Academic journal article Health and Social Work

HIV/AIDS Case Managers and Client HIV Status Disclosure: Perceived Client Needs, Practices, and Services

Academic journal article Health and Social Work

HIV/AIDS Case Managers and Client HIV Status Disclosure: Perceived Client Needs, Practices, and Services

Article excerpt

Social support facilitates emotional adjustment to chronic illness, including HIV infection. Access to social support among people living with HIV/AIDS depends on the degree to which an individual has disclosed his or her HIV status to sources of social support, such as family members, friends, and sex partners (Kimberly & Serovich, 1996). People living with HIV/AIDS who are unable to disclose their HIV status to family, friends, and others in their social networks have less social support and fewer coping resources and experience greater emotional distress than do individuals who are able to disclose their HIV status (Parsons, Misseldine, Van Ora, Purcell, & Gomez, 2004). In addition to serving a vital role in opening access to social support, HIV status disclosure is necessary for informing sex and drug-sharing partners of past and current risks of HIV exposure. Decisions to disclose HIV status to sex and drug-sharing partners are perhaps the most difficult disclosure decisions facing people with HIV/AIDS because the people being disclosed to may themselves have become infected with HIV. Of the many stressors that people living with HIV/AIDS experience, the decision to disclose their HIV status is among the most stressful (Kalichman, DiMarco, Austin, Luke, & DiFonzo, 2003).

Decisions to disclose HIV status depend on several factors, including how long the person has been HIV-positive (Mansergh, Marks, & Simoni, 1995), access to social and emotional resources (Sowell et al., 1997), and the nature of the relationship between the person with HIV/AIDS and the person being disclosed to (Serovich, Kimberly, & Greene, 1998). For example, disclosure of HIV to sex partners, injection drug-using partners (see, for example, Latkin et al., 2001; Lee, Rotheram-Borus, & O'Hara, 1999), and perhaps health care providers is uniquely associated with informing people that they may have been exposed to HIV and protecting people from possible exposure. Disclosure to sex partners and drug-sharing partners is therefore more focused on the needs of others than on one's own needs. For people living with HIV/AIDS, sexual decisions are closely linked to knowledge of a sex partner's HIV status and disclosure of their own status to sex partners (Wenger, Kusseling, Beck, & Shapiro, 1994).

Unfortunately, the potential for rejection, abandonment, physical and emotional abuse, and other adverse consequences creates substantial barriers to disclosing HIV status. It is therefore often the case that people who have HIV infection do not disclose their HIV status to their sex partners (Bayer, 1996). Studies of HIV-positive men (Zea, Reisen, Poppen, Bianchi, & Echeverry, 2005) and women (Latkin et al., 2001) have found that between 25 percent and 50 percent of people living with HIV/AIDS have not disclosed their HIV status to their sex partners. Decisions to disclose HIV status to family members and friends are often focused on maintaining trust and honesty in a relationship, relieving the stress of concealing one's HIV status, or accessing social support. People living with HIV/AIDS demonstrate a greater inclination to disclose their HIV status to friends than to their family. Research showing that within families, mothers and sisters are told about HIV infection more often than fathers and brothers also demonstrates differences in disclosure between types of relationships (Kalichman et al., 2003). These findings show that HIV status disclosure decisions are complex and that people riving with HIV/AIDS often need assistance in managing their HIV status disclosure decisions.

Case managers are often in a unique position to assist people living with HIV/AIDS in managing decisions to disclose their HIV status. Historically, disclosure assistance has fallen to health department workers, particularly for the purpose of partner notification and contact tracing. Disclosure in the public health context is focused on notifying and protecting others, whereas disclosure in the mental health context is focused on adjustment, social support, and protecting others. …

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