Disclosing HIV Status for African American Women

Black BP, Miles MS. Calculating the risks and benefits of disclosure in African American women who have HIV. Journal of Obstetric, Gynecologic, and Neonatal Nursing. 2002;31:688-697.

Since many people associate HIV infection with illicit behaviors such as promiscuous sex, homosexual contact, or intravenous drug use, personal disclosure of HIV status often carries a social stigma that can lead to emotional distress, depression, and isolation. As an added complication, HIV infection disproportionately affects low-income and minority populations already subject to societal stigma. Nurse researchers conducted a series of interviews on the personal effects of HIV infection with 48 HIV-positive, low-income, African American mothers in the southern United States. The average age of the women in the study was 37 years, most had at least a high school education, 38% were married or partnered, and 66% were unemployed. The nurses visited the subjects in their homes 6 times over a period of 3 months. As the subjects may have perceived tape-recording as an invasion of privacy, information from the interviews was recorded in field notes. Analysis of the major themes of the interviews revealed a careful calculation by these women on the risks and benefits of disclosure of their HIV status. Many of the women feared stigmatization within their family, in their community, and among their church group. Many had witnessed episodes of gossip and other negative encounters regarding persons with known HIV infection, affecting their decision to hide their own status. However, some disclosure was often required in order to receive financial aid, assistance with necessities such as child care and transportation, and emotional support. Disclosure also helped to relieve the sense of secrecy, shame, and isolation. Patterns of disclosure ranged from the very secretive, possibly not even including current sex partners, to selective, involving most close family members and associates, to fully open. Some women reported being severely hurt when a healthcare worker or confidant disclosed their HIV status to others. Nurses need to be aware of the implications of social stigma with HIV infection to help women explore the benefits and risks of disclosure related to HIV infection.