“I Don't Want to Have to Share Every Detail”: Phenomenographic Exploration of Identity Safety in People With HIV in Urban and Rural United States

Abstract Identity safety—the freedom to exist as one's authentic self—combats identity-based discrimination, although research in clinical settings remains sparse. This was a multi-institutional, qualitative interview study, which explored how a diverse group of 17 people with HIV (PWH) experience identity safety during health care encounters. Eligible participants were PWH who received care at a clinic with expertise in serving PWH in Idaho, Montana, or Washington. The authors employed phenomenography to analyze the multiple ways PWH experience identity safety. Agentic actions by participants and actions by health care workers could promote identity safety. Sharing an identity with one's health care provider contributed to—but did not guarantee—safety. Participants diverged in how they experienced nonessential, personal questions. For some, questioning about personal details augmented trust; for others, less questioning respected their desired privacy. Our findings identify actionable ways to promote identity safety, even if health care workers' identities differ from that of their patient.