Context-Dependent Effects of HIV Disclosure on Social Isolation Among Rural PLHIV: A Pilot Configurational Study.

Social isolation is a critical but understudied concern for people living with HIV (PLHIV), particularly in rural U.S. communities where social visibility is high and access to supportive services is limited. Disclosure of HIV status is often framed as a health-promoting behavior that facilitates engagement with care and access to social support, yet it can also increase vulnerability to exclusion and isolation, especially where confidentiality is difficult to maintain. Using data from a pilot survey of rural PLHIV in the United States (n=17), this study examines when disclosure may function adaptively and when it may coincide with a heightened social burden. A Social Isolation Index was constructed from 15 indicators of exclusion across family, community, and institutional domains. Disclosure was measured both by the number of people informed and whether sexual partners were told. Typological methods and Qualitative Comparative Analysis (QCA) were applied to explore how disclosure patterns relate to race, sexual identity, and reported isolation. The results indicate that disclosure is not uniformly protective: several participants who disclosed widely also reported high levels of isolation, with heterosexual and Black participants often reporting a higher cumulative burden. These findings challenge one-size-fits-all assumptions about disclosure in public health messaging and underscore the need for tailored strategies that recognize both disclosure and nondisclosure as potentially adaptive responses in rural and marginalized communities.