HIV status disclosure to sexual partners among gay men and other men who have sex with men: a qualitative meta-synthesis using the social ecological model

Abstract

Gay men and other men who have sex with men living with HIV face the intersecting effects of HIV-related stigma and stigma against sexual minorities when disclosing their HIV status to sexual partners. Existing reviews have primarily employed quantitative methods and single-level analyses, lacking a multi-level, comprehensive analysis that systematically integrates qualitative evidence. This study aims to use the Social Ecological Model (SEM) to integrate qualitative research findings on HIV disclosure among gay men and other men who have sex with men and analyze influencing factors at the micro, meso, and macro levels, as well as their cross-level transmission mechanisms. A systematic search was conducted across nine databases—PubMed, Embase, Web of Science, Cochrane Library, Scopus, CNKI, Wanfang, VIP, and SinoMed—up to September 15, 2025, with update searches performed on March 10 and June 18, 2026, respectively. We included qualitative studies examining the experiences of gay men and other men who have sex with men in disclosing their HIV status to sexual partners. Methodological quality was assessed using the JBI Checklist for Qualitative Research. Data coding and analysis were performed using NVivo 11, following the Thomas and Harden thematic synthesis approach. The study was reported in accordance with the ENTREQ statement and was pre-registered in PROSPERO (CRD420251145302). Twenty studies (2004–2025) were included, involving 603 participants from 7 countries. A total of 754 initial codes were categorized into 10 descriptive themes and synthesized into 5 analytical themes: (1) Fear and Barriers — Internal Resistance to Disclosure (Micro); (2)Stigma Management—Strategic Navigation of Disclosure (Micro); (3)Relationship Dynamics — Intimacy and Context Shaping Disclosure Outcomes (Meso); (4) Support Systems — External Resources Facilitating Disclosure (Meso); (5) Cultural Context — Macro-level Forces Shaping Disclosure Possibilities (Macro). HIV disclosure among gay men and other men who have sex with men is a dynamic process of ongoing negotiation shaped by cross-level interactions. The principal findings encompass a self-perpetuating cycle of fear, the disclosure-risk paradox, the differentiation between passive non-disclosure and active concealment, and the dynamics of cascading disclosure. There is a need to integrate micro-level psychological support, meso-level behavioral skills training and peer networks, and macro-level anti-discrimination policies to implement multi-level coordinated interventions aimed at improving disclosure practices and health outcomes among gay men and other men who have sex with men living with HIV.