A new study tracks the disclosure habits of HIV-positive men who have sex with men in search of the reasons why a large number of men apparently do not reveal their HIV status to their sexual partners. The report, titled "Don't Ask, Don't Tell: Patterns of HIV Disclosure Among HIV-Positive Men Who Have Sex With Men," was published in the journal Sexually Transmitted Infections. Researchers identified themes as to why MSMs attending STI clinics in Los Angeles and Seattle do or do not disclose their HIV status.
A total of 55 HIV-positive MSMs (24 in Seattle, 31 in Los Angeles) who reported recent STI or unprotected anal intercourse with a partner of unknown or negative serostatus were recruited. Study participants underwent in-depth interviews about their disclosure practices that were tape-recorded, transcribed verbatim, coded, and analyzed for content. The results showed that 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," the researchers reported. "Themes for 'likely to disclose' were feelings for partner, feeling responsible for partner's health, and fearing arrest."
Many reported nonverbal disclosure methods. Some thought partners should ask for HIV status; many assumed if not asked, then their partner must be positive. "HIV-positive MSMs' decision to disclose their HIV status to sex partners is complex," concluded the researchers, "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."