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. Author manuscript; available in PMC: 2024 Dec 1.
Published in final edited form as: AIDS Care. 2023 Mar 13;35(12):1982–1997. doi: 10.1080/09540121.2023.2188159

Table 3.

Summaries of the outcome measure and impact of HIV disclosure (quantitative studies)

First Author Outcome variable(s) HIV disclosure measure Associations
Disclosure recipient4 Responses Rate
1. McFall A.M. et al. 2016 Linkage to HIV care was defined as ever visiting a doctor for management of HIV after diagnosis

  1. At least one person

  2. Spouse or primary sex partner

  3. Family member

  1. 77.2%

  2. 68.8%1

  3. 72.1%1

 Among 503 MSM, 87.7% were linked to HIV care. Disclosure of HIV-positive status to at least one person (OR: 2.8; 95%CI: 2.4–6.1) is one of the significant factors affected linkage to care.
2. Hightow-Weidman LB, et al. 2017 1)Engagement in care (participants were asked if they were currently enrolled in or receiving HIV care of any kind); 2) Missed HIV care appointments: (adherence to scheduled medical appointments with HIV care providers over the past 12 months was assessed by self-reported number of missed visits.); 3) ART uptake: participants were asked about current and ever ART use; 4) medication adherence/viral suppression: a VAS was used to assess medication adherence. Viral suppression was provided via self-report for those who reported having had a viral load performed in the past 6 months.

  1. Friends

  2. Family

  3. Sex partners

  1. none vs a few, most or all

  2. none vs a few, most or all

  3. none vs a few, most or all

  1. 14.9% vs 85.1%

  2. 23.2% vs 76.8%

  3. 8.9% vs 91.1%

 Among 193 MSM:

  1. Engagement in care (89.1%) was not significantly associated with disclosure of HIV status to at least one friend (unadjusted POR: 0.62, 95%CI: [0.08, 5.12]; p=0.66), family (unadjusted POR: 1.45, 95%CI: [0.36, 5.91]; p=0.60), and sex partner (unadjusted POR: 1.14, 95%CI: [0.14, 9.69]; p=0.90).

  2. Retention in care (no missed visits:52.2%) was not significantly associated with disclosure of HIV status to at least one friend (unadjusted POR: 1.61, 95%CI: [0.66, 3.95]; p=0.29), family (unadjusted POR: 1.20, 95%CI: [0.56, 2.58]; p=0.63), and sex partner (unadjusted POR: 0.81, 95%CI: [0.25, 2.68]; p=0.73).

  3. 84.4% had been prescribed ART. Disclosure of HIV status to at least one friend (unadjusted POR: 0.20, 95%CI: [0.03, 1.52]; p=0.12), family (unadjusted POR: 1.98, 95%CI: [0.80, 4.88]; p=0.14), and sex partner (unadjusted POR: 0.83 [0.18, 3.90]; p=0.81) were all not significantly associated with ART uptake.

  4. 65% reported undetectable viral load. Disclosure of HIV status to at least one friend (unadjusted POR: 0.57, 95%CI: [0.20, 1.66]; p=0.30) and family (unadjusted POR: 0.86, 95%CI: [0.37, 2.00]; p=0.73) were not significantly associated with self-reported viral suppression, while disclosure to at least one sex partner was associated with higher likelihood of viral suppression (adjusted POR 6.03; 95%CI: [1.62, 22.40]; p=0.01).
3. Anderson K, et al. 2018 Engagement in HIV care (currently engaging in HIV care), ART initiation, and ART adherence Any sexual partners “Yes”, “No” or “I have not had a sexual partner since my diagnosis” 73.6% reporting they had disclosed, and only 6.0% reporting having no partner since receiving their HIV diagnosis Among 2350 MSM:
80.0% were engaged in HIV care, 71% initiated ART, and among those, 37% reported missing at least one dose in the past month. Disclosure of HIV status to a partner was associated with a greater odds of HIV care engagement (aOR = 1.63, 95% CI 1.31, 2.03) and ART initiation (aOR = 1.58, 95% CI 1.37, 1.81).
4. Wohl A.R. et al. 2011 Retention in HIV care, defined as two or more primary care visits in the 6 months before the study interview. Social network numbers who were relatives, friends, providers, and others Yes vs No 85.7% (including both MSM and female) disclosed their HIV status to at least one network member. Among the overall sample (198 MSM and 200 female), the mean number of network members to whom HIV status was disclosed was significantly higher among those who were retained in care compared to those not retained in consistent HIV care (t=3.52; p=0.0005). Among the overall sample, disclosure of HIV status to more network numbers (OR=1.5, 95%CI: 1.1–1.9) is one of the predictors of retention in care. Among MSM subgroup (n=198), 73.2% (145/198) were retained in care; 160 disclosed HIV status to social networkers, with 78/100 Latino MSM and 82/98 African American MSM. The number of network members to whom HIV status was disclosed was not associated with retention in care for both Latino MSM and African American MSM. No aOR was reported, so could not be included in the meta-analysis.
5. Elopre L. et al. 2015 Retention in HIV care, defined as a gap in care >180 days during the 12 months following initial entry into HIV care. 5-level disclosure:

