Effectiveness of interventions promoting HIV serostatus disclosure to sexual partners: a systematic review

The HIV Empowering Adults' Decisions to Share: UK/Uganda (HEADS-UP) Study-A Randomised Feasibility Trial of an HIV Disclosure Intervention for Young Adults with Perinatally Acquired HIV

Young adults with perinatally acquired HIV (PAH) face numerous challenges, including antiretroviral therapy (ART) adherence, managing onward HIV transmission risks and maintaining wellbeing. Sharing one's HIV status with others (onward HIV disclosure) may assist with these challenges but this is difficult. We developed and tested the feasibility of an intervention to help HIV status sharing decision-making for young adults with PAH. The study used a randomised parallel group feasibility design with 18-25-year-olds in Uganda and 18-29 year-olds in the UK. Participants were randomly assigned to intervention or standard of care (SOC) condition. The intervention consisted of four sessions (3 group, 1 individual) with follow-up support, delivered in person in Uganda and remotely in the UK. Assessments were carried out at: Pre-intervention /baseline; Post-intervention (intervention group only); Six-month follow-up. 142 participants were recruited (94 Uganda, 48 UK; 89 female, 53 male). At six-month follow-up, 92/94 (98%) participants were retained in Uganda, 25/48 (52%) in the UK. Multivariate analysis of combined data from both countries, showed a non-significant effect of intervention condition on HIV disclosure cognitions and affect (p = 0.08) and HIV disclosure intention (p = 0.09). There was a significant intervention effect on well-being (p = 0.005). This study addressed important gaps in understanding acceptable and feasible ways of delivering HIV status sharing support for young people living with PAH across two very different settings. The intervention was acceptable in both countries and feasible in Uganda. In the UK, retention may have been affected by its remote delivery.Trial registration: ISRCTN Registry, ISRCTN31852047, Registered on 21 January 2019.

Knowledge of Sexually Transmitted Infections and HIV among People Living with HIV: Should We Be Concerned?

Poor knowledge of sexually transmitted infections (STIs) and HIV among people with HIV (PLHIV) could worsen life quality. We aimed to investigate their STI and HIV knowledge, disclosure and undetectable = untransmittable (U=U). We proposed an anonymous questionnaire regarding STI and HIV to PLHIV attending ten Italian outpatient infectious diseases clinics. Moreover, disclosure and U=U were investigated. The calculated sample size was 178 people. Considering a missing response of 10%, the final sample size was 196. We enrolled 200 PLHIV (73.5% males), with a median age of 52.5 (IQR 41-59) years. The mean score was 7.61 ± 1.22 with no difference by gender, education, and employment. Significant statistical difference was observed by sexual orientation; bisexuals and those who preferred not to answer had a lower score than heterosexuals and MSM (p = 0.0032). PLHIV showed poor knowledge about HIV transmission (25% appropriately answered). Nearly 30% responded that virologically suppressed PLHIV could transmit the infection. Finally, 137 (68.5%) and 158 (79.0%) disclosed to the general practitioner and family and friends, respectively. Nearly 52.0% knew the meaning of U=U, and 83.6% highlighted its positive rebound. In conclusion, important knowledge gaps are present among PLHIV regarding U=U, and its implications are little-known. Improving PLHIVs' awareness will undermine self-stigma and enhance life quality.

Interventions, Barriers, and Facilitators to Address the Sexual Problems of Gay, Bisexual and Other Men Who Have Sex with Men Living with HIV: A Rapid Scoping Review

Sexual problems are common among gay, bisexual, and other men who have sex with men (GBM) after diagnosis with HIV. However, these are often overlooked in care and research, where sexual risk reduction and biomedical aspects of sexual health tend to dominate. We conducted a rapid scoping review to investigate which sexual problems of GBM living with HIV are addressed by interventions, and the barriers and facilitators to their implementation. Literature from high-income countries published in English since 2010 was reviewed. Medline, Embase, PsycInfo, and Scopus databases were searched on July 4, 2022. Targeted sexual problems were categorized according to the ten dimensions of Robinson's Sexual Health Model, and barriers and facilitators, according to the five domains of the Consolidated Framework for Implementation Research (CFIR). Interventions focused solely on the dimension of Sexual Health Care/Safer Sex were excluded. Relevant information was extracted from the qualifying documents with NVivo 12 software for content analysis. Fifty-two documents were included, referring to 37 interventions which mainly took place in the United States (n = 29/37; 78%), were group-based (n = 16; 41%), and used counselling techniques (n = 23; 62%; e.g., motivational interviewing, cognitive-behavioral therapy). Their settings were mostly primary care (n = 15; 40%) or community-based (n = 16; 43%). On average, interventions addressed three sexual health dimensions (SD = 2; range: 1-10). The most targeted dimension was Sexual Health Care/Safer Sex (n = 26; 70%), which concerned sexual risk reduction. Next, Challenges (n = 23; 62%), included substance use (n = 7; 19%), sexual compulsivity (n = 6; 16%), sexual abuse (n = 6; 16%), and intimate partner violence (n = 4; 11%). Third was Talking About Sex (n = 22; 59%) which mostly concerned HIV disclosure. About a third of interventions addressed Culture/Sexual identity (n = 14; 38%), Intimacy/Relationships (n = 12; 33%), and Positive sexuality (n = 11; 30%). Finally, few targeted Body Image (n = 4; 11%), Spirituality (n = 3; 8%), Sexual Anatomy Functioning (n = 2; 5%) or Masturbation/Fantasy (n = 1; 3%). Forty-one documents (79%) mentioned implementation barriers or facilitators, particularly about the characteristics of the interventions (41% and 78%, respectively; e.g., cost, excessive duration, acceptability, feasibility) and of the individuals involved (37% and 46%; e.g., perceived stigmatization, provider expertise). The other three CFIR dimensions were less common (5%-17%). The search strategy of this review may not have captured all eligible documents, due to its limit to English-language publications. Overall, most interventions incorporated a focus on Sexual Health Care/Safer Sex, at the expenses of other prevalent sexual problems among GBM living with HIV, such as intimate partner violence (Challenges), erectile dysfunction (Sexual Anatomy Functioning), and Body Image dissatisfaction. These findings suggest they could receive more attention within clinical care and at the community level. They also highlight the importance of cost-effective and acceptable interventions conducted in non-stigmatizing environments, where patients' needs can be met by providers who are adequately trained on sexuality-related topics.

Associations between HIV disclosure and HIV care continuum outcomes among men who have sex with men living with HIV: systematic review and meta-analysis

ABSTRACTThe objective of this study is to synthesize the existing empirical literature and perform a systematic review and meta-analysis on the relationship between HIV disclosure and engagement in the HIV care continuum among men who have sex with men living with HIV. Twenty-three studies were included, with thirteen quantitative studies and ten qualitative studies. Meta-analytic techniques were used to compute and aggregate effect sizes (odds ratio [OR] and their confidence intervals [95%CI]) for the quantitative studies and a thematic analysis was employed for qualitative studies. Given the small number of eligible studies, meta-analysis was only conducted for the linkage to care outcome, where a positive association was observed from the pooled estimation (OR = 1.51, 95%CI [1.15, 1.99]). Regarding ART initiation, retention in care, and viral suppression outcomes, most of the individual studies revealed a positive association between HIV disclosure and these outcomes. Thematic analysis from qualitative studies complemented the quantitative findings by incorporating the approaching and avoidance motivations underlying the relationship between non-HIV disclosure and the participation in HIV care continuum. The small number of available studies limits the definitive conclusions, and more research is needed to ascertain the magnitude of effect sizes.

