Disclosure

As described in the previous section, concerns about stigma result in many black African people with HIV being unwilling to reveal their HIV status (‘disclose’) to others, and this can deter people from seeking appropriate services and getting support.

Studies suggest that it is more common to disclose to just one or two individuals outside healthcare settings than to disclose to larger numbers of people. Individuals tend to make decisions to disclose or not based on the nature of their relationship and the expected outcome. People may be disclosed to when the relationship is close and trusting; and when they are likely to give emotional or social support. Decisions not to disclose to others are often motivated by a desire not to cause worry to the person. Having HIV may be understood by others to be a death sentence, a perception sometimes grounded in the harsh realities of life in African countries. Others may not be disclosed to because the relationship is not close enough or because disclosure would risk social rejection, breaches of confidentiality, an assumption of promiscuity or worries about contagion.1

The black African heterosexual men and women who took part in a 2008 study in London, were found to be significantly less likely to disclose their HIV status than the gay men in the study (most of whom were white). Of those in a relationship, 65% of heterosexual black African men and 60% of heterosexual black African women had told their partner that they had HIV. A few of those who had not disclosed reported unprotected sex with their partner.2

In the same study, fewer than one in five had disclosed to a parent. Factors associated with disclosure to parents included being unemployed, number of years since diagnosis with HIV, younger age, and having experienced HIV-related discrimination. A total of 22% of men and 31% of women had disclosed to at least one friend.

Disclosure to children can be particularly difficult because of the sexual transmission of HIV, often a taboo topic. The fear of isolation and loss of family support can therefore become a major problem.

Moreover black African men who have sex with men are particularly reluctant to disclose their HIV status because of the fear that they would be blamed for their own infection, because of their sexuality.3,4

References

  1. Calin T et al. Disclosure of HIV among black African men and women attending a London HIV clinic. AIDS Care 19: 385-391, 2007
  2. Elford J et al. Disclosure of HIV status: the role of ethnicity among people living with HIV in London. Journal of Acquired Immune Deficiency Syndrome 47: 514-521, 2008
  3. Paparini S et al. "I count myself as being in a different world": African gay and bisexual men living with HIV in London. An exploratory study. AIDS Care, 20, pp. 601-5, 2008
  4. Keogh P et al. Migrant gay men: redefining community, restoring identity. Sigma Research, 2004
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