The decision to disclose one's serostatus to family members creates considerable emotional strain for people living with HIV (PLWH), regardless of gender and sexual orientation. While disclosure to family members has been linked to positive outcomes including increased social support, improved physical and mental health outcomes, reduced loneliness and stress, and improved HIV disease management, the decision not to disclose can also lead to positive outcomes. To date, most research about serostatus disclosure has focused on the act of disclosing - the who, what, where, and when of disclosing - rather than the decision process involved. Based on lessons learned during the pilot study of this intervention, disclosure decision-making is a lifelong process and PLWH can benefit from an intervention which helps them clarify their disclosure-related goals, weigh the costs and rewards of disclosure and non-disclosure, identify strategies that will minimize potential costs - and even helps them come to terms with the decision not to disclose. Our long-range goal is to further refine and evaluate an intervention designed to enhance HIV disclosure decision-making among PLWH. To reach this goal, we are proposing a course of study with the following specific aims:
Specific Aim 1 : Conduct a randomized, controlled trial (n=450) of the piloted intervention, and assess the effectiveness of the intervention relative to an attention- control condition on a variety of primary outcomes related to disclosure and health.
Specific Aim 2 : Examine the effects of the intervention over time.
Specific Aim 3 : Explore potential moderating effects of participant demographics, relationship characteristics, and contextual variables related to family on intervention effectiveness.
Specific Aim 4 : Evaluate the effects of treatment engagement, retention, and expectations on outcomes. The central hypothesis of this proposal is based on the Consequences Theory of Disclosure. According to the theory, positive persons weigh the rewards and costs of disclosing their status to family. Whenever the rewards outweigh the costs, disclosure occurs. We have adapted our theory and intervention to incorporate fundamental processes of decision making such as clarifying antecedent goals, decision making, and decision evaluation. This proposal is highly innovative in two very important ways. First, to date, no evidence-based intervention has been developed to assist PLWH in making decisions about disclosure to family. Second, the focus of this intervention is on the disclosure decision-making process and comfort/acceptance with the disclosure decision. As such, skills learned through the intervention can be applied to the lifelong process of serostatus disclosure.
The decision to disclose one's serostatus to family members creates significant emotional strain for persons living with HIV (PLWH). Given the importance of family social support to medication adherence, mental and physical health, as well as access to health care for HIV-positive persons, a piloted disclosure decision intervention which has been shown to increase both disclosure and perceived family social support is worthy of a full, randomized-controlled trial.