Exploring Decision Making for HIV Disclosure in Sexual Situations

Background and Purpose:

Advances in treating HIV/AIDS have resulted in a growing number of healthy, sexually active people living with HIV/AIDS (PLHA). Most PLHA reduce their risky sexual behavior once they are diagnosed. However, stigma and power differentials make serostatus disclosure to sexual partners difficult for many PLHA who fear rejection, loss of control, and violence. Although gay men have long been urged to communicate about HIV with sexual partners, such discussions occur less frequently among other men who have sex with men (MSM), to some types of sexual partners (e.g., one-night stands), and in some sexual venues. This study sought to contextualize decision making by MSM for HIV disclosure in sexual situations.

Methods:

We used a multi-stage grounded theory approach for data collection, analysis, interpretation and verification. First, we recorded and transcribed interviews with 30 urban male PLHA. Then, a modified version of Strauss and Corbin’s iterative analytic strategies was employed to generate themes, which were shared with 23 of the interviewees as well as two focus groups (n=13) of additional MSM. Finally, based on participant feedback, themes were reworked and grounded quotations selected.

Results:

Participants ranged in age from 22 to 67. Time living with HIV ranged from one month to 27 years. About 55% identified as gay, 28% as bisexual and 17% as straight. About 85% were African American. Most were on HIV medications, and some described having mental illnesses.

 Four themes will be presented: 

1. Who should I tell? Most participants said they more often tell sex partners who might become long-term relationships than men in brief encounters. Regardless, most said they almost always use condoms.
2. It takes time. Most participants agreed getting over the shock of HIV diagnosis can take time. Many reported getting more comfortable with disclosure over time. However, some rarely disclosed even after living with HIV for more than 15 years.
3. Telling is the right thing to do. Most men said telling is the right thing to do because they do not want to transmit HIV or God would expect them to do so. However, many struggled with these convictions.
4. Timing is everything vs. “It ain’t that deep.” Participants suggested that delaying disclosure can mean trouble, including potential for being harmed, talked about, or reported to police. However, telling potential sex partners is risky business because of the potential to be rejected for sex or a relationship. Equal numbers of participants suggested that planning disclosure and being emotionally ready seemed important compared to those who suggested “It ain’t that deep.”

Conclusions and Implications:

Consistent with the literature, this study demonstrates that HIV disclosure remains a complicated endeavor. Most participants struggled with sorting through conflicts of moral duty with concerns about privacy. Participants generally agreed disclosure is dependent upon sexual partner characteristics as well as personal comfort. Although a variety of “prevention with positives” interventions are effective in transmission risk reduction, participants agreed future research should focus on integrating HIV disclosure in individual and group counseling approaches.