A mixed methods exploration of HIV and drug use disclosure in healthcare settings among HIV-positive women who inject drugs in Ukraine

Disclosing one's HIV status or drug use in healthcare settings has significant implications for public and individual health. It is related to reduced occupational risk of infection for medical providers, improved care, reduction in disease transmission, and other clinical benefits for patients. However, disclosure can be challenging and problematic due to its discrediting aspects. We explored HIV and drug use disclosure experiences in clinical settings among Ukrainian women who live with HIV (WLWH) and inject drugs. This study was conducted in Kyiv, Ukraine. 309 surveys were completed between December 2019 and November 2020, followed by qualitative in-depth interviews with 18 participants. Some women in our study believed that disclosing their status ensured optimal medical care and necessary precautions by providers (e.g., sterilizing equipment). Other participants said they did not disclose after experiencing mistreatment in healthcare settings in the past. Still others utilized alternative strategies to disclose, such as using indirect language or cautiously informing about a less stigmatizing condition such as hepatitis. Clinical implications include training women who live with HIV to use communication skills to support disclosure in healthcare settings, taking into consideration consequences of disclosure to medical professionals to increase women's self-efficacy around this process.