Serostatus Disclosure Among Adults with HIV: Patterns and Predictors and Implications for Targeted HIV Policy and Practices

Purpose: Although there are approximately 1.2 million individuals living with HIV in the U.S; with 56,000 new infections annually, research also indicates that one in five of them (21 percent) are still undiagnosed (CDC, 2008). While individuals with HIV are living longer with less morbidity, HIV transmission continues. Prevention and control of HIV infection depends on the success of strategies to prevent new infections and treat currently infected individuals. One of these secondary prevention strategies is serostatus disclosure to potential sex partners. Unfortunately less is known about patterns of HIV serostatus disclosure to sex partners, family members, and friends among individuals with HIV. Using HIV disclosure profiles, this study seeks to examine patterns of disclosure among HIV patients' network. Method: This study is a cross-sectional examination of sociodemographic and HIV-related factors, and their association with HIV serostatus disclosure (n=809). These data were gathered at an urban, Midwestern HIV clinic among individuals receiving care between June and December 2008. Interviews were conducted by trained staff who were not identified as clinic staff, as to reduce the social desirability in individual responses. Results: Bivariate analyses and logistic regression were conducted to assess differences in the sample by sociodemographic factors and HIV-related measures. The mean age of the sample was 42 years. The majority were male (n = 544; 53%) and African American (n = 530; 66%). Almost three-quarters of the sample was currently receiving cART (n = 596; 74%), with 56% (n 336) having viral loads < 50 copies/mL. Disclosing to any family member was endorsed by three-quarters of the sample (n = 608), with a small proportion (n = 50) reporting that no one knew of their HIV status. More than 60% reported disclosing to a primary sex partner or spouse. Men reported disclosing to friends more often than women (64% vs. 48%; p <0.001) and Caucasians more often disclosed to friends than African Americans (71% vs. 54%; p< 0.001). Of participants who reported having sex in the previous 3 months, 60% reported having sex partners who were HIV seronegative. Implications: These results suggest that HIV serostatus disclosure to sex partners is consistent, while patterns of serostatus disclosure to friends and family members differ by gender and race. The reports of disclosure to sex partners seem artificially high, due to the continued sexually transmitted infection incidence rates. Patients who are engaged in care in Missouri are required to annually sign a document that endorses that they have been counseled and informed that they are required by law to inform all sex partners that they have HIV. The disparities in disclosure rates to friends and family may highlight HIV stigma that either is expressed or understood to exist in a community. Theoretically, disclosure of HIV serostatus leads to experienced social support. The need for social support among individuals with HIV may be an integral component of HIV treatment as it has been shown to improve health outcomes and reduce high risk behaviors. Specific ideas for targeted policy and practices will be discussed.