Don't Ask, Don't Tell: Patterns of HIV Disclosure Among HIV Positive Men Who Have Sex With Men With Recent STI Practicing High Risk Behavior in Los Angeles and Seattle

In industrialized nations, a high incidence of HIV persists among men who have sex with men (MSM). Research suggests that many MSM do not disclose their HIV status to sex partners. Researchers in the current study identified themes as to why MSM attending STI clinics in Los Angeles and Seattle do or do not disclose their HIV status.

A total of 55 HIV-positive MSM (24 in Seattle, 31 in Los Angeles) who reported recent STI or unprotected anal intercourse with a partner of unknown or negative serostatus were recruited. Study participants underwent in-depth interviews about their disclosure practices that were tape recorded, transcribed verbatim, coded and analyzed for content.

The results showed that HIV disclosure themes fell into a continuum from unlikely to likely. "Themes for 'unlikely to disclose' were HIV is 'nobody's business,' being in denial, having a low viral load, fear of rejection, 'it's just sex,' using drugs, and sex in public places," the researchers reported. "Themes for 'likely to disclose' were feelings for partner, feeling responsible for partner's health, and fearing arrest. Many reported non-verbal disclosure methods. Some thought partners should ask for HIV status; many assumed if not asked then their partner must be positive."

"HIV positive MSM's decision to disclose their HIV status to sex partners is complex," concluded the researchers, "and is influenced by a sense of responsibility to partners, acceptance of being HIV positive, the perceived transmission risk, and the context and meaning of sex. Efforts to promote disclosure will need to address these complex issues."

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