title: "You just can't trust everybody": the impact of sexual risk, partner type and perceived partner trustworthiness on HIV-status disclosure decisions among HIV-positive black gay and bisexual men.
abstract: HIV remains an intractable public health concern in the USA, with infection rates notably concentrated among Black gay and bisexual men. Status disclosure by HIV-positive individuals can be an important aspect of risk reduction but doing so poses dilemmas concerning privacy, stigma and self-protection, especially among populations subjected to multiple types of stigmatisation. Understanding the factors related to the disclosure process can help to inform prevention efforts. Using exploratory in-depth interviews, this qualitative study examines the disclosure process among a sample of twenty HIV-positive Black gay and bisexual men (mean age = 40) recruited through a non-profit health centre in a mid-western city in the USA. Data were analysed using a thematic analysis approach with HIV-disclosure as an a priori sensitising concept. Fears of stigma and secondary disclosure within social networks were critical barriers to talking about HIV with sexual partners and disclosure decisions involved a complex process centred on three primary themes: degree of sexual risk, partner type and perceived partner trustworthiness. The unique combinations of these contextual factors resulted in increased or decreased likelihood of disclosure. A conceptual model explicating a potential process by which these contextual factors influence disclosure decisions is presented.
authors.affiliation: a Department of Social Work , College of Arts and Sciences, Rutgers University-Newark , Newark , USA.
authors.forename: Jason D P
authors.initials: JDP
authors.lastname: Bird
authors.affiliation: a Department of Social Work , College of Arts and Sciences, Rutgers University-Newark , Newark , USA.
authors.forename: Michael
authors.identifier: http://orcid.org/0000-0001-9197-5855
authors.initials: M
authors.lastname: Eversman
authors.affiliation: b School of Social Service Administration , University of Chicago , Chicago , USA.|c School of Social Service Administration , STI/HIV Intervention Network , Chicago , USA.
authors.forename: Dexter R
authors.initials: DR
authors.lastname: Voisin
mesh_terms: D000328:Adult; D001741:Black or African American / Q000523:psychology*; D015658:HIV Infections / Q000517:prevention & control; D006679:HIV Seropositivity / Q000523:psychology*; D018451:Homosexuality, Male / Q000523:psychology*; D006801:Humans; D008297:Male; D012309:Risk-Taking; D012650:Self Disclosure; D012747:Sexual Partners; D000072339:Sexual and Gender Minorities / Q000523:psychology*; D057545:Social Stigma; D035502:Trust; D014481:United States
keywords: Black men; HIV prevention; HIV-related stigma; USA; communication and disclosure; gay and bisexual men