Stigma in the line of face: Self‐disclosure of patients' HIV status to health care providers

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Abstract
Patients who are HIV+ are often faced with the choice of whether or not they should tell their health care providers that they are HIV+. Although appropriate health care and safety require the communication of such information, the stigmatization associated with HIV puts at risk the patients’ pride, dignity, and ultimately the quality of their health. Using Goffman's (1963, 1967) notions of face and stigma, the present study described the major influential factors prompting the act of disclosure of HIV, the act itself, and the effect that act appears to have had on the patient/provider relationship. Phase I of the study gathered pilot data through in‐depth interviews, leading to a quantitative questionnaire used in Phase II. A sample was obtained through AIDS organizations around the U.S. and via electronic mail addresses for AIDS/HIV electronic discussion groups. The interviews and surveys asked respondents to recall a time when they had to make the decision to disclose or not disclose their HIV+ status to a care provider. The results indicated that patients typically did disclose their HIV+ status despite their strong feelings of stigmatization. Three key factors were related to their decisions: 1) perceived necessity of disclosure; 2) subjective feelings of comfort about the disclosure; and 3) perceptions of stigmatization. Patient satisfaction levels were also related to these factors. Implications for face maintenance and health care management as well as the determinants of subjective comfort are discussed.