• Reinforce the facts of U=U 

• Affirm their control over the decision to share their status 

• Discuss potential benefits as well as potential challenges of sharing 

• Assess their commitment to sharing 

• If committed, work on a plan, and offer support.  

• Reinforce the facts of U=U 

• Empathically explain the risks of having unprotected sex with a detectable viral load. Ensure they are aware of the law surrounding transmission and failure to share 

• Affirm their control over the decision to share their status 

• Discuss potential benefits as well as potential challenges of sharing 

• Assess their commitment to sharing 

• If committed, work on a plan, and offer support. Advise consistent condom use if the sex is unprotected until viral suppression is achieved. Discuss the benefits and effectiveness of PrEP use for sexual partners if viral load is still detectable. Keep in mind that the client may be wary of using these preventative methods as they may lead to unwanted sharing of their status. Stay empathetic and non-judgmental while still relaying the risks of unprotected sex without these methods.  

See 1 and 2, depending on whether the PLWH is virally suppressed.  

Explain the extent to which other doctors can access their medical records as well as when they might (medical practitioners won’t tend to access the infectious diseases history unless directly relevant to the patients treatment/care with them). Discuss the serious implications of inappropriate access or sharing of health information to reassure the client.  

Sharing someone’s HIV status without their consent can be a breach of privacy and illegal, and the individual living with HIV has the right to file a complaint and get support from HIV legal services/charities such as: 

• THT 

• National AIDS trust 

There is no one way to share one’s status. Below are some steps that can be useful:  

• Goal setting – Knowing the motivation behind sharing and what the client hopes to achieve may help shape the conversation.  

• Considering what they want to share, what they need to share, and how the person may react before starting the conversation.  

• Choosing the right environment to share can help ensure a supportive and comfortable conversation (for more details on where to share, see question 17). 

• • Privacy  

• • Comfort 

• • Familiarity   

• • Safety  

• • Support  

• Considering sharing their story and journey.  

• • Provide clear information on HIV. 

• • Reflect on how much information they would like to share, such as how they acquired HIV or any other questions asked.  

• Starting the conversation – some may prefer to start with a clear and straightforward statement, while some prefer to begin gently (e.g., “there’s something I want to tell you that I’ve wanted to say for a long time.”).  

• During the conversation, the PLWH may want to: 

• • Provide reassurance to the other party (e.g., “I cannot transmit HIV through sex” or “I am completely healthy”).  

• • Choose the right tone. 

• • Stay patient and positive. 

• • Be open to questions.  

• • Use supportive language throughout. 

• • Stress the importance of them not telling others.  

• Boundaries – Sharing their status with another individual does not mean the client owes them any explanations, medical history or answers to intrusive questions. If the individual being disclosed to has further questions that the client cannot or does not wish to answer, they can redirect them to online resources. 

• After the conversation – giving the other party some time to process can help them come to terms with it. In the meantime, the PLWH may want to seek support and make sure to take care of their own emotional wellbeing. 

• Reinforce the facts of U=U. Discuss legal context and harm-reduction options  (PrEP, condom use and ART). 

• Affirm their control over the decision to share their status 

• Discuss potential benefits as well as potential challenges of sharing 

• Discuss partial sharing options (e.g., that they have a health condition that requires daily medication).  

• Assess their commitment to sharing 

• If committed, work on a plan, and offer support. 

U=U: If the patient is on effective treatment, their viral load becomes undetectable and they cannot transmit HIV through sex. Need to know their current viral load.  

Modes of transmission: Clarify how HIV is transmitted, and that it cannot be transmitted through casual contact (including kissing, hugging, sharing food/drinks/toilet).  

Prevention options for partners: Even if the client is virally suppressed, they may still want to consider using condoms or asking their (HIV-negative) partner to use PrEP.  

Rights and Boundaries: People living with HIV are not obligated to share their status with sexual partners if they are virally suppressed, and sharing should not mean or result in a loss of privacy or control.  

Treatment: HIV is treatable and manageable with medication.  

Further support: Advise clients on where they can access further resources and support.  

Legal facts: Ensuring the client understands the law around sharing can help them plan when they share (and help them avoid potential legal risks in certain countries – look here to find information on the law in different countries: https://www.unaids.org/sites/default/files/media_asset/01-hiv-human-rights-factsheet-criminalization_en.pdf).  

Emotional/preparation tips: Practice judgment-free empathy, while discussing possible fears and reactions. Remind clients that they are in control and that anxiety and fear are normal. 

Here are some factors they may want to consider to help them determine when to share:  

• At a particular stage in the relationship.  

• Before any sex – this allows the partner to make informed decisions and take necessary precautions. However, some people are happy not sharing their status before sex, particularly when there is no risk of transmission.  

• Early in the relationship – Sharing their status early on, once they feel comfortable, feel a level of trust, and see potential for the relationship to continue, can be helpful in building trust from the start. Delayed sharing could result in loss of trust.  

• Later in the relationship – Some PLWH may wait, particularly if they are virally suppressed. This may imply a preference to wait until trust has been developed, or until they are comfortable sharing more about themselves.  

Legal concerns: Advise consistent condom use if the sex is unprotected until viral suppression is achieved. Discuss the benefits and effectiveness of PrEP use for sexual partners if viral load is still detectable. For Information on UK law on when to share with a sexual partner, visit: https://www.tht.org.uk/hiv/living-well-hiv/legal-issues/how-law-works, or https://www.unaids.org/sites/default/files/media_asset/01-hiv-human-rights-factsheet-criminalization_en.pdf, for information on international law.  

See questions 1 and 2 for further information. 

Validate their feelings: Discuss the concerns the client has and remind them that they are not alone. Acknowledge the emotional burden and emphasize that their personal worth is not determined by their HIV status.  

