Decisions to Disclose
or Not Disclose About
an HIV Positive Diagnosis
Living with HIV means facing a lifetime of physical, psychological, and social challenges (e.g., Bartlett & Gallant, 2001; Castro et al., 1998; Hoffman, 1996; Nott & Vedhara, 1999; Siegel, Karus, Epstein, & Raveis, 1996). Along with others who have potentially life-threatening diseases, an HIV diagnosis frequently involves confronting a wide range of troubles such as financial and health problems; upheavals in relationships with family members, lovers, friends, and coworkers; in addition to significant physical discomfort (e.g., Bor, Miller, & Goldman, 1993; Chidwick & Borrill, 1996; Derlega & Barbee, 1998a; Greene & Faulkner, 2002; Kalichman, 1995; Miles, Burchinal, Holditch-Davis, Wasilevski, & Christian, 1997; Pakenham, Dadds, & Terry, 1996; Sowell et al., 1997; Thompson, Nanni, & Levine, 1996; Van Devanter, Thacker, Bass, & Arnold, 1999; Winstead et al., 2002). Some difficulties, however, may be unique for people living with HIV Unlike other diseases, someone who is known to have HIV may become the target of prejudice (e.g., Herek et al., 2002). This kind of reaction is likely to affect the way people living with HIV process decisions to disclose their infection. However, more information is still needed about how HIV disclosure choices are made.
This chapter explores how people make decisions to disclose an HIV diagnosis to another person. Using CPM (see chap. 2), we are able to identify the way certain decision criteria are applied in making the decision to reveal or not reveal one's HIV status. The criteria, therefore, shape the decisions that lead to HIV disclosure and, perhaps, let a confidant divulge private information about the diagnosis to others. Using decision rules, the person with HIV attempts to exercise some control over when, who, and how others know this private information.
CPM argues that when individuals are in novel situations, such as learning about HIV status, typical rules guiding their privacy decisions may become ineffective (Petronio, 2000a, 2002). The most common relational rules are related to keeping confidences andprivacy (Argyle & Henderson, 1985; Argyle, Henderson,