My biggest concern/issue is keeping my diagnosis of HIV + from my family. I have been told I will need to start meds sometime soon and want to know if it is possible to manage this without telling my husband (HIV-) and children ( under 16). I know the pain this would cause them (my husband has been treated for depression and anxiety disorders over minor provocation) and I have always been the one to hold the family together and reassure everyone. The is no current suspicion of infidelity and sharing this will I know break up the family. I have someone out of town to confide in that is non-judgemental but I want to know if once I start meds my status will be discernable. An additional challenge is that my husband is an MD but not in infectious disease.

I don't see how you could hide your HIV status indefinitely. It will need to be revealed at some point, or you will be discovered, which will likely add to the problem because of the distrust generated by the concealment.

I know that it is extremely difficult to think of disclosing your status to your husband, but it is the right thing to do. If your husband is loving and supportive, then I'm sure he will help you. If not, then the situation will be difficult to manage in any case.

As for your children, they also deserve to know something as important as this, if they are old enough to understand. You said they are under 16, which is a wide range. If you have a 14 year old child, then you could have a discussion about your status and what it means about your health and prognosis. If you have a child under 5, then you should wait. Children in the 5-12 year old range would require some judgment and making an individual decision as to what it is appropriate to say.

Also, by not revealing your status to the family, you cannot make plans or arrangement with your husband regarding care for the children should you become ill and temporarily unable to care for them. It is best to make such plans ahead of time if you can.

As to whether your status will be discernable, you may develop side effects with HAART that are difficult to conceal (peripheral neuropathy, diarrhea). But regardless of your reaction to medications, your status will be known to the family eventually. Discussing it early on is probably wiser than waiting.