Fig. 1.

Conceptual overview of social context, gender dynamics and disclosure of ARV-based gel use in an open-label study in KwaZulu-Natal. Disclosure is a behavior enacted along a continuum from none to full. Disclosure is influenced by factors at multiple levels: the woman’s individual situation, her relationship dynamics, and the social and cultural context. These various factors, in turn, operate along continuums that push women toward greater or less disclosure. In the figure, the right end of each continuum pushes toward full disclosure while the left end pushes toward no disclosure. Factors also influence each other across levels (indicated by curved arrows). For example, the degree of HIV stigma in a woman’s social context influences her ability to communicate about sex and HIV within her relationship, which in turn influences the extent to which she perceives disclosure to be a barrier to or facilitator of her ability to use the gel. Whether and how much a woman discloses about gel use to her partner reflects these combined effects and can change if the factors also change