Social relationships, mental health, and stigma: A qualitative study of social networks and HIV disclosure in Western Kenya

Abstract

The disclosure of one’s HIV-positive status is a personal decision that can play an important role in engagement in HIV treatment and care. Social network approaches situate individuals within broader webs of social connections that influence health and wellbeing and thus hold the potential to elucidate key social factors shaping the process of disclosure. As part of a larger clinical study examining how substance use and mental health shape HIV outcomes, we recruited 61 individuals newly diagnosed with HIV at two clinics in Western Kenya to participate in an egocentric social networks study. We conducted a survey that generated a visual network map to guide a subsequent qualitative interview about experiences being diagnosed and living with HIV. We thematically analyzed the qualitative data and visual network maps to examine the social contexts and patterns of HIV disclosure, with the goal of identifying supportive contexts of disclosure. The mean age was 36.7 years (range: 20–62); women were significantly younger than men and more likely to self-report a mental health issue. Typically, participants disclosed their HIV-positive status to a small number of close, trusted alters in their network, including intimate partners, siblings and other family members, and friends. The need for mental health support in the wake of a new diagnosis, especially among women, encouraged disclosure. Across nearly all stories, stigma was a powerful deterrent to sharing one’s status, and multiple people noted prior disclosure to others not named in their current networks because their relationships were negatively impacted. Our study shows how the intersection of social relationships, mental health, and stigma is critical in understanding decision-making processes around disclosure. Selective disclosure typically improved participants’ wellbeing while stigma precluded disclosure and exacerbated distress. Our study offers suggestions for social network interventions to support people living with HIV/AIDS.