title: Considerations for purposeful HIV status disclosure among women living with HIV in Ghana.
abstract: Although disclosure of positive HIV status has recognized benefits, enacted and perceived stigma is a continuing problem in Ghana, especially affecting women living with HIV (WLHIV). This qualitative study investigates how WLHIV make these decisions. We interviewed 40 WLHIV, analysing their transcripts using thematic content analysis. Four themes emerged from the data: selectivity in disclosure; disclosure for education, prevention and to provide support; concern for the potential confident, and safety in secrets. Women's awareness of and concerns about HIV-related stigma led them to seriously weigh the costs and benefits of disclosure decisions. Overall, our participants disclosed only when they believed that disclosure would benefit them or the confidant. They did not condone open disclosure, and preferred non-disclosure to minimize harm to themselves and loved ones. Though disclosure occurred for HIV education and prevention purposes, personal safety was the priority. We recommend revision of current post-HIV testing and pre-treatment counselling procedures to incorporate WLHIVs' judgements about disclosure and discussion of the perceived benefits of disclosure. Disclosure is an intricate process that involves support seeking and educating others while averting harm. Continued research of the factors related to disclosure is important to enhance understanding of the disclosure process.
authors.affiliation: a School of Public Health , The University of Texas Health Science Center at Houston , Houston , TX , USA.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Poku
authors.affiliation: b Institute of Statistical, Social, and Economic Research , University of Ghana , Legon , Ghana.
authors.forename: Adobea Yaa
authors.initials: AY
authors.lastname: Owusu
authors.affiliation: a School of Public Health , The University of Texas Health Science Center at Houston , Houston , TX , USA.
authors.forename: Patricia Dolan
authors.initials: PD
authors.lastname: Mullen
authors.affiliation: a School of Public Health , The University of Texas Health Science Center at Houston , Houston , TX , USA.
authors.forename: Christine
authors.initials: C
authors.lastname: Markham
authors.affiliation: a School of Public Health , The University of Texas Health Science Center at Houston , Houston , TX , USA.
authors.forename: Sheryl A
authors.initials: SA
authors.lastname: McCurdy
mesh_terms: D000328:Adult; D005260:Female; D005869:Ghana; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology*; D006801:Humans; D007407:Interviews as Topic; D008875:Middle Aged; D009042:Motivation; D036301:Qualitative Research; D012449:Safety; D057545:Social Stigma; D012944:Social Support; D014342:Truth Disclosure
keywords: HIV; decision-making; disclosure; stigma; women