HIV Status Disclosure Paradox: Implications of HIV Disclosure on Safer Sexual Practices among Women Living with HIV/AIDS

Objective: HIV status disclosure is typically encouraged because of its purported benefits. Unintended consequences of status disclosure to People Living with HIV/AIDS (PLHA) and their partners, however, rarely receive research attention. Understanding unintended consequences is essential to addressing the public health challenge of reducing HIV/AIDS incidence and re-infection. This study explores how status disclosure may impederather than facilitate-behavioral adherence. Methods: A semi-structured interviews with 20 HIV positive women (mean age=27.9 (SD=8.2); 70% romantically involved), we explored why or why not these women adhere to sexual behavioral recommendations to protect against reinfection and transmission to partners. Interviews were transcribed, independently coded, and thematically analyzed. Participants understood condom use and ART adherence benefits. This did not always translate into adherence. Stigma concerns and partner willingness to risk transmission and reinfection influenced oscillations in behavioral adherence. Results: We found evidence for the “HIV Status Disclosure Paradox,” which includes four types. HIV status nondisclosure was related to greater behavioral adherence by (1) promoting abstinence and/ or singlehood, or (2) motivating infected women to insist on consistent condom use. Disclosure was related to (3) male partners’ willingness to risk transmission or reinfection by insisting on unprotected sex and women’s relinquishment of responsibility after disclosure, or (4) selecting partners accepting of HIV status or weeding out unaccepting partners. Conclusion: These paradoxes coupled with suboptimal medical adherence suggest increased risk potential among PLHA and their partners. Disclosure counseling with patients and partners should incorporate information and messages to minimize unintended consequences that increase transmission or reinfection risk.