Pathways of onward HIV disclosure in relationships among vertically infected young people receiving antiretroviral therapy: a qualitative analysis from the BREATHER Plus trial, South Africa.

For young people living with HIV (YPLHIV) navigating their status since birth, managing onward disclosure of a potentially stigmatising condition in relationships is challenging, and may or may not lead to social support, with implications for wellbeing. In this study, we investigate how vertically infected young people in a clinical trial setting in KwaZulu-Natal, South Africa navigate onward disclosure. Data were from the qualitative component of the BREATHER Plus randomised controlled trial evaluating the efficacy, safety and acceptability of short cycle dolutegravir/tenofovir based triple antiretroviral therapy (ART) in YPLHIV aged 12-19 years. We analyse data on thirty-five participants receiving ART engaged in clinical trials at the research site: 29 in longitudinal in-depth interviews (IDIs) and 12 across three focus group discussions (FGDs) including six in IDIs and FGDs. The Disclosure Processes Model was applied in the thematic analysis. Pre-disclosure was characterised by social assessments of potential confidants. During disclosure, reciprocal vulnerability and partial information-sharing were employed. Post-disclosure processes entailed linear and non-linear feedback trajectories, impacting future disclosures. The findings show that the cohort of vertically infected young people on ART navigated many bidirectional disclosure pathways to maintain social connection in relationships and counselling guidelines need to be responsive to this.