Barriers, Facilitators and Opportunities for HIV Status Disclosure Among Young Men Who Have Sex With Men: Qualitative Findings from the Tough Talks Intervention

• Published in: AIDS and behavior 2024-10, Vol.28 (10), p.3283-3299
• Main Authors: Muessig, Kathryn E., Vecchio, Alyssa C., Hanshaw, Brady D., Soberano, Zachary, Knudtson, Kelly A., Claude, Kristina Felder, Larsen, Margo Adams, Hightow-Weidman, Lisa B.
• Format: Article
• Language: English
• Subjects: Adult; Autonomy; Barriers; Decision Making; Disclosure; Health Psychology; HIV; HIV Infections - prevention & control; HIV Infections - psychology; Homosexuality, Male - psychology; Human immunodeficiency virus; Humans; Infectious Diseases; Intervention; Interviews as Topic; Male; Medical decision making; Medicine; Medicine & Public Health; Men who have sex with men; Original Paper; Public Health; Qualitative Research; Self Disclosure; Self Efficacy; Sexual and Gender Minorities - psychology; Sexually transmitted diseases; Social Stigma; STD; Telemedicine; Trauma; Truth Disclosure; Young Adult; Young men
• ISSN: 1090-7165; 1573-3254; 1573-3254
• DOI: 10.1007/s10461-024-04406-y

Disclosing one’s HIV status can involve complex individual and interpersonal processes interacting with discriminatory societal norms and institutionalized biases. To support disclosure decision-making among young men who have sex with men (YMSM) living with HIV, we developed Tough Talks ™, an mHealth intervention that uses artificially intelligent-facilitated role-playing disclosure scenarios and informational activities that build disclosure skills and self-efficacy. Qualitative interviews were conducted with 30 YMSM living with HIV (mean age 24 years, 50% Black) who were enrolled in a randomized controlled trial assessing Tough Talks ™ to understand their experiences with HIV status disclosure. Interviews were recorded, transcribed, and thematically coded. Barriers to disclosure focused on fear, anxiety, stigma, and trauma. Facilitators to disclosure are described in the context of these barriers including how participants built comfort and confidence in disclosure decisions and ways the Tough Talks ™ intervention helped them. Participants’ narratives identified meaning-making within disclosure conversations including opportunities for educating others and advocacy. Findings revealed ongoing challenges to HIV status disclosure among YMSM and a need for clinical providers and others to support disclosure decision-making and affirm individuals’ autonomy over their decisions to disclose. Considering disclosure as a process rather than discrete events could inform future intervention approaches.