Entertainment-education to reduce internalized stigma, increase intimate partner status disclosure intentions, and increase antiretroviral medical adherence intentions: A randomized controlled trial targeting black women living with HIV in the Southern U.S

BACKGROUND

Black women in the Southern U.S. account for 67% of all new HIV diagnoses across women of all races and ethnicities. In comparison to women of other racial and ethnic identities, Black women disproportionately experience internalized stigma, lower levels of disclosure self-efficacy, and lower rates of medical adherence. The disclosure processes model hypothesizes that persons living with HIV can be disclosure avoidance oriented or disclosure approach oriented. Disclosure avoidance is facilitated by various forms of stigma and negative outcome expectations. While disclosure approach orientation is facilitated by factors such as positive disclosure attitudes and disclosure self-efficacy. Despite the important role of disclosure in ending the HIV epidemic, extant interventions are limited. Recent research suggests entertainment-education (EE) may be an effective intervention for HIV status disclosure. Entertainment-education is a persuasive strategy that consists of intentionally embedding health and social messages into entertaining content.

METHODS

The present study evaluated the comparative efficacy of the 90 DAYS film for improving internalized HIV stigma, disclosure beliefs, positive disclosure attitudes, disclosure self-efficacy, HIV disclosure intentions, and medical adherence intentions. A randomized controlled trial was employed consisting of 130 Black women living with HIV in the Southern U.S. Participants were recruited primarily via a Qualtrics panel and randomly assigned to either view the 90 DAYS film or a standard of care brochure.

RESULTS

Results indicated the EE condition significantly outperformed the brochure condition on the following outcomes: disclosure beliefs (p = .046), positive disclosure attitudes (p = .008), disclosure self-efficacy (p = .007), and intentions to disclose to an intimate partner (p = .038). Statistically significant differences were not observed for internalized stigma or medical adherence intentions.

CONCLUSION

Findings suggest that EE is an effective strategy for improving psychosocial influences of disclosure and disclosure intentions. Theoretical and practical implications of this work are discussed.

The proportion of HIV disclosure to sexual partners among people diagnosed with HIV in China: A systematic review and meta-analysis

Background

Sexual behavior is one of the main routes of HIV/AIDS spread. HIV disclosure to sexual partners has been confirmed to be an important strategy for HIV/AIDS prevention and control. We conducted a systematic review and meta-analysis to pool proportions and characteristics of HIV disclosure to sexual partners among people diagnosed with HIV in China.

Methods

We searched eight databases and extracted the data on HIV disclosure to partners. Heterogeneity of the data was tested with I ². Published bias subjectively and objectively analyzed through the funnel plot and Egger's regression test. Subgroup analyses were performed to explore the variation in the proportion by sexual partnership types (unclassified, regular, casual sexual partners), whether being men who have sex with men (MSM), and when to diagnose. The sources of heterogeneity were analyzed. Sensitivity analysis was carried out to evaluate the stability of the results.

Results

Out of 3,698 studies, 44 were included in the review; 11 targeted on MSM. The pooled proportion of HIV disclosure to sexual partners was 65% (95% CI: 56%-75%; 34 studies). Sub-group analyses indicated the proportions of HIV disclosure to regular, casual and unclassified sexual partners were 63% (95% CI: 45%-81%; 31 studies), 20% (95% CI: 8%-33%; nine studies), and 66% (95% CI: 59%-73%; 14 studies), respectively. Fifty-seven percent (95% CI: 45%-69%; three studies) disclosed on the day of diagnosis, 62% (95% CI: 42%-82%; four studies) disclosed within 1 month, and 39% (95% CI: 2%-77%; four studies) disclosed 1 month later. Among MSM, the disclosure to regular male partners, regular female sexual partners, spouses, and casual partner were 47% (95% CI: 29%-65%; six studies), 49% (95% CI: 33%-65%; three studies), 48% (95% CI: 18%-78%; seven studies), and 34% (95% CI: 19%-49%; four studies), respectively.

Conclusions

The disclosure prevalence of people diagnosed with HIV to sexual partners still need improving in China, and it varies among partner types, key populations, and time being diagnosed. HIV disclosure strategies and procedures need to be developed more detailed and tailored based on the pain points of disclosure status, so as to ultimately prevent HIV transmission through sexual contact.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022291631, identifier: CRD42022291631.

HIV Serostatus Disclosure and Its Predictors Among Children Living With HIV in Ethiopia: A Systematic Review and Meta-Analysis

Background

HIV disclosure among children refers to when the caregiver is having disclosed to the child that he or she has HIV specifically. Disclosure significantly improved adherence to treatment and quality of life among children living with HIV/AIDS. Even though, the benefits of disclosure are considerable, informing a child of his or her own HIV status is often delayed. There is a dearth of studies on HIV serostatus disclosure among children in Ethiopia. Therefore, this study aimed to assess the pooled prevalence of HIV serostatus disclosure and associated factors among children living with HIV in Ethiopia.

Methods and Materials

Using a combination of search terms and Boolean operators, studies were retrieved from Pub Med/MEDLINE, EMBASE, CINAHL, Science Direct, Scopus, Web of Science, Cochran library, and Google Scholar. Five authors independently assessed the quality of each study using the modified Newcastle Ottawa Scale (NOS) for cross-sectional studies. STATA Version 11 software was used for statistical analyses. The random-effects (Der Simonian and Laird) method was used for the meta-analysis. The heterogeneity test was carried out with the help of I-squared (I2) statistics. A leave-one-out sensitivity analysis was carried out.

Results

A total of 12 articles with 3,410 participants were included in this systematic review and meta-analysis. The pooled prevalence of HIV serostatus disclosure among children was 36.87% (95% CI: 29.30, 44.44; I2 = 95.8%). Children aged older than 10 years (p = 0.003) and caregivers with primary and above education (p < 0.001) were factors significantly associated with HIV serostatus disclosure among children.

Conclusions

The finding of this study showed that HIV serostatus disclosure among children is relatively low. Therefore, developing clear guideline on HIV serostatus disclosure among children, strengthening public health education or community awareness creation about HIV/AIDS to promote the benefits of disclosure and extensively provision of counseling by health care providers are essential to enhance HIV serostatus disclosure among children.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42021239035.

Attitudes Toward HIV-Positive Status Disclosure Among U=U-Aware Sexual and Gender Minority Individuals in the USA: a Consensual Qualitative Research Approach

Introduction

The U=U (i.e., undetectable equals untransmittable) campaign is founded upon biomedical advancements that have positioned HIV as a manageable condition with effectively zero risk of transmission. In spite of these developments, attitudes of sexual and gender minority populations regarding the necessity of seropositive status disclosure remain unexamined.

