Laws in China relating to HIV disclosure are inconsistent. After a patient has tested HIV-positive, service providers struggle to decide who should be informed first: patients, family members, or both. To understand service providers' attitudes and practices regarding the HIV notification process in China, 1101 service providers from a southwestern province of China were surveyed. Opinions were gathered from providers at five different levels of health care facilities (provincial, city, county, township and village). A mixed methods approach was used to analyze perceptions of informing family members of a patient's HIV status. Quantitative analysis was used to examine whether providers held a favorable attitude toward notifying family members first and qualitative analysis was used to explore the reasons and consequences of notifying family members first. Nearly half of service providers felt family members should be informed of a patient's HIV status first. Providers who were older, had contact with HIV patients, or had less medical education were more likely to agree with a family-first notification practice. Psychological pressure, concern about protecting family members, the need for family support, and consideration for local regulations were cited as the main reasons for this practice. There is an immediate need to re-examine HIV notification policies so that there are consistent guidelines and procedures for providers throughout China.