Publication Cover
AIDS Care
Psychological and Socio-medical Aspects of AIDS/HIV
Volume 27, 2015 - Issue sup1: DISCLOSURE AND HIV SPECIAL ISSUE
1,704
Views
3
CrossRef citations to date
0
Altmetric
EDITORIAL

What's in the telling? Understanding social, psychological and clinical aspects of HIV disclosure

, , &

The course of HIV infection includes a parallel pathway of disclosure (Asudani, Corser, & Patel, Citation2004). Multiple types of HIV disclosure have been identified across a wide spectrum of HIV prevention and treatment cascade (Arnold, Citation2008; Arun, Singh, Lodha, & Kabra, Citation2009; Ateka, Citation2006; Bairan et al., Citation2007). They all need to be under the spotlight of academic research. HIV testing, often seen as an entry point to diagnosis and disease management, involves disclosure of risk behaviors and disclosure of partners on the part of the individual being tested and disclosure of test results on the part of the healthcare providers (Atuyambe et al., Citation2014; Bachanas et al., Citation2013; Bedell, van Lettow, & Landes, Citation2014). Onward disclosure of serostatus is then the complex behavior under consideration in most HIV disclosure research (Afifi & Afili, Citation2009).

Disclosure, or self-disclosure, is a process in which personal (often private or confidential) information is verbally communicated from one person (i.e., the discloser) to another person (i.e., the target; Chelune, Citation1979). HIV disclosure includes an array of behaviors associated with the practice in which HIV-infected persons disclose their HIV serostatus to their partners, family members, or friends; or when a child is informed of her/his own HIV status (Qiao, Li, & Stanton, Citation2013b). Essentially, it is the process of moving from unawareness to knowledge, invariably a unidirectional, irrevocable act (Li, de Wit, Qiao, & Sherr, Citation2015). Disclosure has been viewed as an integral component in the public health effort to reduce incident HIV infections and improve HIV treatment and care (Remis, Citation2013). In detail, much research has also been done in terms of factors enabling or hindering disclosure, correlates and predictors of disclosure, preparation for disclosure and consequences of disclosure (Jorjoran Shushtari, Sajjadi, Forouzan, Salimi, & Dejman, Citation2014; Kumar, Waterman, Kumari, & Carter, Citation2006; Latkin et al., Citation2012; Lee, Bastos, Bertoni, Malta, & Kerrigan, Citation2014; Liamputtong & Haritavorn, Citation2014; Linda, Citation2013; Lyimo et al., Citation2014).

Existing research and theorizing suggest that HIV disclosure is not a single event but a process of gradual and selective delivery of information embedded in the context of a social relationship (Lesch et al., Citation2007; Moses & Tomlinson, Citation2013). A growing number of empirical studies have focused on the process of HIV disclosure, including decision-making, disclosure patterns, and post-disclosure adjustment. These elements are shaped by various social, psychological and clinical factors (Bott & Obermeyer, Citation2013; Letteney, Krauss, & Kaplan, Citation2012; Li et al., Citation2007). Studies have elaborated a cycle of how HIV disclosure has had complex, often reciprocal influences on behavioral, psychosocial, and clinical aspects of the lives of HIV-infected individuals (Butler et al., Citation2009; Carballo-Dieguez, Miner, Dolezal, Rosser, & Jacoby, Citation2006; Dageid, Govender, & Gordon, Citation2012; De Baets, Sifovo, Parsons, & Pazvakavambwa, Citation2008). Disclosure has also been found to be layered with different needs, demands, and ramifications of various forms of disclosure ranging from sexual partners, to close family members, to friends and social acquaintances, to children, to employers, and to employees (Eustace & Ilagan, Citation2010; Fesko, Citation2001). Conceptual frameworks need to provide understanding of the drivers and inhibitors of disclosure, on variations in the disclosure process and how these may (or may not) affect various physical or psychosocial outcomes (Chaudoir & Fisher, Citation2010; Chaudoir, Fisher, & Simoni, Citation2011; Qiao et al., Citation2013b). Both intended and unintended consequences of disclosure need to be considered (Serovich, McDowell, & Grafsky, Citation2008; Shamu, Zarowsky, Shefer, Temmerman, & Abrahams, Citation2014). Active, coerced, and accidental disclosure may all have different effects on the behavior and mental health of all individuals concerned (Feigin, Sapir, Patinkin, & Turner, Citation2013).

