‘It’s a very gray, very messy area’: Factors influencing undetectable gay men’s HIV status disclosure decisions to sexual partners Öffentlichkeit

Abstract

Objective: HIV disclosure to sexual partners is a multifaceted yet stigmatized process. Previous qualitative literature has examined this process, but few studies have focused specifically on gay-identified men, a group disproportionately affected by the HIV epidemic in the United States. Additionally, the concept of ‘undetectable equals untransmittable’ (U=U) has raised discussions around the ethics and morals of disclosure, but few studies have broached this topic during a period of wider knowledge and acceptance of U=U. Similarly, few studies have examined how HIV criminalization laws impact undetectable persons’ disclosure patterns. Thus, this study explores the factors that impact undetectable gay men’s HIV status disclosure decisions to sexual partners.

Methods: Using a model presented by Bird and Voisin (2010) as a framework, semi-structured interviews were conducted with 20 self-identified undetectable gay men about topics related to the cognitive, contextual, and interpersonal factors impacting their decisions to disclose to sexual partners. Interviews were coded and analyzed using thematic analysis. 

Results: Three themes emerged from the data: ‘sense of obligation,’ ‘situational disclosure,’ and ‘partners’ responsibility in the disclosure process.’ All themes covered the cognitive, contextual, and inter-personal factors contributing to status disclosure decisions, respectively and mostly aligned with the Bird and Voisin model. These factors were nuanced and, at times, contradictory to one another. Being undetectable modified how some participants felt about disclosure but there was not one consistent pattern across all participants. 

Conclusions: This study examined the cognitive, contextual, interpersonal, and structural factors that influence undetectable gay men’s HIV status disclosure decisions to sexual partners. These factors were related to feeling obligated to disclose; how disclosure is situational; and sexual partners’ responsibilities in the disclosure process. Findings demonstrated the complexities of this process and had implications for the modernization or repeal of HIV criminalization laws as a way to mitigate structural HIV stigma.

Table of Contents

Chapter 1: Introduction.......1

Chapter 2: Literature Review.......12

Chapter 3: Student Contribution And Methodology.......32

Chapter 4: Manuscript.......37

Chapter 5: Discussion.......69

References.......76

Appendix A: Interview Guide......91

Appendix B: Codebook.......95

About this Master's Thesis

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School	Rollins School of Public Health
Department	Behavioral Sciences and Health Education
Degree	M.P.H.
Submission	Master's Thesis
Language	English
Research Field	Psychology, Behavioral Sciences GLBT Studies Health Sciences, Public Health
Stichwort	Stigma HIV Undetectable Disclosure
Committee Chair / Thesis Advisor	Elizabeth Walker, PhD, MPH, MAT, Emory University
Committee Members	Colin Talley, PhD, Emory University Sophia A. Hussen, MD, MPH, Emory University

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