Psychosocial stressors experienced by people living with HIV during the pre-disclosure phase: a phenomenological analysis

Introduction The disclosure of HIV serostatus is central to HIV care and prevention across African countries; however, the psychological experience of the period preceding disclosure has received little direct attention in the Ghanaian evidence base. The research examined the psychosocial stressors experienced by people living with HIV during the pre-disclosure phase, defined as the period between diagnosis and disclosure to a given person, in Cape Coast, Ghana.Methods A qualitative study design with a focus on Moustakas' transcendental phenomenological approach was used. In-depth semi-structured interviews were conducted with 24 purposively sampled people living with HIV receiving antiretroviral therapy (ART) at the Cape Coast Metropolitan Hospital in Ghana. Data analysis was done with Moustakas' phenomenological analysis, aided by Quirkos 3 software.Results Four themes and twelve subthemes were identified. Theme A, emotional stress (two subthemes), comprised anxiety, depressive experience including suicidal ideation, and the repeated rehearsal of feared outcomes. Theme B, fear (six subthemes), spanned fear of infecting a partner, discrimination, intimate partner violence, disgracing the family, losing financial support and losing employment; for one participant, fear of job loss delayed the start of ART. Theme C, blame (two subthemes), comprised anticipated blame from partners and others, and self-blame. Theme D, structural stressors (two subthemes), comprised preparing for disclosure without professional guidance, and knowledge gaps expressed as denial and supernatural attribution of HIV.Conclusion The pre-disclosure phase is a critical though under-resourced clinical moment. Psychological counselling, peer support and gender-sensitive economic and safety protections should be integrated into HIV care pathways from diagnosis, before disclosure takes place.