UCSF

Forty years into the HIV epidemic, the most impacted group continues to be Black gay and bisexual men, for whom living with HIV comes with a substantial social burden, particularly in communities with high levels of HIV-stigma and homophobia. One way in which this is manifested is in the complex disclosure/nondisclosure process. HIV status disclosure has been, and continues to be privileged in public health research, as it is seen as critical to educating others, reducing sexual transmission, and garnering needed social support. Most of this research has been centered on the individual and has focused on understanding the decision-making process about how, when, and to whom they will disclose. Other research aims to identify barriers and facilitators of disclosure, with the ultimate goal of encouraging disclosure. At the individual level, however, exploring the disclosure process requires an understanding of previous experiences, social environments, and the dynamics of social relationships as HIV risk, diagnosis, and disclosure are each embedded in ongoing social relations. This dissertation takes a sociological approach to understanding the dynamics of HIV disclosure among Black gay and bisexual men living with HIV (BGBM-LWH) in Baton Rouge, Louisiana. BGBM, existing at the intersections of race, class, and sexuality, account for the majority of new infections in the state of Louisiana, and their experiences are embedded in a culture of silence and shame around sexuality and HIV. Thus, their HIV diagnosis and disclosure experiences offer a crucial site for this intersectional analysis which explores disclosure and its outcomes as socially and structurally constituted. Between June 2019 and June 2020, I conducted semi-structured, in-depth, qualitative interviews with 30 BGBM-LWH. I used a grounded theory analysis to explore not only men’s HIV disclosure-specific narratives, but to situate them in the context of their biographies, their social and cultural environment, and their ongoing social and familial relationships.

The results of my analyses are presented in three chapters. First, I illustrate the ways in which HIV status disclosure can result in disruptions to one’s biography and can lead to long-term, negative, and unforseen consequences. These included loss of employment or housing, as well as disrupted social networks, familial relationships, and support systems. Further, I illustrate how their intersectional social locations alongside structural racism, homophobia, and HIV stigma shaped the nature of those disruptions and long-term consequences. Second, I reveal the emotion and emotion work that accompanied men’s disclosure experiences. Men described having to manage and control their own emotions and “dig deep” to get the nerve to disclose. In turn, they described having to manage others’ emotional reactions and feeling a sense of guilt for being the cause of sadness for their friends and family. Lastly, I develop a grounded theory of the social interactions and structures that produce and reproduce HIV stigma on an ongoing basis. These included: the transmission of misinformation at the community level; witnessing or experiencing acts of marginalization at the individual level; HIV criminal nondisclosure laws and sex education policies at the institutional level; as well as silence and gossip at the level of social interactions. This project expands on sociological and public health literatures to produce an analysis of HIV disclosure that places social and structural environment at the center, as opposed to the individual, and offers new sites for research and intervention.