Build their confidence: Remind them that they do not have to justify themselves or violate their boundaries. Reduce their fear by discussing or role-playing concerns.  

Address internalised stigma: The client may need some space to reflect on and question how they feel about living with HIV. It may be helpful to suggest contact with other people with HIV.  

Reassure client: There is no universal ‘right-time’ to disclose, the most important thing is the client feels safe, respected and manageable.  

Encourage reflection: If the client is not virally suppressed, earlier sharing to sexual partners before sex may be necessary in reducing the risk of HIV-transmission. Goal-setting can also be a useful tool, and encouraging the client to reflect on why (and to whom) they want to share can facilitate timing and planning.  

• Validate these concerns 

• Encourage reflection on the likelihood of a negative response 

• Build confidence in the ability to manage a negative response 

• Work on a plan of how to manage a negative response, e.g., trying to stay calm and respectful, and politely correcting them and suggesting helpful websites.  

Sharing with close family members: Offer support and reassurance through recognition of their concerns, and encourage reflection on why they would like to share. Planning whether to share (e.g., is the family member likely to be able to manage the information?) and how to share can also help ease anxiety: timing (is the relationship stable? Is the moment private and calm?) language (simple, effective terms) and goals (trust and security) can be explored.  

Sharing with professionals: Reframe sharing their status with health professionals as a health decision rather than a personal confession and clarify when it may be useful to disclose (ex., if sharing their status is beneficial to the client’s health and treatment). Reassure clients that health information is confidential.  

In the UK, people living with HIV can be prosecuted for either reckless or intentional transmission. 

In England and Wales: An individual may be found guilty of transmission if all the statements below apply:  

• Individual had sex with someone who didn’t know they had HIV  

• Individual knew they had HIV at the time of sexual contact 

• Individual understood how HIV is transmitted 

• Individual had sex without a condom 

• HIV was transmitted 

The Offences Against the Person Act 1861 allows individuals to be prosecuted for reckless transmission (under Section 20) and intentional transmission (under Section 18). HIV must have been transmitted for successful prosecution. Therefore, sharing is not legally required in England and Wales if the individual is virally suppressed or had protected sex.  

In Scotland: Individuals can be prosecuted regardless of whether HIV was transmitted under the law offence of Culpable and Reckless Conduct. The law focuses on whether the behaviour was ‘reckless’ rather than if HIV was actually transmitted. Since it may be difficult to prove that the behaviour was not reckless, sharing is strongly recommended regardless of condom usage or viral suppression (and is necessary if the individual engages in unprotected sex and/or is not virally suppressed).  

Information on UK law: https://www.tht.org.uk/hiv/living-well-hiv/legal-issues/how-law-works  

Information on International law: https://www.unaids.org/sites/default/files/media_asset/01-hiv-human-rights-factsheet-criminalization_en.pdf 

Some people that clients may consider telling include:  

Sexual/Romantic partners: Sharing with these individuals can help build intimacy and trust, and allow them to make informed decisions about their health.  

Close family and friends: Sharing with these individuals may allow the client to build an emotional support system.  

Healthcare professionals: Clients may want to consider telling other professionals other than their HIV specialist if it results in a more comprehensive treatment.  

Mental health & Support workers: Talking to a mental health professional can help clients manage internalised stigma and other negative emotions, as well as guide them through sharing their status.  

Deciding where to share is a very personal choice, and different individuals may choose different settings. Some may have preferences such as:  

• Privacy – can help create a space for an open and honest communication.  

• Comfort – a location where both parties feel comfortable and at ease to help reduce anxiety.  

• Familiarity – A familiar environment can produce a more natural and comfortable conversation.  

• Neutral ground – choosing a neutral location (like a quite cafe) can be especially helpful for those unsure about how the person will react. This way, both parties may feel less defensive.  

• Counsellor’s or Health Professional’s office – some may feel more comfortable having the conversation with professional support. This support may provide a safe and supportive space, and certain professions (e.g., doctors) may also be able to answer and explain all questions.   

• Safety – some PLWH choose a public space, where both parties can leave if they wish. Some choose to have a safe space nearby.  

• Support – some may choose to have a familiar person close by for support. 

• Method – some may choose to share face to face but some may prefer to share in a letter, video call, text, email or phone.  

Ultimately, the PLWH should choose a place where they feel safe, comfortable and supported.  

Some useful ways to prepare to share include:  

• Having a plan – planning when/where/how/what to say and writing it out.  

• Practicing the conversation – rehearsing what to say, practicing with a friend or counsellor, or even in front of the mirror.  

• Reflecting on the journey – reflecting on HIV experience and understanding thoughts and feelings can help with communication.  

• Acknowledging emotions – it’s okay to feel anxious or uncertain. Reflecting on these feelings and:  

• Being kind and non-judgmental.  

• Feeling confident about ability to overcome this challenge. 

• Reflecting on what they might say to another PLWH they cared about who was in their situation.  

• Reflecting on why they might be concerned about the outcome of sharing, (e.g., Have they shared a secret with this individual before, can they keep private information to themselves, etc).  

• Reflecting on past sharing experiences that have worked out well despite feelings of anxiety.  

• Seeking support from friends, family, professionals or a support group about plan.  

• Planning for different reactions, and potential responses to them.  

• Preparing for questions and having answers ready to educate and reassure.  

The following strategies could be suggested: 

• Correct misinformation (ex., yes I am living with HIV, I am on treatment and cannot pass it on through sex..”) 

• Set boundaries (ex., “I wasn’t ready to talk about this yet, please do not share with anyone else”) 

• Say nothing  

• Reach out to their healthcare provider, a counsellor/mental health service or their support group.