“I must carefully evaluate the benefits and risks to determine the appropriate person to disclose to” exploring preferences in selection of disclosure recipients among older people living with HIV in China: a qualitative analysis

The disclosure of HIV status offers significant benefits for both individual and public health. The willingness to disclose HIV status and the choice of disclosure recipients are key factors in HIV prevention, treatment, and support. Older people living with HIV (OPLWH) face more complex considerations in disclosure due to unique physiological, psychological, and social factors. However, research on their preferences for disclosure recipients remains limited. From May to June 2024, we conducted semi-structured interviews with 12 OPLWH undergoing follow-up treatment at infectious disease healthcare facilities in Wuxi, China. Using Braun and Clarke's thematic analysis, we identified four primary themes: (1) unique factors related to OPLWH, including health conditions, intersecting stigmas, and fear of losing support; (2) role selection based on role status and obligations; (3) reactions of disclosure recipients, encompassing acceptance, rejection, and uncertainty; and (4) multifaceted impacts of disclosure, including both positive and negative effects. Our findings indicate that OPLWH's unique attributes and social roles influence their selection of disclosure recipients, while recipient reactions and the resulting impacts shape their disclosure experiences. Healthcare providers and HIV-focused social organizations should assess the physiological, psychological, and social conditions of OPLWH, as well as the motivations behind their choice of disclosure recipients. Based on this, tailored guidance should be offered to mitigate negative subsequent factors, enhancing their health, social integration, and quality of life.