title: It's not just what you say: relationships of HIV dislosure and risk reduction among MSM in the post-HAART era.
abstract: In the post-HAART era, critical questions arise as to what factors affect disclosure decisions and how these decisions are associated with factors such as high-risk behaviors and partner variables. We interviewed 1,828 HIV-positive men who have sex with men (MSM), of whom 46% disclosed to all partners. Among men with casual partners, 41.8% disclosed to all of these partners and 21.5% to none. Disclosure was associated with relationship type, perceived partner HIV status and sexual behaviors. Overall, 36.5% of respondents had unprotected anal sex (UAS) with partners of negative/unknown HIV status. Of those with only casual partners, 80.4% had >1 act of UAS and 58% of these did not disclose to all partners. This 58% were more likely to self-identify as gay (versus bisexual), be aware of their status for <5 years and have more partners. Being on HAART, viral load and number of symptoms were not associated with disclosure. This study - the largest conducted to date of disclosure among MSM and one of the few conducted post-HAART - indicates that almost 1/5th reported UAS with casual partners without disclosure, highlighting a public health challenge. Disclosure needs to be addressed in the context of relationship type, partner status and broader risk-reduction strategies.
authors.affiliation: HIV Center for Clinical and Behavioral Studies, NY State Psychiatric Institute, Columbia University, New York, New York, USA. rlk2@columbia.edu
authors.forename: R
authors.initials: R
authors.lastname: Klitzman
authors.forename: T
authors.initials: T
authors.lastname: Exner
authors.forename: J
authors.initials: J
authors.lastname: Correale
authors.forename: S B
authors.initials: SB
authors.lastname: Kirshenbaum
authors.forename: R
authors.initials: R
authors.lastname: Remien
authors.forename: A A
authors.initials: AA
authors.lastname: Ehrhardt
authors.forename: M
authors.initials: M
authors.lastname: Lightfoot
authors.forename: S L
authors.initials: SL
authors.lastname: Catz
authors.forename: L S
authors.initials: LS
authors.lastname: Weinhardt
authors.forename: M O
authors.initials: MO
authors.lastname: Johnson
authors.forename: S F
authors.initials: SF
authors.lastname: Morin
authors.forename: M J
authors.initials: MJ
authors.lastname: Rotheram-Borus
authors.forename: J A
authors.initials: JA
authors.lastname: Kelly
authors.forename: E
authors.initials: E
authors.lastname: Charlebois
mesh_terms: D001294:Attitude to Health; D015658:HIV Infections / Q000517:prevention & control / Q000523:psychology / Q000635:transmission*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D012650:Self Disclosure; D012747:Sexual Partners / Q000523:psychology*; D014342:Truth Disclosure; D047568:Unsafe Sex / Q000517:prevention & control*