Disclosure and Self-Efficacy Among HIV-Positive Men Who Have Sex with Men: A Comparison Between Older and Younger Adults

Abstract

Men who have sex with men (MSM) continue to be disproportionately affected by HIV in the US. HIV among older adults also continues to be an important public health problem. Age is associated with disclosure of HIV serostatus and self-efficacy for condom use. However, studies examining self-efficacy and disclosure among older MSM (age 50 and older) living with HIV are lacking. The aim of this study was to assess the associations between being 50 and older, and disclosure behaviors, intentions and attitudes, and self-efficacy for condom use, disclosure, and negotiation for safer sex practices among HIV-positive MSM. Data were gathered from 340 participants at the baseline assessment of a longitudinal disclosure intervention study. Linear regression was used to determine the association between being older (age 50 and older) and disclosure behaviors, intentions and attitudes, and selfefficacy for condom use, disclosure, and negotiation for safer sex practices. After adjusting for time since diagnosis and number of sexual partners, MSM aged 50 and older scored lower in disclosure behavior (b = -7.49; 95% CI: -14.8, -0.18) and in self-efficacy for negotiation of safer sex practices (b = -0.80; 95% CI: -1.57, -0.04) compared to MSM 18-34 years. Intervention and prevention programs should endeavor to improve disclosure and self-efficacy for negotiating safer sex practices among older HIV-positive MSM. More health care providers should initiate sexual health discussions, especially among older HIV-positive MSM populations, which may help to improve their disclosure behavior and self-efficacy for negotiating safer sex practices.

HIV Disclosure and Transmission Risks to Sex Partners Among HIV-Positive Men

“…10 In addition, beliefs that sex is safer as a result of ART and HIV suppression were also associated with nondisclosure. Results from the multivariable model showed that these three factors, disclosure self-efficacy, risk reduction communication skills, and infectiousness beliefs, independently contribute to condomless sex in the context of nondisclosure to nonconcordant sex partners.…”

“…That is, greater disclosure of HIV status was associated with practicing safer sexual behaviors and this was true across subgroups of men who have sex with men, men who have sex with women, and women who have sex with men. In another recent study, Brown et al 10 reported that among men who have sex with men, older men (age 50 and older) were less likely to disclose their HIV status than younger men and older men were less self-efficacious in their perceived ability to disclose.…”

Attitudes to disclosure of HIV-serostatus to new sexual partners and sexual behaviours among HIV-diagnosed gay, bisexual and other men who have sex with men in the UK

“…Since the introduction of widespread antiretroviral therapy (ART), evidence on the association between non-disclosure and condom use among HIV-diagnosed MSM has been mixed; certain studies found that nondisclosure was associated with higher prevalence of condomless sex or condomless sex with HIV-serodifferent partners (CLS-D) (Cook, Valera, & Wilson, 2015;Hirsch Allen et al, 2014;Klitzman et al, 2007;Morin et al, 2005;Parsons et al, 2005;Simon Rosser et al, 2008;Wilson et al, 2016), others found no evidence of an association (Kalichman, DiMarco, Austin, Luke, & DiFonzo, 2003;Marks & Crepaz, 2001;Poppen, Reisen, Zea, Bianchi, & Echeverry, 2005;Przybyla et al, 2014;Simoni & Pantalone, 2004;van Kesteren, Hospers, van Empelen, van Breukelen, & Kok, 2007), while some reported that non-disclosure was linked to condom-protected sex (Abler et al, 2015;Klitzman et al, 2007;Serovich et al, 2018;Simon Rosser et al, 2008). Studies that examined levels of disclosure to sexual partners showed that those who disclose to some partners tend to report higher levels of condomless sex compared to those who disclose to none or most/all partners (Abler et al, 2015;Brown, Serovich, Kimberly, & Umasabor-Bubu, 2015;Durham et al, 2013;Parsons et al, 2005;Simon Rosser et al, 2008). Only two studies from the UK (2008-09) (Elford, Ibrahim, Bukutu, & Anderson, 2008;Fox et al, 2009) showed prevalence estimates of disclosure to sexual partners, but none examined associations between disclosure and condomless sex.…”

Vengeance, Condomless Sex and HIV Disclosure Among Men Who Have Sex with Men Living with HIV

“…Simple and multiple linear regression models were used to determine the association between vengeance and disclosure behavior, attitudes and intention scores. Prior research has shown that age tends to have positive [15] and negative [16, 17] associations with HIV disclosure depending on how age is operationalized [16]. Age [4, 7] and knowing source of infection [7] have been shown to be associated with vengeance.…”