Moral practices shaping HIV disclosure among young gay and bisexual men living with HIV in the context of biomedical advance

Abstract

Biomedical advances in diagnostics, treatment and prevention increase the means available to reduce HIV transmission risk. Subsequent shifts in HIV status disclosure obligation and ethics may impact how those living with HIV view, enact and experience disclosure. We analysed focus group and interview data to explore how these changes are reflected in disclosure decision-making to sexual partners among young gay and bisexual men living with HIV in the USA. Three interrelated themes were identified: engaging with partners’ varying HIV knowledge; attribution of blame; and negotiating disclosure-related harms. Participants experienced blame from partners that questioned the timing of HIV testing, status disclosure and sex events without regards for viral suppression or use of pre-exposure prophylaxis. Substantial HIV stigma was described in response to disclosure, mitigated in some cases by partners’ higher HIV knowledge. Overall, an uneven diffusion of HIV treatment and prevention knowledge and continuing HIV stigma seemed to limit the translation of biomedical advances into improved disclosure experiences. Our findings suggest that young gay and bisexual men living with HIV may continue to perform much of the moral labour involved in disclosure by managing others’ reactions, correcting inaccurate sexual health information, and negotiating the risks of disclosure-related harm.

Keywords:

• Disclosure
• HIV prevention
• gay and bisexual men
• HIV-related stigma

Acknowledgements

We thank Christopher Hurt for providing background on HIV biomedical treatment and prevention technologies, and Emily Yen for suggesting a focus on ethics.

Disclosure statement

No potential conflict of interest was reported by the author(s).

Notes

1 Data were collected prior to a January 2018 change in North Carolina’s HIV criminalisation legislation, whereby those who have been virally suppressed for six months or more no longer needed to disclose their serostatus and could have condomless intercourse (The Center for HIV Law and Policy 2017).

Additional information

Funding

This work was supported by the US National Institute of Allergy and Infectious Diseases under Grant T32 AI007001; the US National Institute of Mental Health under Grants R44 MH104102 and R43 MH104102; and the University of North Carolina at Chapel Hill Center for AIDS Research (CFAR), a US National Institutes of Health funded programme (P30 AI050410).