“Another way to talk”: Photo-stories to promote safe disclosure among people with HIV

HIV status disclosure can reduce stigma and facilitate medication adherence and safer sex among people with HIV (PWH). Effective disclosure interventions are limited, however. We conducted a pilot photo-stories project with PWH and explored how the project affected participants’ disclosure practices and investigated the value of the strategy for further intervention development.

Participants photographed meaningful aspects of their lives with HIV; shared pictures in small group and individual discussion sessions, and; chose pictures and captions to display in clinic and community exhibits. To assess the relationship between the project and disclosure, we analyzed session transcripts and 300 photographs using theme analysis strategies.  

38 PWH in four cities in the Midwest and Northeast U.S took part in the project. Disclosure was a prominent topic in all group and individual sessions. Disclosure related images included sources of social support, HIV medicines, and symbols of disclosure emotions, among others. Data analysis revealed three categories of participant disclosures to others – fearful, reluctant, and open. The project supported all disclosure types – helping fearful participants manage their emotions, reluctant participants plan for more effective disclosures, and open participants share their HIV status.

Pilot findings suggest that photo-stories can be further developed as a safe and powerful disclosure intervention strategy to improve disclosure and subsequent health outcomes among PLH as well as help clinicians discuss disclosure with patients. The process is acceptable to PWH at all stages of their HIV experience. Processing their life experiences creatively helps PWH problem solve disclosure challenges and celebrate successes.