Self-disclosure of HIV seropositivity in Nairobi, Kenya
Miller, Ann Neville
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Whether, why, to whom, and how people living with HIV/AIDS (PLHAs) disclose their diagnosis to others is a critical issue for HIV prevention and care efforts, but previous investigations of those issues in sub-Saharan African have been limited to one or two questions embedded in studies of social support or stigma. Using Communication Privacy Management Theory as a theoretical framework, this investigation employed key informant interviews, four focus group discussions, and structured interviews of 307 PLHAs to examine targets, methods, and motivations of diagnosis disclosure in Nairobi. In particular, disclosure patterns with respect to four groups were compared: partners, friends, family members, and religious leaders of PLHAs. Results indicated that methods of disclosure, and motivations for both disclosure and non-disclosure, were often relationship-specific. Family members were the group most often disclosed to, and such disclosures were more highly motivated by duty, seeking material support, and preparing for the future than were disclosures to other groups. Non-disclosure to family members was more strongly motivated than non-disclosure to other groups by the desire to protect the other party. Disclosure to religious leaders as opposed to the other groups was more highly motivated by seeking advice. Non-disclosure to friends was more highly motivated by believing that that the person was not HIV-positive, and by concerns about confidentiality, than was disclosure to family. The most frequently mentioned method of disclosure for all groups was direct, face-to-face explanation. However, male PLHAs also frequently employed intermediated disclosure methods for informing partners of their status. Qualitative aspects of the research indicated that intermediaries were also regularly used as vehicles for disclosure to family, as was indirectness. Implications for health communication practice and interpersonal communication theory are drawn in the final chapter.