To disclose or not to disclose, that is the question! antiretroviral therapy, access to resources and stigma in southern Africa

This article discusses the increasing evidence of a dilemma facing people living with HIV and AIDS in southern Africa who are on antiretroviral therapy (ART). Their enrolment in treatment programmes gives them access to resources provided by national and international organizations, but because these resources are insufficient for their households to make ends meet, they also rely on resources available through traditional means, such as social networks. Accessing resources through enrolling in treatment programmes requires disclosure of their HIV status, while accessing resources through social networks forces them to hide their HIV infection and treatment because of the stigma attached to AIDS treatment. In addition, their neighbors' suspicion and envy of their access to outside resources compromises their access to resources through social networks. Thus, HIV-positive individuals carefully balance hiding their HIV infection in some settings with cautiously disclosing it in others in order to gain access to resources available to them both as individuals enrolled in ART and as members of local social networks. The scarcity of resources and the difficulty of access increase the need for HIV-positive individuals to carefully determine where, when and to whom to disclose their HIV status. A wrong decision potentially compromises their survival and that of their households. q 2013 The Editorial Board of the Journal of Southern African Studies.