Table 2.

Alignment of Related Qualitative and Quantitative Findings (Excerpts)

HIV-Related Stigma

Qualitative findings

Strategies to manage stigmatization included normalization,5 education of others about HIV,7,14 helping others prevent infection,1 public advocacy and support of other HIV-positive persons,1,14 attributing HIV-stigma to sexism and/or racism,5,7 identity management,2,5,6,14 and information management.all

Quantitative findings

Among Black women, knowledge of HIV as stigmatizing, felt stigma, and enacted stigma were positively associated with psychological functioning (.847mv) and number of persons disclosed to (−1.036mv).19

Felt Stigma

Qualitative findings

Felt stigma consisted of HIV-positive women’s own feelings of shame, devaluation,1,2,3,7,13,14 fear of rejection and social ostracism,1,4,5,6,9 fear for personal safety,4 fear of discrimination,5 and negative Redefinition of self as HIV-positive.2,3

Quantitative findings

Women with (versus without) felt stigma had greater odds of identifying a support person (.614mv).28

A greater percentage of Black women than White women feared rejection by their family (.453).36

Enacted Stigma

Qualitative findings

Enacted stigma consisted of others’ rejecting behaviors3,4,6,11 discrimination,7,11 and violence.4

Quantitative findings

The number of persons disclosed to increased the odds of enacted stigma (.279mv), but having instrumental social support decreased the odds of enacted stigma (−.300mv).22

Being abused by a perpetrator prior to HIV diagnosis increased the odds of being abused after diagnosis (.476mv).23

Timing of Disclosure

Qualitative findings

Timing of disclosure was immediately after diagnosis,10 delayed until women accept/adjust to diagnosis4 or child is developmentally ready1,10,11,15 or until assess impact on others,4 before imminent disclosure by others (preemptive disclosure),10 or at any opportune moment, when it felt right.1

Quantitative findings

Among Black women, the number of months between diagnosis and disclosure to father (−.222), to extended family (−.239), to children (−.263), to partner (−.433), and to mother (−.449) was shorter than the number of months between diagnosis and disclosure to friends.17

Target of Disclosure

Qualitative findings

Women variously chose to restrict or not to restrict disclosure to children, partners, family, friends, acquaintances, employers, co-workers, religious leaders, and other HIV-positive persons.all

Quantitative findings

A greater percentage of women with AIDS (.524) or who were symptomatic (1.490) disclosed to their sexual partners compared to asymptomatic women, and a smaller percentage of women with AIDS disclosed to their sexual partners compared to symptomatic women (1.490).36

A greater percentage of women than men disclosed to extended family (.215) and to mother (.326).25

Benefits of, Reasons for Disclosure (excluding children)

Qualitative Findings

Conditions, or rules, for disclosure included the need to know,1 right to know/duty to inform,13 capacity or readiness to know, 1,10 likelihood of burden to others from knowing,1 degree of acceptance of HIV, trustworthiness, ability to keep a secret,1 physical proximity, intimacy, and quality of relationship with other,3,10 and perceived benefit versus risk of harm to self or others.1,10

Perceived benefits of disclosure, or reasons to disclose included positive social support,1,3,4,5,6,10,11,13 reconciliation with family,10 avoidance of stress/burden of secrecy, catharsis, relationship authenticity,2,11,13 control of disclosure process,10 minimization of felt stigma,2,14 and healing, wellbeing, improved quality of life, growth, renewed interest in life.3,4

Quantitative Findings

Testing other’s reactions was endorsed to a greater extent by women than men as a reason for disclosing to an intimate partner (.389) and to a friend (.562).21

Catharsis was endorsed to a greater extent by women than men as a reason for disclosing to a parent (.401), friend (.563), and to an intimate partner (.637).21

Similarity (having something in common) was endorsed to a greater extent by women than men as a reason for disclosing to a parent (.487).21

Risks of, Reasons for Nondisclosure (excluding children)

Qualitative Findings

Perceived risks of disclosure, or reasons not to disclose included loss of positive or negative social support,3,13 stigmatization,2,11 disappointment, burden, suffering, stigmatization of loved ones,1,3,6 culturally incongruent roles (adult child cared for by parent instead of reverse),3 loss of privacy,4 and uncontrolled (unplanned) disclosure.1,7,10,13

Quantitative Findings

Protecting the other as a reason for not disclosing to a friend was positively associated with knowledge of HIV as stigmatizing among women (.402) and among men (.246); as a reason for not disclosing to a parent was positively associated with knowledge of HIV as stigmatizing among women (.928) and among men (.723); and as a reason for not disclosing to an intimate partner was positively associated with knowledge of HIV as stigmatizing among women (.254).21

Self-blame as a reason for not disclosing to an intimate partner was positively associated with knowledge of HIV as stigmatizing among women (.270) and among men (.272); as a reason for not disclosing to a friend was positively associated with knowledge of HIV as stigmatizing among women (.523) and among men (.415); and as a reason for not disclosing to a parent was positively associated with knowledge of HIV as stigmatizing among women (1.317) and among men (.711).21

Content of Disclosure

Qualitative Findings

Disclosure was full (everything), partial, or totally concealed.2,5,6

Partial disclosure or total concealment was enabled by virtue of not being seen as at risk for HIV,5 having no visible signs of illness, covering, passing, and by circumventing the need to disclose.6

Quantitative Findings

(All quantitative findings on content of disclosure are in relation to children.)

Disclosing Maternal HIV to Children

Qualitative Findings

Reasons for disclosing to children included perceived ability of older children to understand or cope with the effects of maternal HIV,1,8,9,10,11,15 perceived ability of older children to keep HIV a secret,8,11 desire to protect children from transmission and from courtesy stigma,8,11,15 felt obligations to children (right to know, to tell the truth, should hear it from mother),9,11,15 desire to preserve good relations with children and identity as good mother,8,11 and mothers’ own health and need for help.9,11,15

Quantitative Findings

The odds of needing more physical assistance or social support were greater among mothers who disclosed to children than mothers who did not (.366mv); mothers who disclosed to children had greater personal feelings of social support than mothers who did not (.544mv).29

A greater percentage of mothers with AIDS than symptomatic mothers (.293)27 and asymptomatic mothers (.386) 27 & (.330)18 disclosed to children; a greater percentage of symptomatic mothers than asymptomatic mothers disclosed to children (.444).18

Not Disclosing Maternal HIV to Children

Qualitative Findings

Reasons for not disclosing to children included perceived inability of young children to understand or cope with the effects of maternal HIV,1,9,10,11,15 perceived inability of young children to keep HIV a secret,1,8,11 desire to protect children from transmission and from courtesy stigma,8,11,15 desire to preserve good relations with children and identity as good mother,8,11 and disclosure seen as too threatening.11

Quantitative Findings

Not disclosing to children because of not wanting to burden them (1.036), fear that child will tell others (1.124), and to keep information from them (1.036) were positively associated with felt stigma.31

Not disclosing to children because HIV was deemed personal (1.008) was positively associated with knowledge of HIV as stigmatizing (1.008).31

Note. Superscript numbers refer to reports listed in Table 1. All relationships are bivariate, except where indicated as multivariable (mv).