Examining the Role of Serostatus Disclosure on Unprotected Sex Among People Living with HIV

Abstract

Given the increasing prevalence of HIV, it is important to identify factors associated with safer sex behaviors between people living with HIV and their partners. Utilizing a diverse sample of 242 HIV-infected adults [n = 69 men who have sex with men (MSM); n = 68 men who have sex with women (MSW); n = 105 women who have sex with men (WSM)], we examined the association between serostatus disclosure and unprotected anal or vaginal intercourse (UAVI) and the moderating effect of sexual behavior group on this association. Overall, 88.7% disclosed to their current partner. Approximately 18.8% of MSM, 17.7% of MSW, and 29.5% of WSM reported UAVI. Controlling for age, time since diagnosis, and partner serostatus, we found main effects on UAVI for disclosure and sexual behavior group; specifically, disclosure was inversely related to unprotected sex [AOR = 0.09, 95% CI (0.02, 0.43), p < 0.001], and MSM were less likely to engage in UAVI relative to WSM [AOR = 0.11, 95% CI (0.17, 0.82), p < 0.05]. However, the relationship between disclosure and UAVI was not moderated by sexual behavior group. Future strategies that aim to increase disclosure to partners may consider focusing on its value as a means by which to reduce sexual risk behavior.

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

“…7 However, the factors that influence HIV status disclosure to sex partners are evolving, as HIV treatments are now used for HIV prevention and people may be informed that condoms are not necessary for preventing HIV transmission if they have undetected HIV in their blood plasma. 8 In a diverse sample of men and women living with HIV, Przybyla et al 9 found that 88% had disclosed their HIV status to their current partner and disclosure was inversely related to engaging in condomless intercourse. 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.…”

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

“…Disclosure of HIV status to sexual partners has been considered an integral part of HIV prevention; it is theorised that disclosure is associated with increased condom use or adoption of seroadaptive practices, hence reducing HIV transmission risk (Marks & Crepaz, 2001;O'Connell, Reed, & Serovich, 2015;Serovich, Reed, O'Connell, & Laschober, 2018). However, it remains unclear whether increases in the prevalence of disclosure to sexual partners overall have any effect on reducing the prevalence of condomless sex (CLS) (Conserve, Groves, & Maman, 2015;Hirsch Allen et al, 2014;Przybyla et al, 2014;Wilson et al, 2016).…”

“…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).…”

Effectiveness of Interventions Promoting HIV Serostatus Disclosure to Sexual Partners: A Systematic Review

“…Based on recent studies, rates of HIV sero-status disclosure to sexual partners range from 97 % in South Africa [24], 89 % in the United States [25], 86 % in Brazil [26] to 73 % in Canada [27], and 39 % in Haiti [28]. The characteristics contributing to low rates of disclosure to sexual partners in some regions of the world have been found to be related to shorter length of time since HIV diagnosis, HIV-related stigma, having multiple sexual partners, partners of HIV negative or unknown status, not receiving antiretroviral treatment, emotional distress, low disclosure self-efficacy, and unemployment due to HIV status [22, 28-33].…”