  1. self-reported disclosure to no one

  2. disclose to partners/spouses/significant others (SO) only

  3. disclose to family only

  4. disclose to friends only

  5. disclose to more than one group

 3-level disclosure:

  1. non-disclosure

  2. selectively HIV disclosure (only disclose to one person/group [i.e., to family only, friends only, or significant other/partner/spouse only])

  3. broad disclosure (disclose HIV status to more than one group) (referent)

  1. non-disclosure: 13.3%

  2. partners/spouses/SO only: 9.0%

  3. family only: 17.3%

  4. friends only: 22.7%

  5. more than one group: 37.8%

  6. selective disclosure: 49%

  7. broad disclosure: 38%

 2 30.9% (508/1645) eligible patients-initiated HIV care for the first time. Nondisclosure was twice as likely to have poor retention in care (AOR: 2.1; 95%CI: 1.1, 4.1) compared to persons who reported broad disclosure. Comparing to broad disclosure, disclosure to spouse/partners/significant other (AOR: 0.6, 95%CI: 0.3, 1.6); family only (AOR: 1.2, 95%CI: 0.6, 2.2); and friends only (AOR: 0.9, 95%CI: 0.5, 1.6) were all not significantly associated with poor retention in care; but the relationship between nondisclosure and poor retention in care remained (AOR: 2.2; 95%CI: 1.2, 4.3).
6. Kuhn E, et al. 2016 Viral load strategy (VLS), which rates HIV-positive patients unlikely to transmit HIV by unprotected sexual intercourse if viral load under effective ART Serounknown sex partners Yes vs. No

  1. 85% non-disclose to serounknown sex partners

  2. 66.7% VLS group conceal HIV status to anonymous sex partners

  3. 28.3% non-VLS group conceal HIV status to anonymous sex partners

 68% (185/269) were having undetectable viral load under ART. Participants who are using VLS were less likely to reveal their HIV status to sex partners (p=0.023). Regarding the serocommunication on anonymous settings, 66.7% participants using VLS vs 28.3% of the reference group reported principally conceal their HIV status to anonymous sex partners (P=0.051).
7. Daskalopoulou M, et al. 2017 Viral load non-suppression was defined as clinic-recorded VL>50 copies/ml among those who had started ART at least 6 months prior to VL measure

  1. anyone apart from healthcare staff

  2. confidant(s): friends, family, work colleagues, stable partner

  3. to what extent: none, some, most/all

  1. Overall: no one vs. at least one person

  2. a combined variable (disclosure to friends and family) was defined with three categories: none, some, most or all

  3. Yes vs. No to stable partner

  4. None, some, or most or all to work colleagues

  1. 5.0% non-disclosure to anyone

  2. 85.8% disclose to some/all friends

  3. 59.9% disclose to some/all family

  4. 4.9% non-disclose to a stable partner

  5. 45.8% disclose to some/all colleagues

  6. 95.1% disclose to stable partner/spouse

 3 86.6% of participants had suppressed viral load. MSM were more likely to disclose to some/all friends compared to family (85.8% vs 59.9%). There was no evidence that non-disclosure overall (versus disclosure to anyone) was associated with ART non-adherence or VL non-suppression (PR: 1.5, 95%CI: 0.8, 2.7) among MSM; disclosure to friends and family was also not associated with viral suppression (none vs some: PR: 1.0, 95%CI: 0.6, 1.7; most or all vs. none: PR: 1.3, 95%CI: 0.9, 2.0);
8. Klitzman R, et al. 2007 Being on ART and undetectable viral load were mentioned, but not as main outcomes, also no specific definition.

