Navigating HIV status disclosure: Adolescents' privacy management strategies in Rural South Africa

We examined how adolescents living with HIV in rural KwaZulu-Natal, South Africa, navigate privacy boundaries in disclosure-related issues. We conducted small group discussions with 31 adolescents (aged 16-19 years) recruited from three HIV clinics. Reflexive thematic data analysis was conducted through the lens of communication privacy management theory. Three major themes emerged: (1) ownership and control of private information, in which adolescents demonstrated varying levels of autonomy over their HIV status information, often developing strategies to manage medication discreetly; (2) managing disclosure and privacy boundaries, in which participants developed nuanced privacy rules influenced by stigma, context, and family dynamics; and (3) emotional and social support in disclosure management, highlighting the significant role of support systems in the disclosure process. Overall, participants actively managed privacy boundaries through careful information control, selective disclosure, and strategic coordination with family members and healthcare providers. Our findings show that adolescents in a rural setting actively manage privacy boundaries around their HIV status through well-developed information management strategies. There is a complex interplay between personal agency, family dynamics, and cultural context in shaping disclosure decisions. These insights can provide more effective support interventions for adolescents living with HIV in resource-limited settings.