Over the course of the HIV, epidemic disclosure has been an area of concern, often with few parallels in other disease conditions. In the early days of the epidemic, pre- and post-test counseling cautioned about social reactions to disclosure and provided specific advice and guidance on the issue (CDC, Citation1987, Citation1993, Citation2001; WHO, Citation2011). Legal responses to non-disclosure have spawned an entire criminalization of HIV spread issue (Holmes & O'Byrne, Citation2006; Lichtenstein, Whetten, & Rubenstein, Citation2014; Stein et al., Citation1998). Psychological responses to disclosure have found direct adaptation, support, mental health, and resilience sequelae (Qiao, Li, & Stanton, Citation2013a; Smith, Rossetto, & Peterson, Citation2008). Social research has identified relationship implications from intimate partners to community members (Bairan et al., Citation2007). Research on age and disclosure has shown the diverse needs, requirements, and outcomes for various age cohorts (Chaudoir et al., Citation2011; Hawk, Citation2007). Most importantly, the public health response has clearly articulated the fundamental requirement of full disclosure if inroads to HIV prevention are to be made (Chaiyamahapurk, Pannarunothai, & Nopkesorn, Citation2011; Remis, Citation2013).

We are pleased to present in this special issue, a collection of papers on the social, psychological, and clinical aspects of HIV disclosure. This special issue was designed in conjunction with a special issue recently published in AIDS by the same guest editors (Li et al., Citation2015). These two compilations provide a gathering of insight into social, psychological, and clinical aspects of HIV disclosure within this collection, and an exploration of issues around disclosure intervention design and development in the other collection (Li et al., Citation2015).

The papers in this special issue address topics related to different types of HIV disclosure, reflecting various social relationships between the disclosers and the potential targets of the disclosure, including pediatric disclosure (disclosing children's HIV infection to children), parental disclosure (disclosing parental HIV infection to children), partner disclosure (disclosing HIV infection to partners), and social disclosure (disclosing HIV infection to the wider community beyond). Furthermore, the papers explore a number of factors within the process of HIV disclosure, including cognitive appraisal, privacy management, psychological well-being, health behaviors, and health ethics and patients’ rights. The global HIV epidemic affects widely different populations and, in this special issue, coverage of diverse groups of populations was deemed important to broaden the understanding. Thus, the studies include HIV-infected adolescents, HIV-infected parents, caregivers of HIV-infected children, HIV-infected adults, and HIV-infected men who have sex with men (MSM). In line with different demands, needs, and responses, the studies focused on different types of HIV disclosure among the different populations. Such understanding is key if a thorough understanding of the various outcomes that can be affected by HIV disclosure is to be built. Such outcomes include sexual behaviors, contraception use (Toska, Cluver, Hodes, Kidia, & Thabeng, Citation2015), physical, mental and social outcomes (Vreeman, Scanlon, Marete, Inui, & Nyandiko, Citation2015), treatment adherence (Qiao et al., Citation2015), and clinical outcomes (Itemba et al., Citation2015).

We include three studies focusing on issues related to HIV disclosure to children (either pediatric disclosure or parental disclosure) in resource-poor settings in Africa and Asia. Vreeman and colleagues investigated disclosure status among HIV-infected children aged 10–15 years in Western Kenya and its association with physical, mental, and social outcomes. The children who were aware of their HIV infection did not report worse psychosocial outcomes in terms of behavioral and emotional difficulties, depression, and quality of life. A number of factors were associated with a child's knowledge of his/her HIV diagnosis including older age (OR 1.8, 95% CI 1.5–2.1), better disease stage (OR 2.5, 95% CI 1.4–4.4), and fewer reported caregiver-level adherence barriers (OR 1.9, 95% CI 1.1–3.4; Vreeman et al., Citation2015). The second study was conducted among the caregivers in Ghana who had not disclosed children their HIV status, examining whether the characteristics of caregivers could predict their HIV-related knowledge, stigma, and discrimination, as well as illness perception (Paintsil et al., Citation2015). The study indicated that HIV-negative status and low level of formal education were significantly associated with poor HIV knowledge, and HIV-positive status was related to higher level of stigma perception (Paintsil et al., Citation2015). The third study focused on parental disclosure and was conducted with HIV-infected parents in China with children aged 5–16 years. The study showed that enacted (or experienced) stigma partially mediated the relationships between disclosure and mental health and, of specific importance, medicine adherence (Qiao et al., Citation2015).