  1. Any sexual partners

  2. Main partner

  3. Casual partner

 Yes/No

  1. 46% disclosed to all partners;

  2. 87.7% disclosed to main partner;

  3. Among men with casual partners, 41.8% disclosed to all, 36.7% to some and 21.5% to no partners.

 76.7% were on HAART and 59% reported an undetectable viral load. Being on HAART, viral load and number of symptoms were not associated with disclosure. (No ORs were reported)
9. Tiamiyu AB, et al. 2020 Being prescribed ART and Viral load <50 copies/ml

  1. Male sexual partners (MSP)

  2. Female sexual partners (FSP)

  1. Yes, all (fe)male sexual partners

  2. Yes, some but not all (fe)male sexual partners

  3. no, none In the analysis, disclosure was dichotomized as disclosure to “some/all partners” or “none”

  1. 1.31.0% disclosed to some or all MSP;

  2. 2.15.3% disclosed to some or all FSP

 Compared to those who had not disclosed their HIV status to MSP, participants who had disclosed were more likely to be prescribed ART (58.8% vs 40.0%, p<0.001) and to have viral load <50 copies/ml (47.7% vs 24.7%, p<0.001).
Participants who had disclosed their status to FSP were more likely to be prescribed ART (61.8% vs 43.1%, p=0.013). There were no statistically significant differences between participants who had and had not disclosed their HIV status to FSP in terms of viral suppression (32.4% vs 29.3%, p=0.350).
After adjusting for other factors, HIV status disclosure to MSP was more likely among participants who were virally suppressed (RR: 1.67, 95%CI: 1.24–2.25; p<0.001). HIV status disclosure to FSP was more likely among participants who were prescribed ART (RR:2.27, 95%CI: 1.07–4.83; p=0.033)
10.Simon Rosser BR, et al. 2008 Viral load Secondary sexual partner(s) regardless of the partner’s HIV status

  1. none (0%)

  2. Some (1–99% of partners)

  3. All (100%)

 30% reported disclosing to none; 31% to some; 39% to all. Greater disclosure was associated with detectable viral load (Adjusted OR: 1.85; 95%CI: 1.21, 2.85)
11.Stoelb BL. 2006 CD4 counts, viral load Immediate social network, defined as a participant’s spouse/partner, child/children, mother, father, siblings, and close friends Total number of individuals to whom one has disclosed, Yes/No 2.5% not having had disclosed to anyone; 25.9% disclosed to 100% of their immediate social network The quadratic relationship between percent of serostatus disclosure was not significantly related to viral load (β=−.53, F change=1.42; p=0.24). Regression analyses revealed that neither the linear nor the quadratic relationships between the number of network members told and the viral load were statistically significant. (No ORs were reported)
12. Wei C, et al. 2010 Viral load (Undetectable, detectable, Don’t know/unsure) Sexual partners

  1. None, Some or All

  2. Dichotomized in the analysis: None vs Some/All

 Prevalence of non-disclosure: 88.1% in China, 74.4% in Japan, 69.4% in Singapore, 66.7% in Taiwan and Thailand, 60.0% in Indonesia, 58.7% in Malaysia, 56.8% in Hong Kong, 47.1% in Philippines In multivariable analysis, HIV disclosure was not associated with detectable viral load (AOR: 0.99, 95%CI: 0.51, 1.93).
13. Zhao Y, et al., 2022 Timely linkage to care, defined as the duration of the time from participants’ HIV diagnosis date to their first date of accessing the hospital to initiate ART less than one month Sexual partner

  1. Yes

  2. No

 19.84% chose “Yes”, 80.16% chose “No” Disclosure of HIV status to the sexual partner were positively related to timely linkage to care (β = 0.22, SE = 0.08) (No ORs were reported)
1

This proportion based on both MSM and PWID who already disclosed their HIV status. The OR value for this study is from the pooled sample of both MSM and drug users.

2

The associations were analyzed based on the overall sample (including 307 MSM, 109 men who have sex with women and 92 female who had sex with men), rather than only MSM.

3

The percentage was analyzed based on the overall sample (including 2240 MSM, 367 heterosexual men and 626 women).

4

All the studies did not report HIV disclosure process (e.g., active or passive disclosure) except the dissertation conducted by Stoelb BL. However, HIV disclosure process information were not included in the quantitative analysis in this study.