The moral-behavioural logic of silence: gender, stigma, and disclosure among long-term HIV survivors.

Silence, the deliberate non-disclosure of HIV status - remains an overlooked yet central aspect of long-term antiretroviral therapy (ART) survivorship. While disclosure is promoted as empowerment, such framings may neglect the gendered, relational, and institutional contexts in which non-disclosure occurs. We conducted in-depth interviews with 21 long-term ART users (10-22 years on treatment) in Tamil Nadu, India, and analysed narratives using stigma, social identity, emotion work, spiritual reframing, and institutional betrayal lenses. Silence emerged not as absence, but as a moral-behavioural strategy. Women's silence reflected care-based labour aimed at protecting children and preserve family integrity; while men often framed silence as endurance, restraint, or sacrifice. Participants sustained concealment through spiritual meaning-making and, over time, selectively withdrew from systems experienced as stigmatising or confidentiality-compromising. We identified four interlinked patterns - of emotional rupture, strategic non-disclosure, moral reframing, and institutional withdrawal - highlighting silence as an adaptive, gendered survival strategy. HIV care systems should depathologize silence and redesign counselling approaches to centre dignity, caregiving, and emotional safety.

• Publication year

  2026

• Venue

  AIDS Care

• Publication date

  2026-01-19

• Fields of study

  Sociology, Medicine

• Identifiers
  DOI 10.1080/09540121.2026.2614347PMID 41555183
• External record

  Open on Semantic Scholar

• Source metadata

  Semantic Scholar, PubMed

• No claims are published for this paper.

• No concepts are published for this paper.

• Factors associated with HIV status non-disclosure among people entering care at IeDEA sites in Cameroon: a cross-sectional study

  2025cited by this paper
• Detection and disclosure of workplace mental health challenges: an exploratory study from India

  2024cited by this paper
• Community stigma and discrimination against the incidence of HIV and AIDS

  2023cited by this paper
• [Survival analysis of long-term HIV/AIDS cases aged 15 years and over under antiretroviral treatment in Henan Province from 2002 to 2020].

  2022cited by this paper
• Barriers to timely disclosure of HIV serostatus: A qualitative study at care and treatment centers in Dar es Salaam, Tanzania

  2021cited by this paper
• The Impact of Stigmatization on Social Avoidance and Fear of Disclosure among Older People: Implications for Social Policy Preparedness in a Public Health Crisis

  2021cited by this paper
• Essentials of descriptive-interpretive qualitative research: A generic approach.

  2021cited by this paper
• HIV Stigma and Moral Judgement: Qualitative Exploration of the Experiences of HIV Stigma and Discrimination among Married Men Living with HIV in Yogyakarta

  2020cited by this paper
• Stigma in health facilities: why it matters and how we can change it

  2019cited by this paper
• HIV-related stigma, racial discrimination, and gender discrimination: Pathways to physical and mental health-related quality of life among a national cohort of women living with HIV.

  2017cited by this paper
• Improving women’s health in low-income and middle-income countries. Part I: challenges and priorities

  2017cited by this paper
• Perceptions of Institutional Betrayal Predict Suicidal Self-Directed Violence Among Veterans Exposed to Military Sexual Trauma.

  2016cited by this paper
• HIV Disclosure Anxiety: A Systematic Review and Theoretical Synthesis

  2016cited by this paper
• Purposeful Sampling for Qualitative Data Collection and Analysis in Mixed Method Implementation Research

  2015cited by this paper
• Institutional betrayal.

  2014cited by this paper
• Religion and Disparities: Considering the Influences of Islam on the Health of American Muslims

  2013cited by this paper
• Double Disclosure Bind: Complexities of Communicating an HIV Diagnosis in the Context of Unintended Pregnancy in Durban, South Africa

  2013cited by this paper
• Global action to reduce HIV stigma and discrimination

  2013cited by this paper
• Creating Social Spaces to Tackle AIDS-Related Stigma: Reviewing the Role of Church Groups in Sub-Saharan Africa

  2011cited by this paper
• Understanding HIV disclosure: a review and application of the Disclosure Processes Model.

  2011cited by this paper
• Applied Thematic Analysis

  2011cited by this paper
• The disclosure processes model: understanding disclosure decision making and postdisclosure outcomes among people living with a concealable stigmatized identity.

  2010cited by this paper
• Making sense of the meaning literature: an integrative review of meaning making and its effects on adjustment to stressful life events.

  2010cited by this paper
• Stigma and social barriers to medication adherence with urban youth living with HIV

  2007cited by this paper
• HIV-related knowledge, stigma, and willingness to disclose: A mediation analysis

  2006cited by this paper
• The Right to Love: The Desire for Parenthood among Men Living with HIV

  2003cited by this paper
• Ethical Principles for the Conduct of Human Subject Research: Population-Based Research and Ethics

  1991cited by this paper
• Emotion Work, Feeling Rules, and Social Structure

  1979cited by this paper

• No citing papers are available for this paper.