Methods

The current study analyzed qualitative data regarding the necessity of seropositive status disclosure from 62 sexual minority men as well as transgender and gender non-conforming individuals who have sex with men from 2020 to 2021.

Results

The majority of participants believed disclosure to be necessary and invoked several social and structural factors that informed their attitudes. Participants cited HIV criminalization laws, the ethics of non-disclosure, and disclosure as a means of educating sex partners when appraising the necessity of disclosure. Participants also presented concerns regarding U=U efficacy and HIV stigma.

Conclusions

Findings indicate that the disclosure of seropositive status to sex partners is still important to U=U-aware sexual and gender minority individuals. The majority of the study sample, irrespective of HIV status, believed seropositive status disclosure was necessary in advance of sex.

Policy Implications

Findings suggest opportunities for public health messaging to remediate concerns about U=U efficacy, combat misinformation, and clarify out-of-date information on HIV criminalization.

HIV Positive status disclosure to sexual partners: a qualitative study to explore experiences and challenges among clients attending HIV care services in North-Western Tanzania

HIV status disclosure rates to sexual partners are low in Tanzania, despite the benefits it confers to both partners. This qualitative study drew on the Disclosure Decision Model to explore the decision by people living with HIV (PLHIV) to disclose, or not, their HIV status to their partner. Six focus group discussions and thirty in-depth interviews were conducted in Mwanza, Tanzania in 2019 with PLHIV. Topics covered decision-making around disclosure and disclosure experiences. Thematic content analysis was conducted. Most respondents reported having disclosed their status to their partners. Disclosure was reported to facilitate or hinder the attainment of social goals including having intimate relationships, raising a family, relief from distress and accessing social support. Decisions made by PLHIV about whether to disclose their status were made after weighing up the perceived benefits and risks. The sense of liberty from a guilty conscious, and not "living a lie" were perceived as benefits of disclosure, while fears of stigma, family break-up or abandonment were perceived as risks. Many participants found disclosure was beneficial in promoting their adherence to treatment and clinic appointments. Interventions to support PLHIV with disclosure should include enhanced counselling, strengthening HIV support groups and enhanced assisted partner notification services.

Disclosure processes as predictors of relationship outcomes among people in recovery from opioid use disorder: A longitudinal analysis

BACKGROUND

Personal disclosure of opioid use disorder (OUD) recovery can lead to relationship outcomes such as social support, which is associated with greater treatment retention, or stigma, which is associated with risk of treatment dropout. Although disclosure may have important impacts on the relationships and ensuing recovery trajectories of people with OUD, disclosure processes remain understudied in the context of OUD.

METHODS

Guided by the Disclosure Process Model, this longitudinal study explored the disclosure goals of people in treatment for OUD and examined associations between disclosure goals and relationship outcomes. Data were collected at baseline (N = 146) and three months later (n = 124) from participants who were in treatment for OUD and planning to disclose their OUD history and/or treatment to someone new.

RESULTS

Qualitative baseline data were analyzed to identify disclosure goals. Approach goals (i.e., reasons for disclosure) included support, honesty, amends, set an example, and logistics; avoidance goals (i.e., reasons against disclosure) included judgment, worry, and privacy. Quantitative data suggested that approach goals at baseline were associated with greater likelihood of disclosure within three months (OR=2.16, 95% CI=1.04-4.49) as well as with greater social support [B(SE)= 0.35(0.16), p = 0.03] and relationship closeness [B(SE)= 0.29(0.17), p = 0.01] following disclosures. In contrast, avoidance goals at baseline were associated with greater enacted stigma following disclosures [B(SE)= 0.30(0.14), p = 0.04].

CONCLUSIONS

Findings draw attention to the potentially important role of disclosures in relationship outcomes among people in recovery from OUD. Disclosure may represent a promising intervention target to improve relationship outcomes and recovery trajectories of people in recovery from OUD.

Predictors of HIV Status Disclosure to Sexual Partners Among People Living with HIV in Brazil

The objective of this study was to identify the factors associated with the non-disclosure of HIV seropositivity among people living with HIV/AIDS undergoing antiretroviral treatment. A cross-sectional study was carried out in five HIV clinics in the interior of the state of São Paulo, Brazil. Logistic regression analysis was used to determine independent predictors of HIV status disclosure. It was found that 68.5% revealed their HIV seropositivity to their most recent sexual partner. The variables "casual partner" [OR 19.08, 95% CI (4.08, 20.23), p = 0.001], "sexual partners with negative HIV or unknown HIV" [OR 4.54, 95% CI (1.58, 1.01), p = 0.005], "multiple sexual partners" [OR = 3.17, 95% CI (1.34, 7.35), p = 0.009], and "lack of communication with the partner on HIV prevention"[OR = 8.3, 95% CI (3.88, 16.61), p = 0.001] were independently associated with non-disclosure of the diagnosis. Future HIV prevention interventions should encourage open communication between sexual partners.

Behavioral and Clinical Characteristics of Self-Identified Bisexual Men Living with HIV Receiving Medical Care in the United States-Medical Monitoring Project, 2009-2013

Nationally representative data comparing demographic, risk, and clinical information among bisexual men with other MSM or heterosexuals are lacking. We described differences in demographic characteristics, behaviors, and clinical outcomes among self-identified HIV-positive bisexual, gay, and heterosexual men receiving HIV medical care in the United States. We analyzed data from the 2009-2013 cycles of the Medical Monitoring Project (MMP), a surveillance system that provides nationally representative estimates of behavioral and clinical characteristics of adults with diagnosed HIV in medical care. Altogether, 10% (95% confidence interval [CI] 9-11) of men self-identified as bisexual, 56% (CI 51-61) as gay, and 32% (CI 28-37) as heterosexual. We observed significant differences in demographic factors, clinical outcomes, drug use, and sexual behavior among bisexual men compared with gay and heterosexual men. Providers should consider sexual identities as well as sexual behaviors when developing and implementing prevention programs.

Electronic Adherence Monitoring May Facilitate Intentional HIV Status Disclosure Among People Living with HIV in Rural Southwestern Uganda

HIV status disclosure remains one of the major challenges to effective HIV prevention. Given the complexities and low rates of disclosure, new innovative strategies are needed. Since electronic adherence monitoring (EAM) are unique mobile devices that light up when transmitting data, those who see them often want to know more about them, which can potentially result in HIV status disclosure. We conducted a qualitative study to explore patient experiences with EAM for antiretroviral therapy (ART) in Uganda with a goal of understanding potential ethical concerns, including disclosure. Unexpectedly, several participants reported intentionally using EAM to facilitate HIV status disclosure to others in order to get social support, encourage HIV testing, and create awareness about HIV. Although researchers and clinicians need to be mindful of the potential for unintended HIV status disclosure through the use of EAM, they should also recognize the potential of this approach to support intended disclosure.

