Understanding HIV Disclosure, Support, and Stigma Among Heterosexual Serodiscordant Couples: A Narrative Review

Authors

Jackline Otieno, Virginia Commonwealth University

Original Publication Date

2025

Document Type

Presentation

Comments

11th Annual VCU 3MT® Competition, held on October 3, 2025.

Abstract

For heterosexual serodiscordant couples—where one partner is HIV positive and the other is negative—the fear of rejection, abandonment, or even violence often turns HIV status into a guarded secret. Despite medical advancements that prevent transmission, these couples continue to face significant psychosocial challenges. Jackline Otieno’s research explores these issues through a narrative review examining studies from the past decade on HIV disclosure, support, and stigma among serodiscordant couples. Most studies originated from Africa and revealed three major themes: disclosure as both a personal and relational process; the dual role of support in either facilitating or hindering disclosure and treatment adherence; and the multi-level nature of stigma—internalized, interpersonal, and structural—experienced within relationships and healthcare systems. Otieno’s findings highlight that medication alone cannot ensure well-being; addressing HIV disclosure, stigma, and support through culturally grounded, couple-centered interventions is essential for these relationships to truly thrive.

Transcription

Next, we have Jackline Otieno, Understanding HIV Disclosure, Support, and Stigma Among Heterosexual Serodiscordant Couples: A Narrative Review. They're in the College of Humanities and Sciences, and their advisor is Dr. Eric Benotsch. How many of us are in a loving relationship? Okay. So I want you to imagine that, but you're keeping a secret. And the reason for this is because you fear rejection, abandonment, and sometimes even violence. For serodiscordant couples where one is HIV positive and the other is negative, this is not a hypothetical situation. This is their reality. But why? We have HIV advancement where we have pre-exposure medication for treatment before HIV exposure and then post-exposure treatment after an exposure within 72 hours. So I'm wondering, with HIV advancement treatment, why is this happening? It may interest you to know that HIV disclosure, lack of support and stigma, are some of the psychosocial stressors faced by this group that prevent them from thriving like any other normal couple. So we decided to conduct a narrative review to understand where and why this is happening. Specifically, we did a narrative review and our studies, one of the eligibility criteria was studies within 10 years among serodiscordant couples and addressing at least one of the psychosocial stresses. Majority of our studies were from Africa, 56% of the studies, and one of the three main themes that we found was that HIV disclosure was just not personal, but also relational. It may interest you that these couples struggle with how and where to disclose, why they should disclose, and are they safe when they disclose. Another theme was duality of support, which was in, if they don't have that support, they do not then have to disclose their status. But if they have the support, then this facilitates the disclosure and sometimes even HIV medication adherence. The multi-level nature of stigma was also experienced, internalized in terms of the shame, the guilt of why they are HIV positive, but also interpersonal within the couples that hindered this meaningful conversation, especially surrounding HIV disclosure. But most importantly, structural was experienced in terms of discrimination within the health care providers. now until this point i have been trying to convince you that HIV medication alone is not enough and i hope that is very clear because within serodiscordant couple HIV disclosure support and HIV stigma are some of these psychosocial stresses that keep happening that is preventing these couples from thriving a call to action is to move beyond HIV medicine address HIV disclosure as a unit, not as an individual, but most importantly, culturally grounded interventions and programs that affect, that help these couples. Thank you.

Rights

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