HIV disclosure among adults living with HIV

Abstract

Research on disclosure among heterosexual adult person(s) living with HIV (PLH) was reviewed, omitting disclosure of parental HIV to children. Disclosure has been studied within five additional relational contexts: with partners, family members, friends, healthcare professionals and in work settings. Disclosure is higher among women than men, among Latino and white compared to African-American families, and among younger compared to older HIV-positive adults. Most PLH disclose to their sexual partners and family members, yet there is a significant minority who do not disclose. Similarly, rates of disclosure to employers range from 27-68%, suggesting broad variability in perceived consequences of employment disclosures. Of concern, 40% of PLH do not consistently disclose to their healthcare professionals. Rather than examine HIV disclosures in the context of relationships, it is possible to understand disclosures around personal identity. Disclosure decisions are often made to tell everyone (making HIV status a central attribute of one's identity), no one (requiring strategies for securing social support while remaining anonymous) or some people (requiring strategic decisions based on context). Given that disclosure decisions are central to personal identity, future data on disclosure and interventions designed to increase disclosure or comfort with disclosure must focus on communication strategies adopted by PLH to present a coherent identity.

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

“…partners and relatives, are sometimes considered mutuallyexclusive choices for disclosure (Antelman et al, 2001, Greeff et al, 2008. Although levels of voluntary disclosure to specific actors are low compared with other populations (Mayfield Arnold et al, 2008), our sample has comparatively higher overall disclosure levels than other studies in the region (Medley et al, 2004). This may be explained by the longer time elapsed since diagnosis, as likelihood of disclosure increases with time (Antelman et al, 2001;Lugalla et al, 2012).…”

“…Several reviewers highlighted the need for improved measurement (e.g. Obermeyer et al, 2011;Smith et al, 2008), and several authors proposed models to guide research on disclosure (Bairan et al, 2007;Bird & Voisin, 2011;Chaudoir & Fisher, 2010;Chaudoir et al, 2011;Mayfield Arnold et al, 2008;Serovich et al, 2008) and stigma (Bos et al, 2013;Earnshaw & Chaudoir, 2009;Mahajan et al, 2008). However, although most research has focused on the broader process of increasing one's disclosure levels from none or few confidants to the entire social network, the existing theoretical models interpreted all empirical evidence in terms of causes and consequences of single disclosure events.…”

Helping Patients Talk About HIV: Inclusion of Messages on Disclosure in Prevention with Positives Interventions in Clinical Settings

“…Disclosure to other persons besides sex partners also involves a set of competing and intersecting interpersonal, psychological, and social issues (Kalichman, DiMarco, Austin, Luke, & DiFonzo, 2003;Mayfield Arnold et al, 2008;Stempel, Moulton, & Moss, 1995). Disclosure has the potential to positively impact well-being and health outcomes, given that PLWHA who report higher levels of disclosure to family also report higher levels of medication adherence (Stirratt et al, 2006).…”

“…Serostatus disclosure is a unique and complex process nested within social relationships, situations, and contexts (Cusick & Rhodes, 1999;Derlega, Winstead, Greene, Serovich, & Elwood, 2002). HIV serostatus disclosure to sexual partners may vary by race or ethnicity (Mansergh, Marks, & Simoni, 1995;Marks et al, 1992;Mayfield Arnold, Rice, Flannery, & Rotheram-Borus, 2008), gender (Ciccarone et al, 2003;Duru et al, 2006;Mayfield Arnold et al, 2008;Weinhardt et al, 2004), sexual orientation (Ciccarone et al, 2003;Duru et al, 2006;Weinhardt et al, 2004), partner type (Buchanan, Poppen, & Reisen, 1996;Carballo-Dieguez, Remien, Dolezal, & Wagner, 1997;Crepaz & Marks, 2003;Duru et al, 2006;Mansergh et al, 1995;Perry et al, 1994;Stein et al, 1998;Wolitski, Rietmeijer, Goldbaum, & Wilson, 1998), partner serostatus (Bachmann et al, 2009;Crepaz & Marks, 2003;De Rosa & Marks, 1998;Marks et al, 1992;, psychological well-being (Armistead, Morse, Forehand, Morse, & Clark, 1993;Bennetts et al, 1999;Kalichman & Nachimson, 1999), and substance use (Latkin et al, 2001;Marks & Crepaz, 2001;Reback, Larkins, & Shoptaw, 2003). Personal guidelines may inform the approach of PLWHA (People living with HIV/ AIDS) to disclosing to sex partners (Rutledge, 2009).…”

‘When it comes to HIV, that’s when you find out the genuinity of that love’: The experience of disclosing a HIV+ status to an intimate partner

“…With improved and effective medical treatment, people living with HIV are able to live a normal lifespan, and so disclosure has taken on a different emphasis in terms of entering and living in relationships throughout an individual's life. One could say HIV disclosure is part of revealing aspects of one's identity and according to one theoretical account, in turn an individual's social identity wholly informs their disclosure-related choices (Arnold, Rice, Flannery & Rotheram-Borus, 2008). That is, it is believed that a person's cognitions regarding their social role and social identity come together to form a 'disclosure rule' (disclosure decision) (Arnold et al, 2008).…”