Consequences of HIV Disclosure
and Nondisclosure Decision Making
In this chapter we examine the consequences of HIV disclosure and the choices to maintain privacy for persons with HIV and for others to whom they might or might not disclose the diagnosis. A person deciding if or when to disclose takes into account how benefits weigh against drawbacks (described in chap. 3); included in this process is uncertainty about how the others will react and possible unforeseen consequences. This balance is crucial because of the potential outcomes: specifically, disclosure can provide opportunities for social support but also opens a person to risks. Many of these consequences occur only after disclosure, that is, the consequences are not apparent when the person has not disclosed. However, as CPM argues, given that people manage their privacy, some anticipate consequences and make judgments about revealing or concealing based on reactions they expect (Petronio, 2002).
To fully grasp the consequences of HIV disclosure, it maybe necessary for the person with HIV and others to wait for some period of time. There may also be differences between immediate (what happens literally during or right after the disclosure) and longer term consequences (the next day, week, or month) of someone knowing the HIV diagnosis. Additionally there may be differences associated with direct and indirect disclosure, for instance when a person simply states, “I am HIV positive” or hints around without fully disclosing. Yet much research focuses only on a person knowing the HIV diagnosis (not necessarily how he or she found out) and not on the disclosure recipient (Petronio, 2002). Because the recipient is so critical in maintaining the level of protection or dissemination of a discloser's health status and because that person is necessary for valuable support during the illness, it is imperative to consider how recipients co-manage knowing about a person's HIV status.
In this chapter we first describe reported responses to HIV disclosure based on personal accounts. Then we examine outcomes of social support. Next, we look at the effects of disclosure on psychological health and identity, as disclosure can influence how people cope with HIV Another outcome of disclosure is being stigmatized, and these reports are widespread and influence further HIV disclosure