disclosure of HIV status has been the focus of three decades of research, which have revealed its complex relations to many behaviors involved in HIV prevention and treatment, and exposed its central role in managing the HIV epidemic. The causes and consequences of disclosure acts have recently been the subject of several theoretical models. Although it is acknowledged that individual disclosure events are part of a broader process of disclosing one's HIV status to an increasing number of people, this process has received less theoretical attention. In quantitative studies of disclosure, researchers have often implicitly assumed that disclosure is a single unidimensional process appropriately measured via the total number of one's disclosure acts. However, there is also evidence that disclosure may have different causes and consequences depending on the types of actors involved (e.g. family members, friends) and on the presence or absence of the discloser's intention, suggesting that the unidimensionality assumption may not hold. We quantitatively examined the dimensionality of voluntary and involuntary disclosure to different categories of actors, using data collected via structured interviews in the spring of 2010 from 158 people living with HIV in Kilimanjaro, Tanzania. For voluntary disclosure, nonparametric item response analyses identified two multi-category clusters, family and community, and two single-category dimensions, partner and children. Involuntary disclosure consisted of several single-or twocategory dimensions. Correlation analyses between the resulting disclosure dimensions and stigma and social support revealed distinct relationships for each disclosure dimension. Our results suggest that treating disclosure as a unidimensional construct is a simplification of disclosure...

Patterns and Predictors of HIV-Status Disclosure Among Pregnant Women in South Africa: Dimensions of Disclosure and Influence of Social and Economic Circumstances

“…A limitation of much disclosure research to date is the reliance on cross-sectional data to evaluate what is inherently a process that occurs over time [1]. A further limitation is the commonly used approach of operationalising disclosure as any versus no disclosure, or using sum scores to indicate the total number of persons to whom an individual has disclosed [15]. These approaches treat disclosure to different individuals as interchangeable events.…”

“…These approaches treat disclosure to different individuals as interchangeable events. Rather, it has been argued that disclosure should be conceptualised as a multi-dimensional process consisting of clusters of disclosure events to different individuals, given that disclosure events are neither interchangeable nor independent [15,16]. Based on this idea, two recent studies have sought to extend the methodology of disclosure research using psychometric data reduction techniques in general adult HIV-positive populations [15,16].…”

Disclosure appraisal mediating the association between perceived stigma and HIV disclosure to casual sex partners among HIV+ MSM: a path model analysis

“…HIV disclosure is multi-dimensional, including attitudes toward and intention to disclosure and overt disclosing behavior (Dima, Stutterheim, Lyimo, & De Bruin, 2014; Rimal, Bose, Brown, Mkandawire, & Folda, 2009). Guided by the social cognitive theory (Bandura, 1999) and the theory of reasoned action (Fishbein & Ajzen, 1975; Ajzen, 2001), researchers have found that a number of social cognitive factors, particularly disclosure appraisal, may mediate the process from perceived stigma to HIV disclosure.…”

Factors influencing the decision-making of parental HIV disclosure

“…Disclosure of HIV status has been considered as an important component in HIV prevention and treatment due to its complex relationship with secondary prevention, healthcare access, treatment adherence, psychosocial adjustment, and family function [1]. However, disclosing HIV status to family members, particularly to children, is still a big challenge for people living with HIV (PLHIV) [2].…”

“…In addition to demonstrating the importance of perceived consequences of disclosure (individual-level factors), recent studies have called for a multidimensional perspective to explore HIV disclosure [1]. The practice of disclosure is not just a single individual event [7], but is embedded in certain social relationships and a specific sociocultural context [8].…”