Understanding HIV disclosure among African-Americans and Latinos in the rural southeast to increase access to needed services and support

Minorities in southeast rural communities experience a significant burden of HIV/AIDS. Lack of disclosure by persons living with HIV/AIDS (PLWHA) may limit access to support and needed clinical services. As part of a larger study we sought to identify patterns of disclosure about HIV status among rural African-American and Latinos, as well as barriers and facilitators to disclosure.

We conducted 35 individual interviews (30 English, 5 Spanish) with PLWHA. The interviews were audio-taped, transcribed and entered into Altas.ti for thematic coding and analysis. Transcripts were independently analyzed by six research team members in a back/forth approach between discovery and verification of findings.

Participants identified key people with whom they shared their status and with whom they did not disclose their status. A majority reported very limited to only moderate disclosure. Many did not disclose their status to other PLWHAs in their communities. Barriers to disclosure included concerns related to confidentiality, negative responses of others, possible physical and social isolation, potential stigma from the community, loss of employment status, and denial of HIV status. Additional barriers for Latino participants included: fears related to loss of medical care due to deportation and loss of employment. Facilitators related to disclosure included access to social support and medical care.

Understanding patterns of disclosure, including key people with whom PLWHAs have shared their status, facilitators and barriers to disclosure and cultural differences among rural minorities can inform strategies to provide medical and social support services that are tailored to the needs of PLWHA.