HIV+ women's narratives of non-disclosure: Resisting the label of immorality

Abstract

Increasing partner disclosure rates among HIV+ individuals is widely seen as an important public health strategy to reduce HIV transmission. One approach for encouraging disclosure is to emphasise individuals' moral responsibility to disclose their status to their partners. We use South Africa as a case study to draw attention to two problems with labelling non-disclosure as immoral. First, we argue that because women are tested for HIV at much higher rates than men, any approach that involves blaming HIV+ individuals for not disclosing their status will disproportionately burden women. Second, through the narratives of six HIV+ women, we highlight how a focus on morality undervalues the complexity of sexual partnerships. Specifically, women describe how their perceived obligation to disclose their status is directly influenced by communication with their sexual partners. Women also discuss how the onset of different life events might alter the meaning of HIV and change obligations regarding disclosure within the partnership. The differences in testing rates across gender combined with the complexity of sexual partnerships leads us to suggest that labelling non-disclosure as immoral does little to advance HIV prevention. There is an urgent need to identify alternative interventions that support women through the disclosure process.

Keywords:

• ethics
• qualitative methods
• disclosure
• HIV prevention
• South Africa

This article is referred to by:

Disclosure, sex and moral agency: A response to Groves, Maman and Moodley

Notes

1. We assumed in our analysis that our participants had a single sexual partner because none of the women talked about having more than one partner, despite extensive probing about their sexual relationships during and immediately following pregnancy. In addition, none of the women indicated they were currently sexually active. As such, it is unlikely that the women were engaging in overlapping or new sexual relationships during this time period.