Patterns of HIV Disclosure in Infected Persons Presenting to Establish Care

Background:  While disclosure may be an important aspect of coping with a difficult diagnosis, persons newly diagnosed with HIV must balance the need for social support with the possibility that disclosure may negatively impact relationships. Failure to disclose HIV status has also been associated with increased sexual risk taking behaviors. In this study, we evaluate characteristics associated with nondisclosure in persons presenting to establish HIV care.

Methods:  This was a secondary analysis of data from new patients entering care at a university-based HIV clinic between 4/2008 - 6/2012.  We compared persons who disclosed HIV status to family and friends to persons who disclosed HIV status to non one. Data was analyzed with univariate modeling and, adjusting for variables with statistical significance, logistic regression with multivariable modeling was done to identify correlates of non-disclosure. 

Results:  Of 238 participants, 107 (45%) had not disclosed to anyone and 131 (55%) had disclosed to friends and family. In multivariable analysis, groups less likely to disclose included African Americans when compared to Caucasians (OR 3.23 [95% CI 1.74, 6.00]), persons with CD4 counts < 200 cells/µL when compared to persons with CD4 counts > 350 cells/µL (OR 2.59 [95% CI 1.30, 5.14]), and persons living with a spouse or significant other when compared to persons living alone (OR 2.60 [95% CI 1.23, 5.49]).

Conclusions:  Non-disclosure was common among persons presenting to establish HIV care. African Americans, persons living with significant others and persons with low CD4 counts were more likely to not disclose their HIV status. This population may fear that disclosure of HIV status could result in a negative impact on, or loss of, relationships. Without the support afforded by disclosure, these populations may suffer worse HIV related outcomes.