For people who have been diagnosed with a chronic illness, one inevitable issue to be addressed is whether and how to share this information with others. For persons who are HIV positive, disclosure presents an especially arduous task. The purpose of this article is to offer a strategy to assist marriage and family therapists in facilitating client disclosure of an HN positive status to partners, family members, and friends. In addition, suggestions for setting the stage for disclosure to occur and recommendations for client follow-up are proposed.
For people who are diagnosed with a chronic illness, one issue inevitably to be addressed is whether to share this information with others. Researchers have documented that some people disclose information when they feel distressed and obtain some benefit by doing so (Derlega, Melts, Petronio, & Margulis, 1993; Greenberg & Stone, 1992; Pennebaker & Beall, 1986). For instance, those who disclose freely visit physicians less frequently, demonstrate unimpaired immune function, and exhibit autonomic nervous system regularities to greater degrees than their nondisclosing counterparts (Pennebaker, Colder, & Sharp, 1990). Researchers have also demonstrated that suppressing thoughts or communication about burdensome experiences can increase the likelihood of stress-related difficulties (Greenberg & Stone, 1992). Given these findings, the relationship between disclosure and mental health is important for both therapists and researchers to explore.
Although disclosure when one is distressed has potential benefits, persons with a chronic illness may be in a difficult situation when the information is stigmatizing or potentially damaging. This is especially true for HIV positive persons because sharing their diagnosis can provoke anxiety and perceived threats to personal well-being. As Bolund (1990) stated in regard to cancer, "There is only one disease, AIDS, that has a similarly strong attribution of dread" (p. 13). For HIV positive persons, anxiety or stress may center around fears of impending physical deterioration or lack of quality and availability of medical treatment. In addition to physical stressors, broad social stressors are associated with and HIV/AIDS diagnosis, such as fear expressed by others, ostracism, and degradation, as well as stressors within the individual's family network, such as denial, anger, guilt, and uncertainty (Frierson, Lippman, & Johnson, 1987; Herek & Glunt, 1988; Macklin, 1988). Emotional consequences of disclosure including rejection, abandonment, and isolation have been extensively documented (Lovejoy, 1990; Stulberg & Buckingham, 1988; Zuckerman & Gordon, 1988). These negative consequences are exacerbated if disclosure also leads to an admission of particular sexual or drug-using behaviors. Similarly, physical, social, and emotional stressors associated with the disclosure of an HIV positive diagnosis can be confounded by fear of or actual loss of employment, insurance, housing, medical services, child custody, or right to an education (Anderson, 1989; Herek & Glunt, 1988; Zuckerman & Gordon, 1988).
With these anticipated repercussions, telling family members of one's HIV positive status is likely to be tenuous, difficult, and tension filled (Kimberly, Serovich, & Greene, 1995; Walker, 1991). In studies of HN disclosure to family members, friends, and community associates, rates of disclosure varied from family member to family member and were typically lower than rates of disclosure to sexual partners (Hays et al., 1993; Mansergh, Marks, & Simoni, 1995; Marks et al., 1992; Mason, et al., 1995). The family members most likely to learn of an HIV positive diagnosis were mothers (Mason et al., 1995) and sisters, while fathers were the least likely (Hays et al., 1993; Marks et al., 1992). Typically friends were more likely to receive HIV information over …