Attitudes and Perceptions About Disclosing HIV and Syphilis Results Using Smarttest, a Smartphone App Dedicated to Self- and Partner Testing

We explored interest in disclosing test results through a smartphone app dedicated to self- and partner testing for HIV/syphilis. Fifty-nine cisgender men and transgender women each participated in an in-person survey and interview. We examined their interests in sharing test results by audience (e.g., partners, physicians) and by positive versus negative test result. Participants wanted the ability to share results, with notable interest in disclosing negative results to sexual partners and on social media and forwarding positive results to physicians. Participants envisioned smartphone sharing as a means to normalize testing, to notify partners of results, and to expedite linkage to care. Some questioned the authenticity of results shared by smartphone, while others voiced optimism that a personalized, authenticated app could ensure the security and veracity of results. Smartphone testing apps for HIV/syphilis may facilitate disclosure, partner notification, and linkage to care, but need to address concerns about the security and veracity of results.

Challenges of HIV Self-Test Distribution for Index Testing When HIV Status Disclosure Is Low: Preliminary Results of a Qualitative Study in Bamako (Mali) as Part of the ATLAS Project

Context: The rate of HIV status disclosure to partners is low in Mali, a West African country with a national HIV prevalence of 1.2%. HIV self-testing (HIVST) could increase testing coverage among partners of people living with HIV (PLHIV). The AutoTest-VIH, Libre d'accéder à la connaissance de son Statut (ATLAS) program was launched in West Africa with the objective of distributing nearly half a million HIV self-tests from 2019 to 2021 in Côte d'Ivoire, Mali, and Senegal. The ATLAS program integrates several research activities. This article presents the preliminary results of the qualitative study of the ATLAS program in Mali. This study aims to improve our understanding of the practices, limitations and issues related to the distribution of HIV self-tests to PLHIV so that they can offer the tests to their sexual partners.

Methods: This qualitative study was conducted in 2019 in an HIV care clinic in Bamako. It consisted of (i) individual interviews with eight health professionals involved in the distribution of HIV self-tests; (ii) 591 observations of medical consultations, including social service consultations, with PLHIV; (iii) seven observations of peer educator-led PLHIV group discussions. The interviews with health professionals and the observations notes have been subject to content analysis.

Results: HIVST was discussed in only 9% of the observed consultations (51/591). When HIVST was discussed, the discussion was almost always initiated by the health professional rather than PLHIV. HIVST was discussed infrequently because, in most of the consultations, it was not appropriate to propose partner HIVST (e.g., when PLHIV were widowed, did not have partners, or had delegated someone to renew their prescriptions). Some PLHIV had not disclosed their HIV status to their partners. Dispensing HIV self-tests was time-consuming, and medical consultations were very short. Three main barriers to HIVST distribution when HIV status had not been disclosed to partners were identified: (1) almost all health professionals avoided offering HIVST to PLHIV when they thought or knew that the PLHIV had not disclosed their HIV status to partners; (2) PLHIV were reluctant to offer HIVST to their partners if they had not disclosed their HIV-positive status to them; (3) there was limited use of strategies to support the disclosure of HIV status.

Conclusion: It is essential to strengthen strategies to support the disclosure of HIV+ status. It is necessary to develop a specific approach for the provision of HIV self-tests for the partners of PLHIV by rethinking the involvement of stakeholders. This approach should provide them with training tailored to the issues related to the (non)disclosure of HIV status and gender inequalities, and improving counseling for PLHIV.

The Disclosure Dilemma: Willingness to Disclose a Positive HIV Status Among Individuals Preparing for HIV Testing During Antenatal Care in Tanzania

HIV status disclosure can reduce transmission risks and improve care engagement. Individuals may have strong feelings about HIV disclosure even prior to diagnosis. We assessed willingness to disclose a positive HIV status among pregnant women and their male partners awaiting routine HIV testing during antenatal care in Tanzania (n = 939). Logistic regression models were used to examine factors associated with willingness to disclose to one's inner circle (partner/family member) and outer circle (friend/neighbor) in the event of an HIV diagnosis. Almost all (93%) were willing to disclose to at least one person; participants were more willing to disclose to their inner circle (91%) vs outer circle (52%). Individuals with some form of employment, more stigmatizing attitudes of social distancing of PLWH, greater anticipated HIV stigma, more perceived social support, and prior contact with someone living with HIV were more likely to disclose to their inner circles. Individuals who were older, male, and who had higher levels of perceived social support were more willing to disclose to their outer circle. These findings increase the understanding of the intra- and interpersonal factors that influence HIV disclosure decisions. Tailored pre- and post- HIV test counseling are needed to facilitate social support and overcome barriers to disclosure if they test positive for HIV.

To Disclose, Not Disclose, or Conceal: A Qualitative Study of HIV-Positive Men with Multiple Concealable Stigmatized Identities

People living with HIV (PLHW) and other concealable stigmatized identities (CSIs) face continual decisions about the degree of openness they are willing to allow for their identities in different social contexts. Disclosing or concealment of CSIs describes potential stigma management strategies that may have distinct psychosocial consequences. This study aimed to examine disclosure processes in a sample of sexual minority men (SMM) with intersecting CSIs, who use substances and were suboptimally engaged in HIV care. Interviews (N = 33) were initially double coded following thematic analysis, which identified disclosure as a theme. Subsequently, content analysis and additional selective double coding were used to iteratively identify and refine subthemes related to disclosure decisions. Illustrative quotes and frequencies of the invoked subthemes and identities were recorded for each participant. The majority of participants discussed experiences of disclosure and nondisclosure (N = 31, 94%). Among these, a spectrum of related behaviors and preferences emerged, including active disclosure, passive disclosure, passive nondisclosure, and concealment. Across disclosure-related content, in addition to HIV status, the majority of participants also described navigating decisions about disclosure of sexual orientation (71%), substance use (61%), and multiple identities at once (55%). Findings from this study highlight the fluid and multi-dimensional nature of identity-related disclosure processes in SMM with multiple CSIs. Participants in this study possessed interlocking stigmatized identities and described being varying degrees of "out" across identities and time. Moreover, these findings challenge common beliefs that disclosure is a binary construct associated with positive gain.

90 DAYS: An investigation of a short entertainment-education film to improve HIV status disclosure among black women living with HIV in Miami-Dade County

Within Miami-Dade County, Black women experience disproportionate rates of HIV incidence and prevalence. Status disclosure to sexual partners is central to mitigating the HIV epidemic and ensuring a healthier lifestyle for those living with the virus. The disclosure processes model (DPM) posits that barriers such as stigma and negative outcome expectations often facilitate disclosure avoidance. Therefore, this study investigated the utility and acceptability of an entertainment-education (EE) short film, 90 DAYS, for disclosure among Black women living with HIV in Miami-Dade County. Employing photo-elicitation (Harper, 2002), focus groups were conducted with 48 participants. After screening the 90 DAYS film about stigma and disclosure, participants were asked semi-structured questions based upon extant EE and DPM literature. Via inductive and deductive processes, five themes were derived from the data. Participants found the 90 DAYS film to be an empowering counter-narrative that could be used to overcome multiple disclosure-related factors. They felt it provided a social script for how to disclose to their sexual partners. A novel finding of this investigation was that respondents asserted the film could facilitate safer disclosure events. Additional themes included the film being a resource of hope for young and newly diagnosed women; and an educational tool for the community. Altogether, findings lend promise to the use of EE for addressing disclosure avoidance among Black women living with HIV.

