Objectives:
To identify themes around disclosure among MSM in LA and Seattle.

Methods:
55 MSM HIV positive MSM (24 in Seattle, 31 in LA) reporting recent STI or unprotected anal intercourse with serostatus discordant or unknown partners were recruited from STD clinics in Seattle and LA and underwent indepth interviews that were taperecorded, transcribed verbatim, coded and content analyzed for themes using Ethnograph.

Results:
Ages ranged from 24-52 years (mean 39). Mean years since HIV diagnosis was 9 years and 6 years with one-third and one-half diagnosed in the past 5 years in LA and Seattle respectively. Most interviewed in LA (67%) and some (29%) in Seattle were minority. Themes around disclosure include MSM being more likely to disclose when having sex in a home, context of dating, when feelings for a partner, had a previous positive disclosure experience, or feel responsible for transmission. Nondisclosure themes included not being asked about HIV status, not having insertive anal intercourse, having bathhouse sex, anonymous partners, fearing of rejection, overcome by passion, and using methamphetamines. Many minority MSM in LA reported disclosing because of fear of legal prosecution. MSM reported disclosing indirectly by introducing condoms, asking for low risk sex, showing medications, not listing status online, and displaying HIV materials. Some MSM felt partners should ask for HIV status; many assumed if not asked partner must be positive.

Conclusions:
Our findings suggest many HIV positive MSM either do not disclose or disclose HIV status indirectly and engage in high risk sex with partners with unknown serostatus, fueling incidence of STIs/HIV in Seattle and LA. Indirect ways to disclosure may offer promise.