The process of disclosing positive HIV status: Findings from qualitative research

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Abstract
Self-disclosure of HIV positive status is thought to have the potential to enhance trust and social acceptance in social relationships and to reduce the onwards transmission risks of HIV in sexual relationships where at least one partner is HIVpositive. As part of a wider qualitative study investigating sexual safety in the context of HIV infection, we undertook 73 qualitative in-depth interviews with HIVpositive individuals and the sexual partners of HIVpositive individuals. All HIV positive subjects had some drug use experience but few associations were found between drug use and disclosure of HIVstatus. Disclosure was found to involve processes of 'target' selection on the basis of relationship quality and target opinions. Targets were de-selected to protect the status quo of fixed social relationships. Timing of disclosure was carefully planned to minimize rejection and maximize fairness to others. Full disclosure was rehearsed and usually followed a series of incremental 'clues' which we found could be subject to misinterpretation. Findings illustrate that disclosure could threaten or support the control of personal identity and relationship management, and that sexual safety was not necessarily assured by disclosure. Factors found to influence the disclosure process included incomplete communications, negative ideas about condoms, and the prioritization of relationship quality where disruption to relationships was related to safer sex. The paper concludes by discussing the implications of findings for public health interventions.

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