Disclosure Strategies, Comfort with Disclosure, and HIV Transmission Risk Among HIV-Positive MSM

Background:  Men who have sex with men (MSM) remain disproportionately represented in national HIV/AIDS statistics. Non-disclosure of an HIV-positive status to sex partners, now a felony in many states, has been shown to be a risk factor in HIV transmission. However the protective role of disclosure in MSM mental health and risk behavior is not fully understood.  Data from a randomized-controlled trial (RCT) are used to examine MSM disclosure strategies, comfort using these strategies, and relationships to mental health and sexual behaviors.  

Methods:  Participants were 123 HIV-positive adult MSM recruited in two US cities to participate in an RCT of an intervention designed to assist MSM with disclosure to casual sex partners. Data were obtained from assessments administered at baseline and during session 1 of the 4-session disclosure intervention.

Results:  Direct face-to-face disclosure (n=111, 90%) was the most commonly reported disclosure strategy, but only 60% (n=67) of those who used it reported being comfortable doing so.  Sixty-eight participants (55%) reported disclosing only after being asked by a partner if they were HIV positive, and 50 participants (41%) reported posting their status in an online profile.  Fewer than half of these participants reported being comfortable using these strategies.  Comfort with face-to-face disclosure was positively related to disclosure self-efficacy (t₁₀₄=3.3, p =.00) and outcome expectancy (t₁₀₂= 3.0, p=.00), and negatively related to HIV-stigma (t₁₀₃=4.2, p =.00).  No significant relationships were found to unprotected anal intercourse (UAI) or non-disclosure.

Conclusions:  A variety of strategies to disclose HIV status are employed by MSM, but comfort using these strategies remains relatively low.  Interventions are needed to increase comfort with disclosure to sex partners as mandated by law. Comfort with specific strategies may be a protective factor in MSM mental health and self-efficacy, but the means by which disclosure impacts risk behavior requires further study.