Given the vulnerabilities and resiliencies associated with their unique developmental stages, HIV disclosure among adolescents living with HIV can be a particularly complex process. Special attention from the field to disclosure issues among this population was reflected in several studies in this collection. Nostlinger and colleagues explored social disclosure of HIV status (e.g., disclosure to individuals outside the family) by HIV-infected adolescents aged 13–17 years in Uganda and Western Kenya. They found that higher level of perceived self-efficacy to disclose, greater family support, less stigma, and higher self-esteem were associated with social disclosure (Nöstlinger, Bakeera-Kitaka, Buyze, & Buvé, Citation2015). Toska and colleagues studied HIV-infected adolescents aged 10–19 years in South Africa and examined how knowledge of HIV status by HIV-infected adolescents and their partners was associated with safer sexual activity and contraception use (Toska et al., Citation2015). However, neither knowing their partner's status nor disclosing one's HIV status to a partner was significantly associated with safer sex. These findings challenge assumptions that disclosure is automatically protective in sexual and romantic relationships for HIV-positive adolescents. Qualitative data further indicated that the fear of rejection, stigma, and public exposure after disclosing to partners was the main barrier to disclosure, while counseling by healthcare workers for HIV-positive adolescents did not address these fears and risks (Toska et al., Citation2015).

Several studies explored the practices and perceptions on HIV disclosure, especially partner disclosure, among adult populations. Itemba and colleagues assessed demographic correlates of HIV disclosure in a cohort of HIV-infected adults in Northern Tanzania. They reported that married individuals, those with secondary education, and those diagnosed earlier were more likely to have disclosed their HIV status to larger numbers of friends and relatives (Itemba et al., Citation2015). Another study collected qualitative data among women living with HIV in a rural region with a high HIV prevalence. The study found that being in a long-term and stable partnership is a main facilitator of partner disclosure, and trust, love, loyalty, and support were intertwined with women's sexual choices. Disclosure did not necessarily facilitate low-risk behaviors, and discordant couples may need support and counseling services that go beyond just the disclosure issues (Mkwanazi, Rochat, Tomlinson, Stein, & Bland, Citation2015).

Xiao et al. (Citation2015) employed a communication theory perspective to examine reasons for disclosing or not disclosing HIV status to sexual partners among HIV-infected adults in China. The “communication privacy management” theory (Petronio, Citation2000) was used as the conceptual framework to investigate if key beliefs regarding disclosure were related to the HIV-infected adults’ decision-making of partner disclosure. Fear of rejection and concerns about privacy were significant barriers to partner disclosure, while endorsement of duty to inform/educate and motivation to establish a close/supportive relationship might promote disclosure (Xiao et al., Citation2015).

Walker and colleagues addressed ethical issues related to HIV disclosure in the Chinese socio-cultural context, with a focus on exploring how to respect patients’ autonomy, rights, and privacy. The paper highlighted that the concept of patient rights is compatible with Chinese culture. With respect for patients’ rights and autonomy, Chinese cultural practice of engaging families in care could be promoted in HIV care. In addition, healthcare providers have a duty to disclose truthfully the diagnosis and prognosis to HIV patients, and should receive training in disclosure ethics and skills (Walker, Nie, Qiao, Tucker, & Li, Citation2015).

Murphy and de Wit investigated disclosure expectations and practices among HIV-negative or status-unknown MSM in Australia through an on-line national self-report survey. Over three quarters of the participants expected HIV-positive partners to disclose their HIV status before sexual encounters, and 42% also expected HIV-negative men to declaim their HIV status although less than half consistently discussed their HIV status with sexual partners. Multivariate linear regression analysis suggested that men who expected HIV-positive partners to disclose their HIV status before sex more often lived outside capital cities, were less educated, were less likely to self-identify as gay, perceived more risk of HIV transmission via a range of sexual practices, were less engaged with the HIV-positive community, and expressed more stigma towards people living with HIV (Murphy & De Wit, Citation2015).