Patterns and Predictors of HIV Status Disclosure in the 12 Months After Diagnosis in Mozambique

BACKGROUND

HIV disclosure benefits people living with HIV, their partners, and HIV programs. However, data on the prevalence of disclosure and associated correlates have come largely from patients already in HIV care, potentially overestimating disclosure rates and precluding examination of the impact of disclosure on HIV care outcomes.

SETTING

We used data from an implementation study conducted in Maputo City and Inhambane Province, Mozambique. Adults were enrolled at HIV testing clinics after diagnosis and traced in the community 1 and 12 months later when they reported on disclosure and other outcomes.

METHODS

We examined patterns of participants' disclosure to their social networks (N = 1573) and sexual partners (N = 1024) at both follow-up assessments and used relative risk regression to identify correlates of nondisclosure.

RESULTS

Disclosure to one's social network and sexual partners was reported by 77.8% and 57.7% of participants, respectively, at 1 month and 92.9% and 72.4% of participants, respectively, at 12 months. At both time points, living in Inhambane Province, being single or not living with a partner, having high levels of anticipated stigma, and not initiating HIV treatment were associated with increased risks of nondisclosure to social networks. Nondisclosure to sexual partners at both follow-up assessments was associated with being women, living in Inhambane Province and in a household without other people living with HIV, and reporting that posttest counseling addressed disclosure.

CONCLUSIONS

Although reported disclosure to social networks was high, disclosure to sexual partners was suboptimal. Effective and acceptable approaches to support partner disclosure, particularly for women, are needed.

Disclosure of HIV Status and HIV Sexual Transmission Behaviors among HIV-Positive Black Men Who Have Sex with Men in the BROTHERS (HPTN 061) Study

We assessed whether disclosure of HIV status is significantly associated with reported HIV sexual risk behaviors among HIV positive Black/African American men who have sex with men (MSM) (Black MSM) in six cities in the USA. Participants from the BROTHERS (HIV Prevention Trials Network [HPTN 061]) study focused on assessing the feasibility and acceptability of a multifaceted HIV prevention intervention to reduce HIV infections among Black MSM enrolled between July 2009 and October 2010. All participants completed a behavioral assessment using an audio computer-assisted self-interview that included questions about HIV status disclosure, HIV sexual risk behaviors, and other behaviors. Biological samples were also collected. This analysis focused on baseline data of HIV-positive Black MSM in the HPTN 061 study. Of the 143 HIV-positive Black MSM (majority ≥ 35 years of age) included in this analysis, 58% reported disclosing their HIV status to their last male anal sex partner. Forty-three percent and 42% reported condomless insertive and receptive anal intercourse respectively with their last male partner; whereas, 17% and 18% of the sample engaged in condomless insertive and receptive anal intercourse with a serodiscordant/unknown status partner, respectively. In multivariable logistic regression models, there was no statistically significant association between HIV status disclosure and condomless insertive anal intercourse (aOR = 0.35, 95% CI 0.11, 1.08; p = 0.30), condomless receptive anal intercourse (aOR = 2.48, 95% CI 0.94, 6.52; p = 0.20), or condomless receptive anal intercourse with a serodiscordant/unknown status partner (aOR = 0.55, 95% CI 0.20, 1.49; p = 0.45). However, HIV status disclosure was significantly associated with lower odds of reporting condomless insertive anal intercourse with a serodiscordant/unknown status partner (aOR = 0.19, 95% CI 0.06, 0.68; p ≤ 0.01). Among this multi-city sample of HIV-positive Black MSM, disclosure of HIV status was common and associated with lower HIV sexual risk behaviors. These findings should motivate and guide research to develop prevention messages to increase HIV status disclosures.

A randomised feasibility trial of an intervention to support sharing of HIV status for 18-25-year olds living with perinatally acquired HIV compared with standard care: HIV Empowering Adults' Decisions to Share-UK/Uganda Project (HEADS-UP)

Abstract

Background

Young adults with perinatally acquired HIV (PAH) face several challenges, including adhering to antiretroviral therapy (ART), managing the risk of onward HIV transmission and maintaining positive well-being. Sharing one’s HIV status with others (onward HIV disclosure) may assist with these challenges by facilitating emotional and practical support. Rates of HIV status sharing are, however, low in this population. There are no existing interventions focused on sharing one’s HIV status for young adults living with PAH. The HEADS-UP study is designed to develop and test the feasibility of an intervention to help the sharing of HIV status for young adults with PAH.

Methods

The study is a 30-month multi-site randomised feasibility study across both a high-income/low-HIV prevalence country (UK) and a low-income/high-HIV prevalence country (Uganda). Phase 1 (12 months) will involve developing the intervention using qualitative interviews with 20 young people living with PAH (ten in the UK—18 to 29 years; ten in Uganda—18 to 25 years), 20 of their social network (friends, family, sexual partners as defined by the young person; ten in the UK, ten in Uganda) and ten professionals with experience working with young adults with PAH (five in the UK, five in Uganda). Phase 2 (18 months) involves conducting a randomised feasibility parallel group trial of the intervention alongside current standard of care condition in each country (main study) with 18- to 25-year olds with PAH. A sample size of 94 participants per condition (intervention or standard of care; 188 participants in total: 47 in each condition in each country) with data at both the baseline and 6-month follow-up time points, across UK and Ugandan sites will be recruited. Participants in the intervention condition will also complete measures immediately post-intervention. Face-to-face interviews will be conducted with ten participants in both countries immediately post-intervention and at 6-month follow-up (sub-study).

Discussion

This study will be the first trial that we are aware of to address important gaps in understanding acceptable and feasible ways of delivering HIV status sharing support for young people living with PAH.

Trial registration

ISRCTN Registry, ISRCTN31852047, Registered on 21 January, 2019. Study sponsor: Royal Holloway University of London. Sponsor contact: alicen.nickson@rhul.ac.uk. Date and version: April 2020. Protocol version 3.5.

Attitudes to disclosure of HIV-serostatus to new sexual partners and sexual behaviours among HIV-diagnosed gay, bisexual and other men who have sex with men in the UK

We assessed attitudes to disclosure to new sexual partners and association with sexual behaviours among HIV-diagnosed gay, bisexual, and other men who have sex with men (GBMSM) in the UK Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) study in 2011-12. Among 1373 GBMSM diagnosed with HIV for ≥3 months and reporting sex in the past three months (84% on antiretroviral therapy (ART), 75% viral load (VL) ≤50c/mL), 56.3% reported higher sexual disclosure ("agree" or "tend to agree" with "I'd expect to tell a new partner I'm HIV-positive before we have sex"). GBMSM on ART with self-reported undetectable VL had lower disclosure than those on ART without self-reported undetectable VL and those not on ART. Higher sexual disclosure was associated with higher prevalence of CLS in the past three months; this was due to its association with CLS with other HIV-positive partners. Higher sexual disclosure was more common among GBMSM who had CLS with other HIV-positive partners only (72.1%) compared to those who had higher-risk CLS with HIV-serodifferent partners (55.6%), other CLS with HIV-serodifferent partners (45.9%), or condom-protected sex only (47.6%). Findings suggest mutual HIV-disclosure and HIV-serosorting were occurring in this population. Knowledge of VL status may have impacted on disclosure to sexual partners.

