1. Jason D. P. Bird1, Dexter R. Voisin2
1 Assistant Professor in the Department of Social Work at Rutgers-
Newark, Newark, NJ
2Associate Professor at SSA, University of Chicago, Chicago Illinois
This research was supported, in part, by Howard Brown Health Center, a grant
from the Fahs-Beck Fund for Research and Experimentation, and a
fellowship grant from the School of Social Service Administration at the
University of Chicago.

2. “…You’re an open target for discrimination.
You’re an open target to be
abused...you’re an open target to be
disrespected under any given point…you’re
looked down upon – you’re discriminated
against…there’s no support system...So if I
say something – I’m gonna get talked about,
I’m gonna get exiled -- that same
stereotype...all those years ago, that still
very much exists.”
(Steve, age 51, 11yrs+)

3.  Identified as a health crisis among African
Americans
 African Americans account for nearly half of all
diagnosed cases of HIV
 Black MSM account for 63% of all cases of HIV
infection among Black men

4.  Prevention efforts are moving towards:
 increased routine HIV testing
 prevention interventions for HIV+ individuals
 Literature is unclear about the relationship between
disclosure and safer sex
 No established models regarding the interpersonal
barriers to HIV disclosure

5.  Grounded Theory approach – Semi-structured, one-
on-one interviews (avg. interview = 2.5hrs)
 Eligible if: Previously associated with research at
Howard Brown Health Center; HIV+; African
American aged 18 or older; and, reported engaging
in Unprotected Anal Sex with an HIV- or unknown
male sexual partner in the prior 6 months
 20 HIV+, African American MSM were enrolled
 Data analysis based on Strauss and Corbin’s
framework of Open-Coding, Axial Coding, and
Selective Coding

6.  Mean age– 40 years
 Years positive – 9.2 years
 Majority of the participants identified as a sexual
minority (gay, bisexual, SGL)
 Disclosure Patterns –
 Always: 2
 Never: 3
 Conditional: 15

7. 1. Beliefs about HIV Stigma and the
Enforcement of Sexual Silence
2. Transmission of HIV Information through
Sexual and Social Networks
3. The Role of Trust Assessments in Sexual
Relationships and Strategies for
Disclosure

8.  Multiple Sources of Stigma
 Social and Ethnic Communities
 Gay or Sexual Communities
 Pre-HIV Personal Beliefs
 Multiple Stigmatizing Messages
 Lack of Empathy
 Active Blame of people infected with HIV
 Beliefs about moral failings

9. HIV as Punishment and Social Judgment:
“…Black people see AIDS ...in a Church realm, like
you’re being punished by God... you’ve been
stricken…I really kept it hid ‘cause I didn’t want
people to know.”
(Tyrone, age 36, 10yrs+)
Individuals as Diseased/Contagious:
“…(they) consider you to be un-normal cause you’re
HIV...The non AIDS people don’t like the AIDS
people...because they figure they going around
infecting everybody... They just feel like you’re
dying...You’re going around to help people die…”
(Ben, age 28, 3yrs+)

10. “…I discriminated like everybody else did... thought that you
transfer the virus just by being in the same room – all the
ignorant, paranoid...unsupported...thoughts that went along
down the line, I was one of them people…once I found out, it
was heartbreaking…All the stereotypes that were
associated with HIV and AIDS were inside my head...”
(Steve, age 51, 11yrs+)

11.  Many potential consequences related to
disclosing an HIV+ status
 Transmission of HIV information:
 Primary concern
 Emerged from the data
 Not in previous literature

12. “…if the wrong person gets your information, you
know, they have power...They have power to
wield it however they want to wield it, so you have
to make sure that you empower yourself…I don’t
wanna give that power – because to me, it’s like
them having power over me…”
(Jack, age 32, 10yrs+)
“…really need to understand that you can’t unring a
bell…You can’t un-tell someone, and you can’t
control who they tell…you can’t control what
someone does…It’s out there...”
(David, age 23, 5yrs+)

13. “…he got mad at me one day when he was on his binge
and I didn’t have money and put ‘Ted is HIV positive’
on white lined paper and hung it all over the
apartment building where I was working…And I
came home to find that...”
(Ted, age 42, 3yrs+)

14. What is important in deciding to Disclose?
 Is it “Safe” to Tell
 Controlling information
 Partner assessment for trust
 Taking time to get to know someone

15. Asking Probing Questions
“…you may mention...in a very...non-intrusive type of
way…"Wow, what do you think about this whole
epidemic?" or… things of that nature, and you kind of
gauge their response…how he responds to that
question...has a huge determining factor on if I'm gonna
disclose my status…”
(Nick, age 27, 4yrs+)
Time
“…I’ve learned to have patience…because sometimes
people, they know how to answer your questions right...
they may have a mask on... you need to find the
appropriate questions to ask...get these people to talk to
you…Listen to everything…”
(Jack, age 32, 10yrs+)

16.  An HIV status is a deeply private attribute
 Fears about HIV stigma and the potential
transmission of HIV information serve as
resilient barriers to disclosure
 Unintended consequence of stigma -
facilitates silence and decreases
communication

17.  Controlling to whom one discloses is seen as
both legitimate and imperative to self-
protection
 These concerns make people take a more
cautious, thoughtful approach to disclosure
 HIV disclosure is not a simple, dichotomous
choice – it is a “Conditional Process”

18.  Need to better account for the interpersonal
aspects of sexual negotiation
 Focus on how individuals interpret issues of
sexual safety and HIV transmission
 Interventions should emphasize the need to
reduce HIV-related stigma