The studies in this special issue represent some of the most recent developments in research on HIV disclosure. At the same time, they collectively also reveal current knowledge gaps and future needs. To better understand the dynamics of decision-making disclosure and the actual disclosure process, we need to develop more complex theoretical models to account for multiple disclosures and the evolving ramifications of disclosure in emotional, behavioral, and legal domains. In terms of methodology, the field needs more longitudinal data, more comprehensive measures including psychosocial behavioral scales and biomarkers. In the practice of HIV prevention and care, it is important to develop or adapt evidence-based behavioral interventions to assist HIV-infected people to perform appropriate disclosure, so the benefits of disclosure to them and their family can be maximized (Kennedy, Fonner, Armstrong, O'Reilly, & Sweat, Citation2015; Siberry & Allison, Citation2015). All the efforts in the three aspects will contribute to a higher level of insights which in time will ameliorate the burden of secrecy, facilitate the process of disclosure, and enhance the well-being and adjustment of those challenged with disclosure needs.

Acknowledgement

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Child and Human Development.

Disclosure statement

No potential conflict of interest was reported by the authors.

Funding

The paper was in part supported by the National Institute of Child and Human Development [Grant # R01HD074221].

References

  • Afifi, T. D., & Afili, W. A. (2009). Uncertainty, information management, and disclosure decisions: Theories and applications. New York: Routledge.
  • Arnold, E. A. (2008). HIV disclosure among adults living with HIV. AIDS Care, 20(1), 80–92. doi: 10.1080/09540120701449138
  • Arun, S., Singh, A. K., Lodha, R., & Kabra, S. K. (2009). Disclosure of the HIV infection status in children. Indian J Pediatr, 76(8), 805–808. doi:10.1007/s12098-009-0177-z
  • Asudani, D., Corser, J., & Patel, R. S. (2004). Breaking the ice: HIV serostatus disclosure. Bull World Health Organ, 82(7), 552.
  • Ateka, G. K. (2006). HIV status disclosure and partner discordance: A public health dilemma. Public Health, 120(6), 493–496. doi:10.1016/j.puhe.2006.01.010
  • Atuyambe, L. M., Ssegujja, E., Ssali, S., Tumwine, C., Nekesa, N., Nannungi, A., … Wagner, G. (2014). HIV/AIDS status disclosure increases support, behavioural change and, HIV prevention in the long term: A case for an Urban Clinic, Kampala, Uganda. BMC Health Serv Res, 14, 276. doi:10.1186/1472-6963-14-276
  • Bachanas, P., Medley, A., Pals, S., Kidder, D., Antelman, G., Benech, I., … Bukuku, M. (2013). Disclosure, knowledge of partner status, and condom use among HIV-positive patients attending clinical care in Tanzania, Kenya, and Namibia. AIDS Patient Care STDS, 27(7), 425–435. doi:10.1089/apc.2012.0388
  • Bairan, A., Taylor, G. A., Blake, B. J., Akers, T., Sowell, R., & Mendiola, R., Jr. (2007). A model of HIV disclosure: Disclosure and types of social relationships. J Am Acad Nurse Pract, 19(5), 242–250. doi:10.1111/j.1745-7599.2007.00221.x
  • Bedell, R. A., van Lettow, M., & Landes, M. (2014). Women's choices regarding HIV testing, disclosure and partner involvement in infant feeding and care in a rural district of Malawi with high HIV prevalence. AIDS Care, 26(4), 483–486. doi:10.1080/09540121.2013.841830
  • Bott, S., & Obermeyer, C. M. (2013). The social and gender context of HIV disclosure in sub-Saharan Africa: A review of policies and practices. SAHARA J, 10(Suppl 1), S5–S16. doi:10.1080/02664763.2012.755319
