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Policies mandating HIV status disclosure to decrease incidence create ethical challenges for physicians on whether to breach or maintain infected patients' confidentiality. In Sub-Saharan Africa where HIV incidence is high, there is a need for clear guidelines/policies on making confidentiality decisions. The purpose of this quantitative quasi experiment was to determine whether the gender, gender orientation, and sexual relationship of an infected patient and physicians' demographics predicted physicians' decisions to breach confidentiality. In Plateau State, Nigeria, 222 physicians were given vignette questionnaires containing 6 different descriptions of gender, gender orientation, and sexual relationships of a hypothetical patient. Each physician decided to maintain or breach a patient's confidentiality in a variant. The utilitarian framework was applied, and data were analyzed using logistic regression models. A majority of the participants (70%) indicated a breach by directly informing sex partners or informing or referring to the health department. Only physicians' feature of previous confidentiality breach significantly predicted the decision to breach [p =.028, Exp (B) =.1.345, 95%CI (1.032, 1.753)]. The results suggested that regardless of patients' characteristics, physicians will breach confidentiality to protect sex partners potentially at risk of HIV infection. These findings may bring about positive social change by clarifying reasons for physicians' breach decisions, by informing the development of physicians' decision guidelines that would enhance physicians' practices in managing discordant couples, which could reduce HIV transmission among discordant couples leading to better and longer lives.