HIV-positive individuals' failure to disclose their HIV status to sexual partners -- either intentionally or unintentionally -- is "a significant but underreported factor in the continued spread" of HIV in the United States, some public health experts say in a new book, the New York Times reports. In "Mortal Secrets: Truth and Lies in the Age of AIDS," Columbia University professors Drs. Robert Klitzman and Ronald Bayer conducted oral history interviews between 1993 and 1996 with 49 men and 28 women in New York City about their sexual practices. Participants included 60 HIV-positive individuals and a "diverse representation" of gay men, lesbians, heterosexuals, Asians, Latinos, African Americans and whites, the Times reports. Klitzman said that one of the "most disturbing" findings was that more than 30% of the gay men who were interviewed "admitted that, at some point, they lied about their [HIV] status," adding that in reality the percentage is probably even higher. Bayer said, "Many of the people we interviewed said that it mattered a great deal if they thought they might be harmed or rejected because of [HIV] disclosure or if they felt the world was hostile or hospitable to being HIV-positive," adding, "Fear and terror often shaped their decisions."

Social Acceptance
Social acceptance of HIV-positive status "in a given time and place" also can affect disclosure, the Times reports. Jennifer Kates, director of HIV/AIDS policy at the Kaiser Family Foundation, said that, for example, there is a "greater openness about sexuality and HIV" in Brazil, where the government operates a widespread HIV/AIDS treatment and prevention program, according to the Times. She added, "Brazil is a real success story." In the United States, public health experts say that individual counseling and educational campaigns encouraging disclosure are "more effective than punitive laws" in preventing HIV transmission; currently, 35 states have laws that include criminal penalties for failing to disclose HIV-positive status, the Times reports. Klitzman said, "To say everyone should disclose [their HIV status] all the time is difficult, since some people may be rejected, kicked out of their homes, beaten up or worse as a result of it. So we health professionals need to encourage those individuals who choose not to disclose to consider carefully all of the consequences of their decision" (Markel, New York Times, 11/25).

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