Characteristics Associated with Disclosure Status to Sexual Partners among Kenyan Women

Background:

Kenya has the fourth-largest HIV epidemic across the globe. Disclosure of HIV-positive status plays a critical role in the prevention of HIV transmission. Disclosure, specifically to sexual partners, has been shown to foster safer sexual behaviors in addition to emotional, social, or monetary support from partners.

Objective:

This study was conducted to identify factors associated with HIV-positive status disclosure to sexual partners compared to disclosure to other than sexual partners.

Methods:

A cross-sectional study was conducted from May to August 2012 among 497 HIV-positive women 19–49 years of age who had sex in the past six months. Participants were recruited from the Kenyatta National Hospital and Mbagathi Direct Hospital in Nairobi, Kenya. A questionnaire was administered to obtain data on HIV disclosure. Bivariate and multivariable logistic regression analyses were conducted to identify factors associated with disclosure of HIV-positive status to sexual partners.

Results:

Of the 497 women, 349 reported to whom they had disclosed their HIV status. Approximately 34% had disclosed their HIV-positive status to a sexual partner. Women who disclosed to their sexual partners were 11 times more likely to be married or in a common-law relationship and 4 times more likely for their sexual partner or spouse to be the heads of the households. Frequency of condom use, belief that HIV disclosure is important for HIV prevention and control, knowledge of partner’s HIV status, and number of sex partners were also significantly associated with disclosing to a sexual partner.

Conclusion:

This study found a low rate of disclosure of HIV-positive status by women to sexual partners and identified a number of factors associated with disclosure to sexual partners. These findings can be used in designing interventions that focus on individuals who have not disclosed their HIV-positive status to their sexual partners by demonstrating the importance of disclosure and safe sex practices.

Behavioral interventions promoting HIV serostatus disclosure to sex partners among HIV-positive men who have sex with men: a systematic review

OBJECTIVES

This review aimed to identify intervention components which were effective to promote disclosure of HIV status among men have sex with men (MSM) living with HIV, particularly from a theoretical perspective.

METHODS

A systematic review was performed through searching electronic databases, HIV-related conferences websites, and registered ongoing randomized controlled trials. Studies were included if they reported intervention evaluation results related to HIV disclosure and published before December 31, 2017. Two independent reviewers collected studies and extracted data.

RESULTS

Eight studies met the inclusion criteria and were summarized. Interventions appeared effective in promoting HIV disclosure to their sex partners among MSM living with HIV if they were theory based (e.g., consequence theory and social cognitive theory). Key elements of effective interventions consisted of increasing disclosure self-efficacy, highlighting disclosure benefits, assisting risk assessment, developing disclosure strategy, and using messages under social influence.

CONCLUSIONS

Findings of this review imply that future interventions are more likely to succeed if they apply consequence theory, social cognitive theory, and trans-theoretical model of behavior change and include multiple key intervention components.

Disclosure of HIV serostatus and condomless sex among men living with HIV/AIDS in Florida

Despite campaigns to increase safer sex practices, there are people living with HIV/AIDS (PLWH) who do not disclose their HIV status to sexual partners and engage in condomless sex. The purpose of this research was to: 1) describe factors associated with disclosure of HIV status to sexual partners; and 2) determine if disclosure and/or receipt of prevention counseling are independently associated with condomless sex. We used the Florida Medical Monitoring Project to analyze data from 376 HIV positive men with more than one sexual partner. Results indicated that 55% consistently disclosed their HIV status to sexual partners, 30% inconsistently disclosed, 15% did not disclose, and 48% reported any condomless sex. The odds of having condomless sex was 3.3 (CI = 1.5, 7.3) times greater in men who disclosed to all partners. Results suggest that men who disclose are also those who are more likely to have condomless sex. More research is needed to better understand the complex nature of disclosure and sexual risk behaviors and how disclosure impacts sexual risk.

Discomfort discussing HIV/AIDS and lack of awareness are barriers to partner-to-partner pre-exposure prophylaxis education

We suggest that people living with HIV (PLWH) may serve as pre-exposure prophylaxis (PrEP) educators for partners when informed about PrEP. Participants in this study were a convenience sample of PLWH at a public hospital in Miami. A cross-sectional survey assessed the frequency of serostatus disclosure, PrEP awareness, and willingness to recommend PrEP to intimate partners. To evaluate stigma surrounding human immunodeficiency virus (HIV), comfort discussing HIV with family, friends and intimate partners was interrogated. Surveys were completed by 137 participants; 39.5% had potentially sero-discordant sexual partners. Among respondents, 29.2% reported that they 'occasionally' or 'never' disclose HIV status to sexual partners. In all, 66.4% of patients reported that they had never heard of PrEP. After being educated about PrEP, 86.0% of respondents reported that they would encourage partners to use it. Participants were asked how often the subject of HIV comes up in conversations. Most indicated that 'rarely' or 'never' does it come up with friends and family; 46.1% indicated that 'never' or 'rarely' does it come up with partners. In bivariate analyses, participants with prior awareness of PrEP were more likely to indicate higher frequency of conversations regarding HIV with intimate partners. It is concluded that interventions which utilize partner education to increase PrEP uptake should address stigma and knowledge among other barriers.

Evaluation of HIV Disclosure Behavior Following a Randomized Controlled Disclosure Intervention for Men Who Have Sex with Men Living with HIV

Preventing the transmission of HIV, especially among high-risk populations, is a U.S. public health priority. Interventions aimed at easing the burden of HIV disclosure to casual sexual partners among men who have sex with men (MSM) living with HIV are essential in this endeavor. This randomized controlled study evaluated differences in disclosure behavior between a disclosure intervention (DI) and attention control case management (ACCM) group for MSM living with HIV (N = 315) and determinants (self-efficacy, outcome expectancy) of disclosure. Mixed-effects models results showed no significant differences in disclosure behavior between the DI and ACCM groups. Further, disclosure behavior changed in a curvilinear manner over 12 months and benefited from a booster session. Both disclosure self-efficacy and outcome expectancy predicted disclosure behavior. Interventions targeting HIV disclosure among MSM living with HIV should focus on improving perceptions of disclosure self-efficacy and outcome expectancy and include a booster session to facilitate HIV disclosure.

