Disclosure of HIV-positive status: Towards the development of guidelines, strategies and interventions (Updated 2014)

Key take-home messages

• HIV disclosure is a lifelong process. Reasons for disclosing/not disclosing change constantly. Many individuals have their own personal strategies and reasons for disclosing, which are carefully planned to elicit positive outcomes.
• Common facilitators/reasons for disclosing are: trust in the person receiving the disclosure; positive experiences with previous disclosure; existence of strong social support; to gain social support; to relieve the stress of keeping their HIV status a secret; obligation and duty to inform; self-acceptance of HIV-positive identity; to share knowledge; and to control disclosure (i.e. to disclose before someone else exposes them).
• Common barriers to disclosing are: negative experiences with previous disclosures; fear of discrimination, stigma and rejection; lack of a strong social network; feelings of shame and guilt regarding one’s HIV status; struggle with HIV+ identity; cultural factors (e.g. homophobia) within one’s community; lack of HIV education and inability to cope with the outcome of the disclosure; and concern about harming or burdening others.
• The impacts and outcomes of HIV-disclosure are wide-ranging. Negative outcomes include: rejection, abuse, violence, stigma and discrimination. Positive outcomes include: more high quality social support, stronger family cohesion and relationships, reductions in anxiety and depression, and improvements in physical health. Most studies found more positive outcomes than negative ones, particularly over the long term. Furthermore, the majority of people who have disclosed reported little to no regret post-disclosure.
• There have been few studies examining interventions targeting HIV disclosure. Of the interventions reviewed, those that guided HIV-positive individuals through an introspective process, and helped them develop a disclosure plan and the skills to communicate their status, were found to be most effective in increasing disclosure, and improving disclosure outcomes.

• Determinants of Health
  • Social support
  • Stigma/discrimination
  • Abuse
• Population(s)
  • General HIV+ population
• Mental Health
  • Depression