HIV serostatus disclosure is not associated with safer sexual behavior among HIV-positive men who have sex with men (MSM) and their partners at risk for infection in Bangkok, Thailand

Abstract

BackgroundThe relationship between HIV serostatus disclosure and sexual risk behavior is inconsistent across studies. As men who have sex with men (MSM) are emerging as the key affected population in Bangkok, Thailand with reported HIV prevalence of 30%, we assessed whether HIV disclosure is associated with protected sex in this population.MethodsA risk behavior questionnaire was administered using Audio Computer-Assisted Self-Interviewing (ACASI) to determine whether HIV serostatus disclosure was associated with protected sex in 200 HIV-positive MSM in Bangkok. HIV serostatus disclosure to the most recent sexual partner prior to or at the time of the sexual encounter was assessed. Protected sex was defined as insertive or receptive anal intercourse with a condom at the most recent sexual encounter.ResultsThe mean age was 30.2 years, CD4 was 353 cells/mm3, and one-third was on antiretroviral therapy. At the most recent sexual encounter, HIV serostatus disclosure rate was low (26%); 60.5% of subjects had not discussed their serostatus at all, while 5.5% had not revealed their true serostatus. Seventeen percent reported unprotected anal intercourse and about half had sex with their primary partners. The serostatus of the most recent sexual partner was HIV-positive in 19.2%, HIV-negative in 26.4%, and unknown in 54.4% of subjects. There was no association between disclosure and protected sex, with 41 of 48 (85.4%) disclosers and 104 of 126 (82.5%) of non-disclosers reported protected sex (p = .65). Subjects with HIV-positive partners were less likely to report protected sex overall (20 of 33, 60.6%) compared to those with HIV negative (82 of 96, 85.4%) or unknown (41 of 45, 91.1%) partners (p = .001). Age (27-32 years vs. ≤26 years, p = .008), primary partner status (p < .001), and HIV-positive serostatus of sexual partner (p < .001) were significantly associated with disclosure in the multivariate analyses.ConclusionRates of HIV disclosure to sexual partners by HIV-positive MSM in Bangkok are low. Despite low rates of HIV serostatus disclosure, most HIV-positive MSM reported protected sex with their partners at risk for infection. Future studies should focus on understanding barriers to disclosure and factors driving risk behavior amongst MSM in Thailand.

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

“…The model also included a set of potential confounding variables (age, time since HIV diagnosis, and partner HIV serostatus) selected based on their associations with both HIV serostatus disclosure and unprotected sex in previous studies. 26,37,43,46,47 We followed the strategy of testing the global hypothesis of no interaction first. If interactions were present, the plan was to use the predicted probabilities to examine the disclosure effect by sexual behavior groups.…”

“…41 Other studies, however, found no association between disclosure and condom use. [42][43][44] Although the body of literature attempting to understand the relationship between serostatus disclosure and unprotected sex among PLHIV is growing, it has been common for studies to focus exclusively on specific behavioral risk groups, such as MSM or bisexual men, or to make direct comparisons between genders by combining MSM and MSW and comparing them collectively to women. Study designs that combine sexual behavior groups may miss important between-group differences that can aid in development of effective interventions targeting unique behaviors within and among these three groups.…”

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

“…8,[11][12][13][14][15] However, studies examining the association between age, and HIV disclosure and self-efficacy, especially among US populations are lacking. In addition, very few studies focus on older MSM populations, who are a vulnerable group.…”

“…15 Age has also been shown to be associated with selfefficacy for condom use among people with substance use disorders in Taiwan, 16 among midlife and older women in San Diego, California, 10 and among MSM who seek sex partners from the internet in a national US study. 17 One study of Italian residents found that compared to adults aged 18-49, adults aged 60-75 reported lower scores on perceived behavioral control, the way in which individuals perceive their ability in condom use.…”

“…24 Nevertheless, a few studies have also found no association or negative associations between disclosure and safer sex behavior. 2,15 Low self-efficacy has also been linked to risky behavior, such as missed HIV primary care visits, 25 inconsistent condom use 16 and needle-sharing. 16 Examining outcomes such as the disclosure of HIV serostatus and self-efficacy are crucial for MSM populations.…”