Adolescents disclosing to others
The main benefit of disclosing their HIV status to others is to provide an adolescent a means of support. Particularly for those without the capacity or means to cope with their diagnosis alone, disclosing to someone close, who they trust, can provide emotional as well as practical support. Disclosure to others is also associated with better treatment adherence, both as a result of not having to hide medications and also generally improved mental health through reduction of isolation and secrecy. Open negotiation of condom use and partner HIV testing can also be facilitated as a result of disclosure. This has important public health benefits by preventing further transmission of HIV to sexual partners.
Potential negative consequences exist for adolescents, with differing degrees of risk. Physical harm, discrimination, stigma, unwilling onward disclosure and isolation may be experienced as a result of disclosing HIV status to others. Depending on the country's legal framework, non-disclosure to sexual partners may result in criminalization, and adolescents from key populations may face specific legal consequences.
WHO recommends adolescents should be counselled about the potential benefits and risks of disclosure of their HIV status, and empowered and supported to determine if, when, how and to whom to disclose. Adolescents need the time to explore the potential benefits and risks of HIV disclosure, taking into full consideration their own circumstances and the various people they may wish to disclose to. This can be done considering family, friends and sexual partners, work and education circumstances, religious leaders and the community.
When discussing who to disclosure to, it is important for health care providers to be aware of relevant national laws and policies. Equally important, is that this information is passed on to adolescents so they are also informed of their responsibilities and as well as their rights, especially their right to confidentiality.
In supporting an adolescent on how to disclosure their HIV status, it is important to equip them with information to ensure they can answer questions and manage the reactions of those they are disclosing to. Writing out a plan of what to say, and practising possible questions and responses through role plays, can both assist the adolescent to feel prepared. Further support can be found through sharing of experiences with other adolescents living with HIV.
Adolescents should also consider when and where to disclose. When is the best time for them and for the person/people they are disclosing to. They may want to consider if they have come to terms with having HIV, if they feel prepared, or whether there are other major stressors at the time, like starting HIV-related treatment. It is important to ensure a safe environment for the adolescent when disclosing. Some adolescents may prefer to disclose their status with the presence of a health care provider in a clinic setting, or with others who may already know their status close by.
After the adolescent has disclosed their HIV status, it is beneficial to debrief with the adolescent to reflect on challenges and successes, and how they would do it differently the next time. Some adolescents may wish to bring someone they disclosed to with them to the clinic, so they also have an opportunity to ask any questions. Particularly, for sexual partners this provides an opportunity to discuss HIV testing and counselling options.
It is important to remember that over emphasis on disclosing one's HIV status – especially to parents or sexual partners – may discourage adolescents from engaging with services. Similarly, compulsory disclosure by health care providers (i.e. to authorities) can be a deterrent for adolescents to attend HIV testing and counselling, particularly those from key populations. Disclosure needs to be handled sensitively, first and foremost with the adolescent's wishes being respected.