How to Disclose to Drug Injecting Partners

If you are living with HIV, the thought of disclosing, or telling, your status to others may be incredibly overwhelming and scary. These are completely normal feelings to have. Although disclosing your HIV status may be required in some situations, such as to current and former drug-injecting partners depending on where you live, you can still control when, where, and how you navigate these discussions.

Why should I disclose my status to my drug-injecting partners?

Although there are many instances in which you have full control over who you tell about your HIV status, there are some scenarios in which disclosure may be required. For example, you can choose who, if any, of your friends or loved ones you tell and when. However, since HIV can be spread via sexual or blood-to-blood contact (such as during injection drug use) many states have laws requiring that an HIV-positive individual disclose their status to current drug-injecting partners, and alert past partners of their status as soon as they become aware they have HIV. While this may be frustrating, it is important to consider in order to protect yourself from future legal action as well as to protect others from getting the virus.^1,2

A complete list of each state’s HIV-related laws can be found within The Center for HIV Law and Policy’s State HIV Law database. Additionally, a list of all states with HIV- and STI-specific (sexually transmitted infections, of which HIV is one) laws has been published by the Centers for Disease Control and Prevention. Although many aspects of disclosing your status are up to you, if you live in an area where these laws are present, disclosure to drug-injecting partners may be a necessity.¹

What if I don’t want to disclose my status personally?

In some cases, drug-injecting partners may not be individuals who are close and committed to you, and you may not want to open up to them about your status. Some individuals may not talk to past drug-injecting partners, and may not want to trust them with such a big conversation. Additionally, in some situations, an HIV-positive individual may be worried about violence or abuse from a past or current drug-injecting partner. These are all valid reasons for not wanting to personally disclose your status. Fortunately, although some places may require that these individuals be notified, there may be options around completely disclosing if you don’t want to.

Many institutions around the world, including the World Health Organization, encourage beneficial disclosure. What this means is, if you are HIV-positive you are encouraged to share your status, however, you can do so however you choose.³ If you choose to tell these individuals yourself, either in person, via text, phone call, or any other method, you can. Only if you choose not to tell will other organizations step in. For example, in the United States, your local health department or healthcare facility can disclose for you. This is called partner notification or partner services, and involves collecting names and contact information of past or current drug-injecting partners from you.¹

The health department or your healthcare facility will then contact these individuals and let them know that they may have been exposed to HIV. They can then provide your past or current drug-injecting partners with resources and information so that they can get tested. All of this is done without letting those at risk know who specifically they came into contact with that had HIV. This is a valid option in any situation, especially in cases where privacy or abuse concerns are present.

Common tips for conversations about HIV status

If you do have a strong relationship with your current or former drug-injecting partners and decide to tell them about your status yourself, there are some tips you can try to help the conversation go as smoothly as possible.

Feel confident in your mutual trust and respect

When deciding whether or not to fully disclose on your own and not utilize partner notification, consider whether or not the person you are disclosing to respects and trusts you as much as you respect and trust them. Although HIV-related conversations can be alarming and have strong emotions or reactions, a foundation of trust and respect between you and the person you are talking to will help the conversation go as smoothly as possible and help ensure that your status stays private between the two of you (if that’s what you prefer). If you do not trust a drug-injecting partner or think they will disrespect you by stigmatizing you or sharing your information, it may be a better idea to use partner notification services.

Test the waters first if need be

If you are uncomfortable diving right into a conversation about your HIV status, it may be a good idea to drop hints to bring the topic up briefly before disclosing. Asking questions like “do you know anyone with HIV?” or “have you been tested for HIV?” may open up a smaller-scale conversation before you share your status. You may be surprised by their responses, and some may be positive. If their initial responses are negative, it may be necessary to tailor your approach or consider other options.

Disclose as early as possible

Although it may be hard to do, disclosing as soon as possible can be beneficial. Disclosing your status to past drug-injecting partners shortly after you find out you are HIV-positive may help prevent them from continuing to spread the virus if they have HIV as well (especially since they may be the person you got the virus from and may not be aware that they have it, too). Disclosing as early as possible can also help protect you from legal issues.

Create a positive and safe environment

When you disclose your status, you get to choose where and when you do so. Making sure to set aside a time where the two of you can talk uninterrupted is important in facilitating a positive conversation. The person you are disclosing to might need time to process this information, or may have questions for you. Making sure you have ample time to talk and are in a setting where sensitive issues can be discussed is important. If you are worried about the reaction of the person you’re disclosing to, especially if you are worried that they may get violent or abusive, it may be a good idea to find a semi-public place, just to be safe. Finding somewhere that you can talk in private, while still being in view of others nearby (such as in a public park) may be a good idea to prevent any dangerous reactions.

You can also disclose with your healthcare provider present if you feel more comfortable doing that. However, no matter what, if you are ever physically threatened or hurt by another individual, call the National Domestic Violence Hotline at 1-800-799-SAFE (1-800-799-7233).

Be prepared to provide information and options

You may receive many questions or misconceptions about HIV when you disclose to someone, especially when disclosing to a drug-injecting who may be at risk of getting the virus, too. The more information you are armed with during your discussion, the better. Educating them on what HIV actually is, how it is spread, and safer drug-injecting practices (especially if you are planning to continue injecting drugs together) may be helpful in opening up productive dialogue around HIV. You can also provide information on effective antiretroviral therapy (ART), PrEP (pre-exposure prophylaxis) and PEP (post-exposure prophylaxis) in the event that you are going to continue to inject drugs together.^1-5

Getting help with addiction

Addiction is a complicated illness that often requires support and professional treatment. It is important to remember that addiction is a medical diagnosis, and is not one that should be rooted in blame. Addiction can affect anyone, anywhere, and does not discriminate based on background, age, financial status, or any other characteristic. The most important thing is to seek help if you (or a loved one) think you may be struggling with addiction.

One of the first steps in seeking help with addiction is to visit your healthcare provider if you have one. If you feel like you have a comfortable, safe relationship with your provider, and feel as though you can open up to them, they should be equipped to point you in the direction you need to go. If your provider doesn’t have much experience with navigating addiction, they may have a colleague or know of an organization that does. Your healthcare provider or a trained professional (such as a social worker) in their clinic can help you navigate your next steps.

If you do not have a healthcare provider, or don’t want to talk to your healthcare provider about addiction issues, there are still plenty of options you can utilize. You can use the American Society of Addiction Medicine’s Find a Physician tool or the American Academy of Addiction Psychiatry’s Patient Referral Program to find a specially trained professional in your area. If you’d rather take a first step that isn’t in person, you can also call the Substance Abuse and Mental Health Services Administration’s (SAMHSA) National Helpline at 1-800-662-HELP (1-800-662-4357). These calls are confidential, and trained specialists will provide you with information and local resources.^6,7