Calculating the risks and benefits of disclosure in African American women who have HIV

Objective: To identify the processes involved in and the patterns of disclosure of their HIV diagnosis reported by African American women. Design: Qualitative descriptive. Setting: Southeastern United States; nurse visits in the homes of the participants. Participants: Forty-eight African American women who were HIV-positive and were primary caretakers of young children. Main Outcome Measure: Field notes were analyzed using content analysis. Results: Once the women learned they had HIV, they were faced with the issue of determining "what is at stake" in telling others of their diagnosis. This dilemma was characterized by the threat of stigma, feelings of shame, and the concurrent need for support. The women determined a calculus of disclosure in determining to whom and when to reveal their HIV diagnosis. This calculus involved a careful evaluation of the risks and benefits involved in disclosing their illness. Risks of telling were fueled by societal and experienced stigma associated with HIV, whereas the benefits were primarily fueled by personal needs. The calculus of disclosure was a recursive process, with decisions made and remade over time. Disclosure patterns ranged from secretive to full disclosure. Conclusions: Issues related to stigma and therefore to disclosure of a diagnosis of HIV are highly relevant to HIV-positive African American women. Nurses have an important role in supporting women regarding their disclosure decisions.