Confessional Technologies and the Will to Disclose: Mobilizing Emotions and Lived Experience in AIDS Service Organizations in Canada


This research highlights how frontline workers in the HIV/AIDS sector in Canada mobilize the confessional as a technology of governance to encourage changes in the sexual health and safety and disclosure practices of HIV-positive men and women. The ways in which frontline workers counsel clients are especially important in light of Canada’s aggressive growth in criminal prosecutions against individuals for failing to disclose their HIV status to sexual partners. Drawing on 62 semi-structured interviews with AIDS service organization (ASO) staff from across Canada, we suggest that the work performed by ASO workers constitutes a form of bioethics on the ground, which is rooted in both the worker’s and the client’s lived experiences of HIV. It can be especially fraught if the lived experience is mobilized in ways that are ultimately disempowering for clients who do not relate to the individual’s disclosure narrative.

This is a preview of subscription content, access via your institution.


  1. 1.

    It is important to note that 72% of Canadian nondisclosure cases between 1989 and 2010 involved heterosexual male perpetrators (Mykhalovskiy and Betteridge, 2012). While this might reflect law’s prejudice in terms of who is an ideal victim/perpetrator, it also suggests that men who have sex with men embrace neoliberal sexual health responsibilities more completely than do heterosexual couples, who appear to be more likely to seek punishment for and to feel wronged by nondisclosure.


  1. Adam, B. D., Globerman, J., Elliott, R., Corriveau, P., English, K., & Rourke, S. (2016). HIV-positive people’s perspectives on Canadian criminal law and non-disclosure. Canadian Journal of Law and Society, 31(1), 1–2 3.

    Article  Google Scholar 

  2. Adam, B. D., Corriveau, P., Elliott, R., Globerman, J., English, K., & Rourke, S. (2014). HIV disclosure as practice and public policy. Critical Public Health, 25(4), 386–397.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Adam, B. D., Husbands, W., Murray, J., & Maxwell, J. (2008). Silence, assent, and HIV risk. Culture, Health & Sexuality, 10(8), 759–772.

    Article  Google Scholar 

  4. Árnason, V. (2015). Toward critical bioethics. Camb Q Healthc Ethics, 24, 154–164.

    Article  PubMed  Google Scholar 

  5. Bourne, A., Dodds, C., Keogh, P., Weatherburn, P., & Hammond, G. (2009). Relative safety II: risk and unprotected anal intercourse among gay men with diagnosed HIV. Technical report. London: Sigma Research.

  6. Caron, D. (2014). The nearness of others: searching for tact and contact in the age of HIV. Minneapolis: University of Minnesota Press.

  7. Cruikshank, B. (1993). Revolutions within: self-government and self-esteem. Econ Soc, 22(3), 327–344.

    Article  Google Scholar 

  8. Cruikshank, B. (1999). The will to empower: democratic citizens and other subjects. Ithaca: Cornell University Press.

  9. Dej, E., & Kilty, J. M. (2012). Criminalization creep: a brief discussion of the criminalization of HIV/AIDS non-disclosure in Canada. Canadian Journal of Law & Society, 27(1), 55–66.

    Article  Google Scholar 

  10. Dodds, C., & Keogh, P. (2006). Criminal convictions for HIV transmission: people living with HIV respond. Int J STD AIDS, 17(5), 315–318.

    Article  PubMed  Google Scholar 

  11. Dodds, C., Bourne, A., & Weait, M. (2009). Responses to criminal prosecutions for HIV transmission among gay men with HIV in England and Wales. Reproductive Health Matters, 17(34), 135–145.

    Article  PubMed  Google Scholar 

  12. Douglas, M. (1966). Purity and danger: an analysis of the concepts of purity and taboo. New York: Praeger Press.

  13. Fairclough, N.L. (1995). Critical discourse analysis: the critical study of language. Harlow: Longman.

  14. Foucault, M. (1978). The history of sexuality volume 1: an introduction. New York: Pantheon Books.

  15. Foucault, M. (1980). Power/knowledge: selected interviews and other writings 1972–1977. New York: Vintage Books.

  16. Foucault, M. (1985). The history of sexuality volume 2: the use of pleasure. New York: Vintage Books.

  17. Foucault, M. (1986). The history of sexuality volume 3: the care of the self. New York: Vintage Books.

  18. Foucault, M. (1987). The ethic of care for the self as a practice of freedom: an interview with Michel Foucault on January 20, 1984. Philosophy & Social Criticism, 12(2–3), 112–131.

    Google Scholar 

  19. Foucault, M. (1988). Technologies of the self. In L. Martin, H. Gutman, & P. Hutton (Eds.), Technologies of the Self (pp. 16–49). Massachusetts: Massachusetts Press.

    Google Scholar 

  20. Galletly, C. L., DiFrancisco, W., & Pinkerton, S. D. (2009). HIV-positive persons’ awareness and understanding of their state’s criminal HIV disclosure law. AIDS Behavior, 13(6), 1262–1269.