HIV serostatus disclosure in the Democratic Republic of the Congo: a systematic review

HIV status disclosure among people living with HIV/AIDS has been shown to have a number of both personal and public health benefits, but rates of HIV status disclosure remain low in many African countries, including the Democratic Republic of the Congo (DRC). This systematic review uses the Disclosure Process Model to examine the factors involved in serostatus disclosure and nondisclosure to various persons in the lives of people living with HIV/AIDS (PLWHA) in the DRC, as well as the specific outcomes of their disclosure or nondisclosure. MEDLINE/PubMed, Embase, Web of Science, Global Health, and PsycINFO were searched and research studies were included if: (i) the study discussed disclosure of HIV status; (ii) the study population included HIV-infected people in DRC; and (iii) the study was published in English. Fourteen articles met the inclusion criteria and were included in the study. Factors contributing to nondisclosure were generally associated with high stigma of HIV in adults and concern for emotional wellbeing when disclosing to HIV positive minors. Factors contributing to disclosure among adults were increased social support and religion. In disclosing to HIV positive minors, increasing age and health benefits were identified as approach goals that supported disclosure. The findings highlight the importance of understanding the avoidance and approach goals involved in HIV status disclosure among populations living in the DRC. Interventions and future research directed at increasing HIV disclosure among Congolese PLWHA should move beyond individual-level to consider multilevel factors including circumstantial social behaviors.

"I DIDN'T TELL YOU SOONER BECAUSE I DIDN'T KNOW HOW TO HANDLE IT MYSELF." DEVELOPING A VIRTUAL REALITY PROGRAM TO SUPPORT HIV-STATUS DISCLOSURE DECISIONS

HIV status disclosure is associated with increased sorcial support and protective behaviors against HIV transmission. Yet disclosure poses significant challenges in the face of persistent societal stigma. Few interventions focus on decision-making self-efficacy, and communication skills to support disclosing HIV status to an intimate partner. Virtual reality (VR) and artifcial intelligence (AI) technologies offer poweful tools to address this gap. Informed by Social Cognitive Theory, we created the Tough Talks VR program for HIV-positive young men who have sex with men (YMSM) to practice status disclosure safely and confidentially. Fifty-eight YMSM (ages 18 - 30, 88% HIV-positive) contributed 132 disclosure dialogues to develop the prototype through focus groups, usability testing, and a technical pilot. The prototype includes three disclosure scenarios (neutral, sympathetic, and negative response) and a database of 125 virtual character utterances. Participants select a VR scenario and realistic virtual character with whom to practice. In a pilot test of the fully automated neutral response scenario, the AI system responded appropriately to 71% of participant utterances. Most pilot study participants agreed Tough Talks was easy to use (9/11) and that they would like to use the system frequently (9/11). Tough Talks demonstrates that VR can be used to practice HIV status disclosure and lessons learned from program development offer insights for the use of AI systems for other areas of health and education.

Personal contact with HIV-positive persons is associated with reduced HIV-related stigma: cross-sectional analysis of general population surveys from 26 countries in sub-Saharan Africa

Introduction: HIV-related stigma hampers treatment and prevention efforts worldwide. Effective interventions to counter HIV-related stigma are greatly needed. Although the “contact hypothesis” suggests that personal contact with persons living with HIV (PLHIV) may reduce stigmatizing attitudes in the general population, empirical evidence in support of this hypothesis is lacking. Our aim was to estimate the association between personal contact with PLHIV and HIV-related stigma among the general population of sub-Saharan Africa.

Methods: Social distance and anticipated stigma were operationalized using standard HIV-related stigma questions contained in the Demographic and Health Surveys and AIDS Indicator Surveys of 26 African countries between 2003 and 2008. We fitted multivariable logistic regression models with country-level fixed effects, specifying social distance as the dependent variable and personal contact with PLHIV as the primary explanatory variable of interest.

Results: We analyzed data from 206,717 women and 91,549 men living in 26 sub-Saharan African countries. We estimated a statistically significant negative association between personal contact with PLHIV and desires for social distance (adjusted odds ratio [AOR] = 0.80; p < 0.001; 95% Confidence Interval [CI], 0.73–0.88). In a sensitivity analysis, a similar finding was obtained with a model that used a community-level variable for personal contact with PLHIV (AOR = 0.92; p < 0.001; 95% CI, 0.89–0.95).

Conclusions: Personal contact with PLHIV was associated with reduced desires for social distance among the general population of sub-Saharan Africa. More contact interventions should be developed and tested to reduce the stigma of HIV.

A Systematic Review and Narrative Synthesis of Interventions for Parental Human Immunodeficiency Virus Disclosure

INTRODUCTION

Disclosure of parental human immunodeficiency virus (HIV) infection to their children remains a difficult process for parents living with HIV (PLWH). In order to identify the best strategies to facilitate parental HIV disclosure, it is necessary to examine the efficacy of existing interventions designed to help PLWH parents with the disclosure process to their children.

OBJECTIVES

To systematically review the efficacy of interventions designed to assist PLWH disclose their HIV status to their children.

METHODS

We conducted a systematic review and narrative synthesis of interventions designed to assist PLWH disclose their HIV status to their children. MEDLINE/PubMed, PsycINFO, Embase, Global Health, and Web of Science were searched.

RESULTS

Studies were eligible for inclusion if they evaluated an intervention for parental HIV disclosure. Five studies published between 2001 and 2015 met the inclusion criteria. The interventions were conducted in South Africa, China, and the United States. Three of the studies used two-arm randomized controlled trials, in which the intervention group was given enhanced care while the control group received standard care. Four of the five studies included a theoretically informed intervention and three were limited to mothers. Results showed that four of the interventions increased parental HIV disclosure.

CONCLUSION

The findings suggest that parental HIV disclosure interventions are successful in assisting parents with the disclosure process and can be adapted in different cultural context. Future parental HIV disclosure interventions should include fathers in order to assist men with parental HIV disclosure.

Exploring the HIV continuum of care among young black MSM

BACKGROUND

HIV disproportionately impacts young, black men who have sex with men (YBMSM) who experience disparities across the HIV care continuum. A more nuanced understanding of facilitators and barriers to engagement in care, missed visits, antiretroviral uptake, adherence and viral suppression could improve care and intervention design.

METHODS

A randomized controlled trial of an online intervention, healthMpowerment, enrolled 465 YBMSM (18-30 years); 193 identified as HIV-positive. Bivariable and multivariable analyses of baseline data explored predictors of: engagement in care, missed visits, antiretroviral uptake, self-reported adherence, and viral suppression.

RESULTS

Mean age was 24.9 years; most identified as gay (71.0%) and were receiving HIV care (89.1%). Among those in care, 52.1% reported no missed visits in the past 12 months, 41 (24.6%) reported one missed visit, and 39 (23.4%) reported two or more. Having insurance (prevalence odds ratio [POR] 4.5; 95% CI: 1.3, 15.8) and provider self-efficacy (POR 20.1; 95% CI: 6.1, 64.1) were associated with being in care. Those with a college degree (POR 9.1; 95% CI: 1.9, 45.2) and no recent marijuana (POR 2.6; 95% CI: 1.2, 5.6) or methamphetamine use (POR 5.4; 95% CI: 1.0, 28.5) were less likely to miss visits. Most (n = 153, 84.1%) had been prescribed antiretroviral therapy. A majority of participants (70.8%) reported ≥90% adherence; those with depressive symptoms had 4.7 times the odds of reporting adherence <90% (95% CI: 1.65, 13.37). Of participants who reported viral load testing in the past six months, 65% (n = 102) reported an undetectable viral load. Disclosure to sex partners was associated with viral suppression (POR 6.0; 95% CI: 1.6, 22.4).