  • Butler, A. M., Williams, P. L., Howland, L. C., Storm, D., Hutton, N., & Seage, G. R. III (2009). Impact of disclosure of HIV infection on health-related quality of life among children and adolescents with HIV infection. Pediatrics, 123(3), 935–943. doi:10.1542/peds.2008-1290
  • Carballo-Dieguez, A., Miner, M., Dolezal, C., Rosser, B. R., & Jacoby, S. (2006). Sexual negotiation, HIV-status disclosure, and sexual risk behavior among Latino men who use the internet to seek sex with other men. Arch Sex Behav, 35(4), 473–481. doi:10.1007/s10508-006-9078-7
  • CDC. (1987). Public health service guidelines for counseling and antibody testing to prevent HIV infection and AIDS.
  • CDC. (1993). Technical guidance on HIV counseling.
  • CDC. (2001). Revised guidelines for HIV counseling, testing, and referral.
  • Chaiyamahapurk, S., Pannarunothai, S., & Nopkesorn, T. (2011). HIV prevention with positives and disclosure of HIV status: Practice and views of Thai healthcare providers. J Med Assoc Thai, 94(11), 1314–1320.
  • Chaudoir, S. R., & Fisher, J. D. (2010). The disclosure processes model: Understanding disclosure decision-making and post-disclosure outcomes among people living with a concealable stigmatized identity. Psychol Bull, 136(2), 236–256. doi: 10.1037/a0018193
  • Chaudoir, S. R., Fisher, J. D., & Simoni, J. M. (2011). Understanding HIV disclosure: A review and application of the disclosure processes model. Soc Sci Med, 72(10), 1618–1629. doi: S0277-9536(11)00191-2[pii]10.1016/j.socscimed.2011.03.028
  • Chelune, G. J. (1979). Measuring openness in interpersonal communication. In G. J. Chelune (Ed.), Origins, patterns and implications of openness in interpersonal relationships (pp. 1–27). San Francisco: Jossey-Bass.
  • Dageid, W., Govender, K., & Gordon, S. F. (2012). Masculinity and HIV disclosure among heterosexual South African men: Implications for HIV/AIDS intervention. Cult Health Sex, 14(8), 925–940. doi:10.1080/13691058.2012.710337
  • De Baets, A. J., Sifovo, S., Parsons, R., & Pazvakavambwa, I. E. (2008). HIV disclosure and discussions about grief with Shona children: A comparison between health care workers and community members in Eastern Zimbabwe. Soc Sci Med, 66(2), 479–491. doi: S0277-9536(07)00482-0[pii]10.1016/j.socscimed.2007.08.028
  • Eustace, R. W., & Ilagan, P. R. (2010). HIV disclosure among HIV positive individuals: A concept analysis. J Adv Nurs, 66(9), 2094–2103. doi:10.1111/j.1365-2648.2010.05354.x
  • Feigin, R., Sapir, Y., Patinkin, N., & Turner, D. (2013). Breaking through the silence: The experience of living with HIV-positive serostatus, and its implications on disclosure. Soc Work Health Care, 52(9), 826–845. doi:10.1080/00981389.2013.827143
  • Fesko, S. L. (2001). Disclosure of HIV status in the workplace: Considerations and strategies. Health Soc Work, 26(4), 235–244. doi: 10.1093/hsw/26.4.235
  • Hawk, Skyler T. (2007). Disclosures of maternal HIV infection to seronegative children: A literature review. J Soc Pers Relat, 24(5), 657–673. doi:10.1177/0265407507081453
  • Holmes, D., & O'Byrne, P. (2006). Bareback sex and the law: The difficult issue of HIV status disclosure. J Psychosoc Nurs Ment Health Serv, 44(7), 26–33.
  • Itemba, D., Maro, V., Ostermann, J., Pence, B., Thielman, N., Whetten, K., & Yao, J. (2015). Demographic and clinical correlates of HIV serostatus disclosure in Northern Tanzania. AIDS Care. doi:10.1080/09540121.2015.1090534
