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Disclosure of HIV+ status is a complex, difficult and very personal matter. Disclosing one’s HIV+ status entails communication about a potentially life threatening, stigmatized and transmissible illness. Choices people make about this are not only personal but vary across different age groups, in different situations and contexts, and with different partners, and may change with time, depending on one’s experiences. Disclosure may have lifelong implications since more people are living longer, and often asymptomatically, with HIV. Public health messages have traditionally urged disclosure to all sexual and drug using partners. In reality, some HIV+ persons may choose not to disclose due to fears of rejection or harm, feelings of shame, desires to maintain secrecy, feelings that with safer sex there is no need for disclosure, fatalism, perceived community norms against disclosure, and beliefs that individuals are responsible for protecting themselves. This Fact Sheet primarily focuses on disclosure in the context of sex. Discussing and disclosing HIV status is a two-way street. Be it right or wrong, most people feel that when a person knows that he/she is HIV+ then he/she has an obligation to tell the other person, and counselors are encouraged to help people with this process. Also, laws in some areas require disclosure of HIV+ status prior to sex. However, both partners should be responsible for knowing their own status, disclosing their own status when it seems important, and asking their partner about their status if they want to know. Most HIV+ persons disclose their status to some, but not all, of their partners, friends and family. Disclosure generally becomes easier the longer someone has been living with HIV, as he/she becomes more comfortable with an HIV+ status. Disclosure to sex partners is more likely in longer-term, romantic relationships than in casual relationships (one-night stands, anonymous partners, group scenes, etc.). Disclosure also varies depending on perceived HIV status of partners, level of HIV risk of sex activities, sense of responsibility to protect partners (personal vs. shared responsibility) and alcohol or drug use.

La revelación de la condición de ser VIH+ es un asunto complejo, delicado y muy personal. Se trata de hablar sobre una enfermedad estigmatizada, transmisible y potencialmente mortal. Las decisiones al respecto no sólo son personales sino que varían según la edad, la situación, el contexto y la pareja, y pueden cambiar durante el transcurso del tiempo y según las experiencias de la persona. Históricamente, los mensajes de salud pública han exhortado la revelación del estatus de VIH a toda pareja sexual y de drogas. En la realidad, algunas personas VIH+ tal vez prefieran no revelar su estatus por varios motivos: temor al rechazo o daño, sentimientos de culpabilidad, el deseo de mantenerlo en secreto, creer que al protegerse durante el acto sexual ya no es necesario revelarla, fatalismo, la percepción de normas comunitarias en contra de la revelación y creer que los otros tienen la responsabilidad de protegerse. Esta hoja se centra en la revelación del estatus de VIH dentro del contexto sexual. Comentar y revelar el estatus de VIH es una vía de doble sentido. Ya sea correcto o no, la mayoría de las personas creen que cuando una persona se sabe VIH+ entonces le incumbe informar a su pareja, y a los consejeros se les anima a ayudarles en este proceso. Además, en algunas áreas las leyes requieren la revelación del estatus de VIH+ antes de iniciar el contacto sexual. Sin embargo, ambos integrantes de la pareja deben compartir la responsabilidad de conocer su propia condición, de revelarla cuando lo estimen importante y de preguntar a su pareja sobre la condición del otro si desean enterarse. La mayoría de las personas VIH+ revelan su estatus a algunas pero no a todas sus parejas, amistades y familiares. Generalmente, entre más tiempo se viva con el VIH, más fácil se hace aceptar y revelar dicha estatus. La revelación del estatus de VIH a parejas sexuales es más común en las relaciones románticas de largo plazo que en las casuales (aventuras de una noche, parejas anónimas, sesiones grupales, etc.). La revelación también varía según la percepción del estatus de VIH de las parejas, el nivel de riesgo de VIH de los actos sexuales, el sentido de responsabilidad de proteger a las parejas (responsabilidad personal vs. compartida) y el consumo de alcohol o drogas.

After more than 20 years of the HIV epidemic, with advances in treatment and increases in understanding and acceptance of HIV, getting an HIV+ diagnosis still can be a traumatic experience. HIV+ persons must come to terms with their own infection and be concerned with possible infection in past and future partners. Talking to partners about HIV is especially hard because even though it is a manageable disease, HIV still is not curable. Disclosure assistance services (also known as partner counseling and referral services or PCRS) are an array of voluntary and confidential services available to persons living with HIV and their exposed sex and/or needle-sharing partner(s). Disclosure assistance is cost effective and can play a critical role in identifying those individuals most at risk for HIV infection, and linking those who are infected to early medical care and treatment. Most HIV+ persons make the decision to disclose or not disclose to their partners on their own. But HIV+ persons may want support for telling their partners about HIV, whether by encouragement for self-disclosure or by having someone who is well-trained carefully and confidentially notify a partner for them. In one study, persons who received disclosure assistance were over three times more likely to have informed a partner of their risk. In the past few years, HIV counseling and testing programs across the US have shifted their emphasis from testing anyone, to finding and testing persons at greatest risk for HIV infection. At general HIV testing sites, around 1% of clients tested are found to be HIV+, whereas 8-39% of clients tested through disclosure assistance are found to be HIV+.