title: Don't ask, don't tell: patterns of HIV disclosure among HIV positive men who have sex with men with recent STI practising high risk behaviour in Los Angeles and Seattle.
abstract: OBJECTIVE
  A high incidence of HIV continues among men who have sex with men (MSM) in industrialised nations and research indicates many MSM do not disclose their HIV status to sex partners. Themes as to why MSM attending sexually transmitted infection (STI) clinics in Los Angeles and Seattle do and do not disclose their HIV status are identified.
  
  
  METHODS
  55 HIV positive MSM (24 in Seattle, 31 in Los Angeles) reporting recent STI or unprotected anal intercourse with a serostatus negative or unknown partner from STI clinics underwent in-depth interviews about their disclosure practices that were tape recorded, transcribed verbatim, coded, and content analysed.
  
  
  RESULTS
  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. Themes for "possible disclosure" were type of sex practised and partners asking/disclosing first. 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.
  
  
  CONCLUSIONS
  HIV positive MSM's decision to disclose their HIV status to sex partners is complex, 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.
authors.affiliation: Department of Epidemiology, School of Public Health, Box 951772, University of California Los Angeles, Los Angeles, CA 900095-1772, USA. pgorbach@ucla.edu
authors.forename: P M
authors.initials: PM
authors.lastname: Gorbach
authors.forename: J T
authors.initials: JT
authors.lastname: Galea
authors.forename: B
authors.initials: B
authors.lastname: Amani
authors.forename: A
authors.initials: A
authors.lastname: Shin
authors.forename: C
authors.initials: C
authors.lastname: Celum
authors.forename: P
authors.initials: P
authors.lastname: Kerndt
authors.forename: M R
authors.initials: MR
authors.lastname: Golden
mesh_terms: D000328:Adult; D001294:Attitude to Health; D004644:Emotions; D005239:Fear; D015658:HIV Infections / Q000453:epidemiology / Q000523:psychology*; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D007398:Interpersonal Relations; D015141:Los Angeles / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012650:Self Disclosure; D012747:Sexual Partners; D012941:Social Responsibility; D014342:Truth Disclosure; D047568:Unsafe Sex; D019562:Viral Load; D014861:Washington / Q000453:epidemiology