CONCLUSIONS

Multi-level facilitators and barriers to engagement across the continuum of care were identified in this sample of YBMSM. Understanding the distinct needs of YBMSM at each stage of the continuum and addressing them through tailored approaches is critical for long term success in care.

HIV Disclosure and Transmission Risks to Sex Partners Among HIV-Positive Men

Disclosure of HIV-positive status to sex partners is critical to protecting uninfected partners. In addition, people living with HIV often risk criminal prosecution when they do not inform sex partners of their HIV status. The current study examined factors associated with nondisclosure of HIV status by men living with HIV in Atlanta, GA (92% African African, mean age = 43.8), who engage in condomless sex with uninfected sex partners. Sexually active HIV-positive men (N = 538) completed daily electronic sexual behavior assessments over the course of 28 days and completed computerized interviews, drug testing, medication adherence assessments, and HIV viral load retrieved from medical records. Results showed that 166 (30%) men had engaged in condomless vaginal or anal intercourse with an HIV-uninfected or unknown HIV status sex partner to whom they had not disclosed their HIV status. Men who engaged in nondisclosed condomless sex were less adherent to their HIV treatment, more likely to have unsuppressed HIV, demonstrated poorer disclosure self-efficacy, enacted fewer risk reduction communication skills, and held more beliefs that people with HIV are less infectious when treated with antiretroviral therapy. We conclude that undisclosed HIV status is common and related to condomless sex with uninfected partners. Men who engage in nondisclosed condomless sex may also be more infectious given their nonadherence and viral load. Interventions are needed in HIV treatment as prevention contexts that attend to disclosure laws and enhance disclosure self-efficacy, improve risk reduction communication skills, and increase understanding of HIV infectiousness.

'When it comes to HIV, that's when you find out the genuinity of that love': The experience of disclosing a HIV+ status to an intimate partner

Despite a medical discourse of the 'normalisation' of HIV, it remains a highly stigmatising condition and makes the issue of disclosing one's HIV status particularly complex. This article reports on the experience of 18 people living with HIV in the United Kingdom of disclosing their HIV+ status in arguably their most important relationship, their intimate partnership. Five main themes arose: disclosure as the battlefield, preparing psychologically to disclose, disclosure as a test of the partner's love, disclosure as an opportunity for the partner to know them more deeply and the renegotiation of the relationship narrative.

Mutual HIV status disclosure is associated with consistent condom use in public sector ART clients in Free State province, South Africa: a short report

Risky sexual behaviour in PLWHA on antiretroviral therapy threatens both prevention and treatment efforts, but disclosure promises to support safer sexual practices. This paper investigates the association between HIV self-disclosure and consistent condom use in a cohort of public sector patients on antiretroviral (ARV) treatment. Using data from the FEATS cohort study, logistic regression analysis shows that knowledge of your partner's HIV status is positively associated with consistent condom use (OR 2.73, 95% CI 1.37-5.43, p = 0.004) and so too mutual HIV disclosure (OR 3.38, 95% CI 1.60-7.18, p = 0.001). Prevention and treatment programmes, through couple HIV counselling and testing (CHCT) and other assistance programmes, should focus on supporting the mutual disclosure of HIV status among PLWHA on ARV treatment.

A qualitative investigation into the HIV disclosure process within an intimate partnership: 'The moment I realized that our relationship was developing into something serious, I just had to tell him'

OBJECTIVES

This study sought to elucidate the process through which people living with HIV (PLWH) in the United Kingdom disclose their status to an intimate partner (IP).

DESIGN

A qualitative cross-sectional survey design was used.

METHOD

A total of 95 PLWH took part. They were presented with a series of open-ended questions enquiring into their last experience of disclosing to an IP. The data were analysed using thematic analysis.

RESULTS

Disclosure became a salient issue when the discloser acknowledged their relationship as meaningful. A decision to tell was mostly made to build a foundation for the evolving relationship. Once the decision was made, it was enacted via one of two mechanisms (self-initiated or opportunistic) and partners' reported reactions fell within one of four main reaction types. In the long-term for couples who remained together, disclosure was understood to have brought them closer. However, for both those whose relationships remained intact, and for those whose relationship had since broken down, sexual difficulties associated with being in a sero-discordant partnership pervaded. At a personal level, the experience resulted in increased confidence in living with the diagnosis, and an increased sense of disclosure mastery.

CONCLUSIONS

Disclosure is a highly nuanced process. In particular, it was found to be largely characterized by the IP relational context in which it was occurring. The clinical and theoretical implications of these findings are discussed. In particular, these findings highlight a need for the provision of long-term support to PLWH in negotiating their relationships throughout the process. Statement of contribution What is already known on this subject? Disclosing a HIV+ status to an intimate partner (IP) is key in addressing the global HIV epidemic, social stigma, and the psychological and physical well-being of people living with the condition. It is increasingly recognized that HIV disclosure is a process, rather than an event. Researchers have begun to initiate a line of research into a process-based theoretical account of disclosure. What does this study add? This study provided a nuanced account of the disclosure process within an IP relationship. The process was found to be largely influenced by the discloser's subjective experience of the intimate partnership. The findings point to a need for a disclosure intervention that supports couples more longitudinally, particularly in negotiating the emotional and sexual difficulties that often arise upon disclosing.

HIV testing, care, and treatment experiences among the steady male partners of female sex workers living with HIV in the Dominican Republic

Male steady partners of female sex workers (FSW) living with human immunodeficiency virus (HIV) represent a key population for treatment as prevention and/or pre-exposure prophylaxis interventions. This study uses data collected from male steady partners who were referred by FSW living with HIV participating in a multi-level HIV prevention and care intervention in Santo Domingo, Dominican Republic. We conducted a socio-behavioral survey and HIV testing with all men (n = 64) and 16 in-depth interviews with a sub-sample to obtain more depth. Thirty-five of the 64 participants were living with HIV; 27 were previously diagnosed and 8 were diagnosed during our study. As a result, 45% of men were members of sero-discordant sexual partnerships. Of men with no previous HIV diagnosis (n = 37), 15 had never been tested for HIV and nine had not been tested in the past two years. Ninety-three percent of men previously diagnosed with HIV reported receiving HIV care in the past 6 months and 78% were taking anti-retrovirals. Low HIV testing was partly due to men not feeling at risk for HIV, despite having an HIV-infected partner. Additionally, a lack of tailored care inhibited engagement in anti-retroviral treatment for those infected. HIV testing was low, highlighting a need for test-and-treat strategies. Men not living with HIV would benefit from regular testing and would be good candidates for pre-exposure prophylaxis. While almost all men who had been diagnosed with HIV were engaged in care and adherent to anti-retroviral therapy, future research should assess whether they are achieving optimal HIV outcomes for their health and prevention of ongoing transmission.