Managing the risk of intimacy: accounts of disclosure and responsiveness among people with HIV and intimate partners of people with HIV

Abstract

It is well known that concerns about sexual risk tend to decline among people in intimate relationships where there is established commitment and trust. In the context of relationships at increased risk for HIV transmission, interactions involving disclosure and partner responsiveness are key to maintaining intimacy and physical safety. This paper explores concepts of risk and sexual intimacy articulated by a community sample of 30 people living with HIV and their intimate relationship partners. Data revealed the shifts in intimate relationship dynamics upon the disclosure of an HIV diagnosis, the importance of intimacy in the context of managing one or both partners' HIV care and responses to new advances in HIV prophylaxis. Findings suggest that participants' experiences of self-disclosure and partner responsiveness most often resulted in an increased sense of protectiveness from and for partners. This suggests that health-promoting messaging should be adapted to be more relevant to intimate couple communication and mutual support.

From “Secret” to “Sensitive Issue”: Shifting Ideas About HIV Disclosure Among Middle-Aged and Older Rural South Africans in the Era of Antiretroviral Treatment

“…In this period, if they tested positive, they may have disclosed to a spouse or partner, but even that disclosure was deemed risky in the 2013 FGD. In 2018, FGD participants reported more confidence that disclosure to one’s partner was important, even if it remained complicated (Green et al, 2018; Odiachi et al, 2018).…”

“…Pre-ART, on the other hand, if a partner was HIV positive or asked to use condoms, these discussions were often seen as a signal of lack of trust or betrayal within the couple (Bhatia et al, 2017). While a majority of older persons are divorced or widowed, the opportunity this new discourse on disclosure offers suggests that disclosure is being or can be recast as a symbol of love and trust, rather than of betrayal, similar in ways to disclosure in younger persons’ relationships (Green et al, 2018). Older men, for example, who are widowed or otherwise single, may need or want someone to take care of them.…”

“…Prior to ART being available in sub-Saharan Africa, HIV-related stigma had an inhibitory effect on HIV positive status disclosure to both partners and family members (Emlet, 2006; Treves-Kagan et al, 2016). The advent of ART as a life-saving medication has lessened stigma, and for some disclosure has become more acceptable (Chan et al, 2015; Green et al, 2018). And yet, Africans continue to report relatively low levels of disclosure of HIV positive status to others, including to their sexual partners (Kalichman et al, 2020; Treves-Kagan et al, 2016).…”

‘Your husbands are bringing it to you’: South African rural women and HIV in Darrell Roodt’s Yesterday (2004)

“…Her response is that she is a married woman and therefore does not need to. Green et al (2018) suggest that established commitment and trust account for the decline in concerns about sexual risk among people in intimate relationships. However, Yesterday's response, and her expression of surprise at being asked the question, could suggest that within her socio-cultural context, married women are not supposed to or not expected to use condoms.…”

“…This flashback suggests that the husband's violent outburst may have been out of character. In a paper looking at intimate partner disclosures and responsiveness among people living with HIV, Green et al point out that health-promoting messaging should also be 'more relevant to intimate couple communication and mutual support' (Green et al 2018(Green et al , 1117, which suggests that such disclosures can be difficult for both partners. However, the husband's brutal attack on Yesterday cements the position of men as the source of women's suffering within the film's world.…”