HIV disclosure in Ugandan schools: A qualitative study of how educators navigate the institutional ecology of information, HIV stigma, and care.

Adolescents living with HIV (ALHIV) spend much of their daily lives in school environments, yet little research has examined how HIV-related disclosure unfolds within educational institutions. Most studies focus on disclosure decisions within families or clinical settings, leaving limited understanding of how schools encounter and manage knowledge of students' HIV status. This study examines how educators learn about and respond to the presence of students living with HIV within school communities. The analysis draws on 19 qualitative interviews with educators participating in a school-based HIV stigma reduction trial in southwestern Uganda. Interviews, analyzed using iterative thematic analysis, explored how educators became aware of students' HIV status, how disclosure was managed within school settings, and how schools responded to the needs of students living with HIV. Findings show that HIV disclosure within schools rarely occurs as a singular event in which caregivers formally inform school authorities. Instead, awareness of students' HIV status often emerges through indirect observation, selective disclosure, peer interactions, and the circulation of information across school and community networks. Educators frequently played informal roles in supporting treatment adherence, monitoring medication routines, and coordinating with caregivers while attempting to maintain confidentiality. To conceptualize these dynamics, the study introduces the concept of an institutional ecology of disclosure, highlighting how knowledge of adolescents' HIV status emerges through interconnected relationships among caregivers, educators, peers, and community actors. Strengthening institutional protocols, educator training, and coordination between schools and health services may help support adolescents living with HIV while minimizing stigma and unintended disclosure.