  • Jorjoran Shushtari, Z., Sajjadi, H., Forouzan, A. S., Salimi, Y., & Dejman, M. (2014). Disclosure of HIV status and social support among people living with HIV. Iran Red Crescent Med J, 16(8), e11856. doi:10.5812/ircmj.11856
  • Kennedy, C. E., Fonner, V. A., Armstrong, K. A., O'Reilly, K. R., & Sweat, M. D. (2015). Increasing HIV serostatus disclosure in low- and middle-income countries: A systematic review of intervention evaluations. AIDS. 29(Suppl 1), S7–S23. doi:10.1097/QAD.0000000000000671
  • Kumar, A., Waterman, I., Kumari, G., & Carter, A. O. (2006). Prevalence and correlates of HIV serostatus disclosure: A prospective study among HIV-infected postparturient women in Barbados. AIDS Patient Care STDS, 20(10), 724–730. doi:10.1089/apc.2006.20.724
  • Latkin, C., Yang, C., Tobin, K., Roebuck, G., Spikes, P., & Patterson, J. (2012). Social network predictors of disclosure of MSM behavior and HIV-positive serostatus among African American MSM in Baltimore, Maryland. AIDS Behav, 16(3), 535–542. doi:10.1007/s10461-011-0014-z
  • Lee, L., Bastos, F. I., Bertoni, N., Malta, M., & Kerrigan, D. (2014). The role of HIV serostatus disclosure on sexual risk behaviours among people living with HIV in steady partnerships in Rio de Janeiro, Brazil. Glob Public Health, 9(9), 1093–1106. doi:10.1080/17441692.2014.952655
  • Lesch, A., Swartz, L., Kagee, A., Moodley, K., Kafaar, Z., Myer, L., & Cotton, M. (2007). Paediatric HIV/AIDS disclosure: Towards a developmental and process-oriented approach. AIDS Care, 19(6), 811–816. doi:10.1080/09540120601129301
  • Letteney, S., Krauss, B., & Kaplan, R. (2012). Examining HIV-positive parents’ disclosure to their children: A biopsychosocial approach. Soc Work Public Health, 27(4), 345–360. doi:10.1080/19371918.2010.500881
  • Li, L., Sun, S., Wu, Z., Wu, S., Lin, C., & Yan, Z. (2007). Disclosure of HIV status is a family matter: Field notes from China. J Fam Psychol, 21(2), 307–314. doi:10.1037/0893–3200.21.2.307
  • Li, X., de Wit, J., Qiao, S., & Sherr, L. (2015). HIV disclosure to children in low- and middle-income countries: Towards effective interventions. AIDS, 29(Suppl 1), S1–S5. doi:10.1097/QAD.0000000000000730
  • Liamputtong, P., & Haritavorn, N. (2014). To tell or not to tell: Disclosure to children and family amongst Thai women living with HIV/AIDS. Health Promot Int. doi:10.1093/heapro/dau057
  • Lichtenstein, B., Whetten, K., & Rubenstein, C. (2014). “Notify your partners – it's the law”: HIV providers and mandatory disclosure. J Int Assoc Provid AIDS Care, 13(4), 372–378. doi: 10.1177/2325957413494481
  • Linda, P. (2013). To tell or not to tell: Negotiating disclosure for people living with HIV on antiretroviral treatment in a South African setting. SAHARA J, 10(Suppl 1), S17–S27. doi:10.1080/02664763.2012.755320
  • Lyimo, R. A., Stutterheim, S. E., Hospers, H. J., de Glee, T., van der Ven, A., & de Bruin, M. (2014). Stigma, disclosure, coping, and medication adherence among people living with HIV/AIDS in Northern Tanzania. AIDS Patient Care STDS, 28(2), 98–105. doi:10.1089/apc.2013.0306
  • Mkwanazi, N., Rochat, T., Tomlinson, M., Stein, A., & Bland, R. (2015). Living with HIV, disclosure patters and partnerships a decade after the introduction of HIV programmes in rural South Africa. AIDS Care. doi:10.1080/09540121.2015.1028881
  • Moses, S., & Tomlinson, M. (2013). The fluidity of disclosure: A longitudinal exploration of women's experience and understanding of HIV disclosure in the context of pregnancy and early motherhood. AIDS Care, 25(6), 667–675. doi:10.1080/09540121.2012.736606
