Smith Charlotte, Cook Rachel, Rohleder Poul
Department of Psychology, Anglia Ruskin University, Cambridge, UK.
School of Psychology, The University of East London, UK.
Br J Health Psychol. 2017 Feb;22(1):110-127. doi: 10.1111/bjhp.12220. Epub 2016 Dec 2.
This study sought to elucidate the process through which people living with HIV (PLWH) in the United Kingdom disclose their status to an intimate partner (IP).
A qualitative cross-sectional survey design was used.
A total of 95 PLWH took part. They were presented with a series of open-ended questions enquiring into their last experience of disclosing to an IP. The data were analysed using thematic analysis.
Disclosure became a salient issue when the discloser acknowledged their relationship as meaningful. A decision to tell was mostly made to build a foundation for the evolving relationship. Once the decision was made, it was enacted via one of two mechanisms (self-initiated or opportunistic) and partners' reported reactions fell within one of four main reaction types. In the long-term for couples who remained together, disclosure was understood to have brought them closer. However, for both those whose relationships remained intact, and for those whose relationship had since broken down, sexual difficulties associated with being in a sero-discordant partnership pervaded. At a personal level, the experience resulted in increased confidence in living with the diagnosis, and an increased sense of disclosure mastery.
Disclosure is a highly nuanced process. In particular, it was found to be largely characterized by the IP relational context in which it was occurring. The clinical and theoretical implications of these findings are discussed. In particular, these findings highlight a need for the provision of long-term support to PLWH in negotiating their relationships throughout the process. Statement of contribution What is already known on this subject? Disclosing a HIV+ status to an intimate partner (IP) is key in addressing the global HIV epidemic, social stigma, and the psychological and physical well-being of people living with the condition. It is increasingly recognized that HIV disclosure is a process, rather than an event. Researchers have begun to initiate a line of research into a process-based theoretical account of disclosure. What does this study add? This study provided a nuanced account of the disclosure process within an IP relationship. The process was found to be largely influenced by the discloser's subjective experience of the intimate partnership. The findings point to a need for a disclosure intervention that supports couples more longitudinally, particularly in negotiating the emotional and sexual difficulties that often arise upon disclosing.
本研究旨在阐明英国的艾滋病毒感染者（PLWH）向亲密伴侣（IP）披露其感染状况的过程。
采用定性横断面调查设计。
共有95名艾滋病毒感染者参与。向他们提出了一系列开放式问题，询问他们最近向亲密伴侣披露感染状况的经历。使用主题分析法对数据进行分析。
当披露者认为他们的关系有意义时，披露就成为一个突出问题。做出告知的决定主要是为了为不断发展的关系奠定基础。一旦做出决定，就会通过两种机制之一（自我主动或机会主义）来实施，伴侣报告的反应属于四种主要反应类型之一。从长期来看，对于仍在一起的夫妻，披露被认为使他们关系更亲密。然而，对于那些关系保持完整的人以及那些关系后来破裂的人来说，血清学不一致伴侣关系中存在的性困难普遍存在。在个人层面，这种经历增强了感染者应对诊断的信心，并增强了披露掌握感。
披露是一个非常微妙的过程。特别是，发现它在很大程度上受披露时亲密伴侣关系背景的影响。讨论了这些发现的临床和理论意义。特别是，这些发现凸显了在整个过程中为艾滋病毒感染者提供长期支持以帮助他们处理关系的必要性。贡献声明关于这个主题已知的情况是什么？向亲密伴侣披露艾滋病毒阳性状况是应对全球艾滋病毒流行、社会耻辱以及感染者身心健康的关键。人们越来越认识到艾滋病毒披露是一个过程，而不是一个事件。研究人员已开始对基于过程的披露理论进行一系列研究。本研究增加了什么？本研究对亲密伴侣关系中的披露过程进行了细致入微的描述。发现该过程在很大程度上受披露者对亲密伴侣关系的主观体验影响。研究结果表明需要一种更具纵向性的披露干预措施，特别是在处理披露后经常出现的情感和性困难方面，以支持夫妻双方。
