Impact of AIDS Disclosure on Rural African American Men. African Americans (AAs), especially men, are disproportionately represented among people with HIV/AIDS, accounting for 49% of the people with the disease, but only 13% of the population. In the rural south AAs account for 56% of all AIDS cases. AA men have the highest rate of HIV infection in the country. Living in rural areas compounds the problems associated with living with HIV/AIDS because of decreased or lack of services and resources, lack of transportation, and conservative cultural norms which result in shunning and stigmatization. These factors create an environment that makes HIV+ men reluctant to disclose their disease to others. People who do not disclose their HIV/AIDS have been reported to: 1) lack the knowledge and skills to manage their disease, 2) use health care services less, 3) potentially infect others, and 4) lack social support. There are potential negative consequences to disclosure, such as rejection and shame, but disclosure is critical to accessing supportive resources and services necessary for positive health outcomes. Disclosure is recognized as a complex process that changes over time. The purpose of this qualitative study is to explore the process and context of HIV disclosure by AA men to partners and family, and the perceived health outcomes, benefits and consequences of the disclosures. The proposed study will address the following research questions: 1) How do HIV+ AA men describe their disclosure experiences to their sexual partners and family members? 2) What factors facilitate or inhibit disclosure to others? 3) What consequences of disclosure do HIV+ AA men describe for themselves, their partners, and their families? And, 4) What would be helpful to assist rural HIV+ AA men in making disclosure decisions? Grounded theory methodology will be used to examine the disclosure process, with Communication Privacy Management Theory (a decision making theory for sharing private information) informing data collection. The sample will consist of 40 HIV+ AA men recruited from rural AIDS Service Organizations and clinics. Participants who have been diagnosed for at least six months will be interviewed about their disclosure decisions and the process of disclosing their HIV status. They will be questioned about their disclosure decisions about to whom they have disclosed their HIV diagnosis, what motivated them to disclose, the content of the disclosure message, and consequences and benefits of disclosure. The interviews will be audio taped and transcribed for analysis. The constant comparative method will be used for analysis. The findings of this study will provide essential information for developing culturally relevant interventions to guide disclosure decisions which will be supportive of the health and quality of life of rural HIV+ AAs.
Findings from this project will elucidate key aspects of disclosure decisions and experiences for rural African Americans men with HIV Disease. These data are critical in developing culturally relevant interventions to increase the likelihood of HIV+ African American men making disclosure decisions that enhance their disease management and quality of life and decrease transmission to others.
| Gaskins, Susan W; Payne Foster, Pamela; Sowell, Richard L et al. (2012) Making decisions: the process of HIV disclosure for rural African American men. Am J Mens Health 6:442-52 |
