Skip to main content
NCBI home page
Sexually Transmitted Infections logoLink to Sexually Transmitted Infections
. 2004 Dec;80(6):512–517. doi: 10.1136/sti.2004.010918

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

P Gorbach 1, J Galea 1, B Amani 1, A Shin 1, C Celum 1, P Kerndt 1, M Golden 1
PMCID: PMC1744943  PMID: 15572626

Abstract

Objectives: 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.

Full Text

The Full Text of this article is available as a PDF (79.6 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Ciccarone Daniel H., Kanouse David E., Collins Rebecca L., Miu Angela, Chen James L., Morton Sally C., Stall Ron. Sex without disclosure of positive HIV serostatus in a US probability sample of persons receiving medical care for HIV infection. Am J Public Health. 2003 Jun;93(6):949–954. doi: 10.2105/ajph.93.6.949. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Galvin Shannon R., Cohen Myron S. The role of sexually transmitted diseases in HIV transmission. Nat Rev Microbiol. 2004 Jan;2(1):33–42. doi: 10.1038/nrmicro794. [DOI] [PubMed] [Google Scholar]
  3. Janssen R. S., Holtgrave D. R., Valdiserri R. O., Shepherd M., Gayle H. D., De Cock K. M. The Serostatus Approach to Fighting the HIV Epidemic: prevention strategies for infected individuals. Am J Public Health. 2001 Jul;91(7):1019–1024. doi: 10.2105/ajph.91.7.1019. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Kalichman S. C., Rompa D., Cage M., DiFonzo K., Simpson D., Austin J., Luke W., Buckles J., Kyomugisha F., Benotsch E. Effectiveness of an intervention to reduce HIV transmission risks in HIV-positive people. Am J Prev Med. 2001 Aug;21(2):84–92. doi: 10.1016/s0749-3797(01)00324-5. [DOI] [PubMed] [Google Scholar]
  5. Marks G., Crepaz N. HIV-positive men's sexual practices in the context of self-disclosure of HIV status. J Acquir Immune Defic Syndr. 2001 May 1;27(1):79–85. doi: 10.1097/00126334-200105010-00013. [DOI] [PubMed] [Google Scholar]
  6. Molitor F., Truax S. R., Ruiz J. D., Sun R. K. Association of methamphetamine use during sex with risky sexual behaviors and HIV infection among non-injection drug users. West J Med. 1998 Feb;168(2):93–97. [PMC free article] [PubMed] [Google Scholar]
  7. Purcell D. W., Parsons J. T., Halkitis P. N., Mizuno Y., Woods W. J. Substance use and sexual transmission risk behavior of HIV-positive men who have sex with men. J Subst Abuse. 2001;13(1-2):185–200. doi: 10.1016/s0899-3289(01)00072-4. [DOI] [PubMed] [Google Scholar]
  8. Quinn T. C., Wawer M. J., Sewankambo N., Serwadda D., Li C., Wabwire-Mangen F., Meehan M. O., Lutalo T., Gray R. H. Viral load and heterosexual transmission of human immunodeficiency virus type 1. Rakai Project Study Group. N Engl J Med. 2000 Mar 30;342(13):921–929. doi: 10.1056/NEJM200003303421303. [DOI] [PubMed] [Google Scholar]
  9. Reback Cathy J., Larkins Sherry, Shoptaw Steven. Changes in the meaning of sexual risk behaviors among gay and bisexual male methamphetamine abusers before and after drug treatment. AIDS Behav. 2004 Mar;8(1):87–98. doi: 10.1023/b:aibe.0000017528.39338.75. [DOI] [PubMed] [Google Scholar]
  10. Serovich Julianne M., Mosack Katie E. Reasons for HIV disclosure or nondisclosure to casual sexual partners. AIDS Educ Prev. 2003 Feb;15(1):70–80. doi: 10.1521/aeap.15.1.70.23846. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Sheon Nicolas, Crosby Michael G. Ambivalent tales of HIV disclosure in San Francisco. Soc Sci Med. 2004 Jun;58(11):2105–2118. doi: 10.1016/j.socscimed.2003.08.026. [DOI] [PubMed] [Google Scholar]
  12. Van de Ven P., Kippax S., Crawford J., Rawstorne P., Prestage G., Grulich A., Murphy D. In a minority of gay men, sexual risk practice indicates strategic positioning for perceived risk reduction rather than unbridled sex. AIDS Care. 2002 Aug;14(4):471–480. doi: 10.1080/09540120208629666. [DOI] [PubMed] [Google Scholar]
  13. Varghese Beens, Maher Julie E., Peterman Thomas A., Branson Bernard M., Steketee Richard W. Reducing the risk of sexual HIV transmission: quantifying the per-act risk for HIV on the basis of choice of partner, sex act, and condom use. Sex Transm Dis. 2002 Jan;29(1):38–43. doi: 10.1097/00007435-200201000-00007. [DOI] [PubMed] [Google Scholar]
  14. Wasserheit J. N. HIV infection and other STDs: so close and yet so far. Sex Transm Dis. 1999 Nov;26(10):549–550. doi: 10.1097/00007435-199911000-00001. [DOI] [PubMed] [Google Scholar]
  15. Wolitski R. J., Rietmeijer C. A., Goldbaum G. M., Wilson R. M. HIV serostatus disclosure among gay and bisexual men in four American cities: general patterns and relation to sexual practices. AIDS Care. 1998 Oct;10(5):599–610. doi: 10.1080/09540129848451. [DOI] [PubMed] [Google Scholar]
  16. Zea María Cecilia, Reisen Carol A., Poppen Paul J., Díaz Rafael M. Asking and telling: communication about HIV status among Latino HIV-positive gay men. AIDS Behav. 2003 Jun;7(2):143–152. doi: 10.1023/a:1023994207984. [DOI] [PubMed] [Google Scholar]

Articles from Sexually Transmitted Infections are provided here courtesy of BMJ Publishing Group

RESOURCES