    Article  PubMed  Google Scholar 

  21. Green, G. & Sobo, E.J. (2000). The endangered self: managing the social risks of HIV. London: Routledge.

  22. Heimer, C. A. (2013). ‘Wicked’ ethics: compliance work and the practice of ethics in HIV research. Soc Sci Med, 98, 371–378.

    Article  PubMed  Google Scholar 

  23. Hochschild, A. (1979). Emotion work, feeling rules, and social structure. Am J Sociol, 85(3), 551–575.

    Article  Google Scholar 

  24. Hunt, N. R. (1997). Condoms, confessors, conferences: among AIDS derivatives in Africa. J Int Inst, 4(3) Available at: (accessed 2 June 2016).

  25. Hunt, A. & Wickham G. (1994). Foucault and the law. London: Pluto Press.

  26. Kilty, J.M. (2014). Dangerous liaisons, a tale of two cases: constructing women accused of HIV/AIDS non-disclosure as threats to the (inter)national body politic, within the confines: women and the law in Canada (pp. 271–292). Toronto: Women’s Press.

  27. Kinsman, G. (1996). ‘Responsibility’ as a strategy of governance: regulating people living with AIDS and lesbians and gay men in Ontario. Econ Soc, 25(3), 393–409.

    Article  Google Scholar 

  28. Klitzman, R., & Bayer, R. (2003). Tell it slant: sex, disclosure, and HIV. Stud Gend Sex, 4(3), 227–262.

    Google Scholar 

  29. Lincoln, Y.S. and Guba, E.G. (1985). Naturalistic inquiry. Newbury Park: Sage Publications.

  30. Lupton, D. (1994). Moral threats and dangerous desires: AIDS in the news media. London: Taylor & Francis.

  31. Lupton, D. (1995). The imperative of health: public health and the regulated body. London: Sage Publications.

  32. Lupton, D. (2003). Medicine as culture: illness, disease and the body in western societies. Thousand Oaks: Sage Publications.

  33. Miller, J. (2005). African immigrant damnation syndrome: the case of Charles Ssenyonga. Sex Res Soc Policy, 2(2), 31–50.

    Article  Google Scholar 

  34. Mykhalovskiy, E. (2011). The problem of ‘significant risk’: exploring the public health impact of criminalizing HIV non-disclosure. Soc Sci Med, 75(5), 668–675.

    Article  Google Scholar 

  35. Mykhalovskiy, E., & Betteridge, G. (2012). Who? What? Where? When? And with what consequences? An analysis of criminal cases of HIV non-disclosure in Canada. Canadian Journal of Law and Society, 27(1), 31–53.

    Article  Google Scholar 

  36. Nguyen, V. K. (2004). Antiretroviral globalism, biopolitics and therapeutic citizenship. In A. Ong & S. J. Collier (Eds.), Global assemblages: technology, politics and ethics as anthropological problems (pp. 124–144). Malden: Blackwell.

    Google Scholar 

  37. Nguyen, V.K. (2010). The republic of therapy: triage and sovereignty in West Africa’s Time of AIDS. Durham: Duke University Press.

  38. Nguyen, V. K. (2013). Counselling against HIV in Africa: a genealogy of confessional technologies. Culture, Health & Sexuality, 15(S4), S440–S452.

    Article  Google Scholar 

  39. O’Byrne, P. (2012). Criminal law and public health practice: are the Canadian HIV disclosure laws an effective HIV prevention strategy? Sexuality Research and Social Policy, 9(1), 70–79.

    Article  Google Scholar 

  40. Rose, N., & Novas, C. (2006). Biological citizenship. In A. Ong & S. J. Collier (Eds.), Global assemblages: technology, politics and ethics as anthropological problems (pp. 289–305). Malden: Blackwell.

    Google Scholar 

  41. Serovich, J. M., Oliver, D. G., Smith, S. A., & Mason, T. L. (2005). Methods of HIV disclosure by men who have sex with men to casual sexual partners. AIDS Patient Care STDs, 19(12), 823–832.

    Article  PubMed  PubMed Central  Google Scholar 

  42. Simoni, J., & Pantalone, D. (2004). Secrets and safety in the age of AIDS. Topics in HIV Medicine, 12(4), 109–118.

    PubMed  Google Scholar 

  43. van dijk, T. A. (1993). Principles of critical discourse analysis. Discourse and Society, 4(2), 249–283.

    Article  Google Scholar 

  44. van dijk, T. A. (2001). Discourse, ideology and context. Folia Linguistica, 35(1), 11–40.

    Google Scholar 

Download references

Author information



Corresponding author

Correspondence to Jennifer M. Kilty.

Ethics declarations

We received approval from the University of Ottawa’s Research Ethics Board in January 2014.

Conflict of Interest

The authors declare that they have no conflict of interest.


This research was supported by the Canadian Institutes of Health Research [grant number 220829-190399-2001].

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Kilty, J.M., Orsini, M. Confessional Technologies and the Will to Disclose: Mobilizing Emotions and Lived Experience in AIDS Service Organizations in Canada. Sex Res Soc Policy 14, 434–444 (2017).

Download citation


  • Bioethics
  • HIV nondisclosure
  • Confessional
  • Emotions