  • Murphy, D., & De Wit, J. (2015). The need to know: HIV status disclosure expectations and practices among non-HIV-positive gay men in Australia. AIDS Care. doi:10.1080/09540121.2015.1062077
  • Nöstlinger, C., Bakeera-Kitaka, S., Buyze, J., & Buvé, A. (2015). Factors influencing social disclosure among adolescents living with HIV in Eastern Africa. AIDS Care. doi:10.1080/09540121.2015.1051501
  • Paintsil, E., Renner, L., Antwi, S., Dame, J., Enimil, A., Ofori-Atta, A., … Reynolds, N. (2015). HIV knowledge, stigma and illness beliefs among pediatric caregivers’ in Ghana who have not disclosed their Child's HIV Status. AIDS Care.
  • Petronio, S. (Ed.). (2000). Balancing the secrets of private disclosures. Mahwah, NJ: Lawrence Erlbaum Associates.
  • Qiao, S., Li, X., & Stanton, B. (2013a). Disclosure of parental HIV infection to children: A systematic review of global literature. AIDS Behav, 17(1), 369–389. doi:10.1007/s10461-011-0069-x
  • Qiao, S., Li, X., & Stanton, B. (2013b). Theoretical models of parental HIV disclosure: A critical review. AIDS Care, 25(3), 326–336. doi:10.1080/09540121.2012.712658
  • Qiao, S., Li, X., Zhou, Y., Shen, Z., Tang, Z., & Stanton, B. (2015). The role of enacted stigma in parental HIV disclosure among HIV-infected parents in China. AIDS Care. doi:10.1080/09540121.2015.1034648
  • Remis, R. (2013). Disclosure of positive HIV status: A public health issue? Can J Public Health, 104(5), e357–358.
  • Serovich, J. M., McDowell, T. L., & Grafsky, E. L. (2008). Women's report of regret of HIV disclosure to family, friends and sex partners. AIDS Behav, 12(2), 227–231. doi:10.1007/s10461-007-9295-7
  • Shamu, S., Zarowsky, C., Shefer, T., Temmerman, M., & Abrahams, N. (2014). Intimate partner violence after disclosure of HIV test results among pregnant women in Harare, Zimbabwe. PLoS One, 9(10), e109447. doi:10.1371/journal.pone.0109447
  • Siberry, G., & Allison, S. (2015). HIV Disclosure: NIH's funding proprieties. AIDS, 29(Suppl 1), S109–118.
  • Smith, R., Rossetto, K., & Peterson, B. L. (2008). A meta-analysis of disclosure of one's HIV-positive status, stigma and social support. AIDS Care, 20(10), 1266–1275. doi:10.1080/09540120801926977
  • Stein, M. D., Freedberg, K. A., Sullivan, L. M., Savetsky, J., Levenson, S. M., Hingson, R., & Samet, J. H. (1998). Sexual ethics. Disclosure of HIV-positive status to partners. Arch Intern Med, 158(3), 253–257. doi: 10.1001/archinte.158.3.253
  • Toska, E., Cluver, L., Hodes, R., Kidia, K., & Thabeng, M. (2015). Sex and secrecy: The role of disclosure to peers and partners in the sexual health practices of HIV-positive adolescents in a community-based sample in South Africa. AIDS Care. doi:10.1080/09540121.2015.1071775
  • Vreeman, R. C., Scanlon, M. L., Marete, I., Inui, T. S., & Nyandiko, W. M. (2015). Characteristics of HIV-infected adolescents enrolled in a disclosure intervention trial in Western Kenya. AIDS Care doi:10.1080/09540121.2015.1026307
  • Walker, S., Nie, J., Qiao, S., Tucker, J., & Li, X. (2015). Truth-telling to the patient, family, and the sexual partner: A rights approach to the role of healthcare providers in adult HIV disclosure in China. AIDS Care. doi:10.1080/09540121.2015.1071772
  • WHO. (2011). Guideline on HIV disclosure counselling for children up to 12 years of age. Geneva: WHO.
  • Xiao, Z., Li, X., Qiao, S., Zhou, Y., Shen, Z., Tang, Z., & Stanton, B. (2015). Using communciation privacy management theory to examine HIV disclosure to sexual partners/spouses among PLHIV in Guangxi. AIDS Care. doi:10.1080/09540121.2015.1055229