Objectives:
To explore the use and mis-use of HIV status disclosure as a prevention tool among MSM, facilitators and barriers to discussing status, and behavior change after status disclosure.

Methods:
Recently diagnosed HIV+ MSM and MSM who tested HIV- were recruited from Seattle-area public HIV testing sites between 6/02 and 8/03 as part of the ongoing Seattle Area MSM Study. The prevalence of HIV status disclosure was obtained from Audio Computer Administered Self-Interviews (ACASI). Content analysis of qualitative interviews obtained main reasons for and against asking about status and behavior change after status disclosure.

Results:
Eighty-eight participants were included in this analysis, including 28 newly-diagnosed HIV+ and 60 HIVMSM. Median age was 33 and median number of recent sex partners was 5. Sixty-one percent discussed HIV status with their most recent anal sex partner; only 33% knew this partner’s status before sex. According to qualitative interviews, the status information was often distorted and/or ignored by the participant, leading to unprotected sex. Primary barriers to status discussion included sexual desire, lack of communication with anonymous partners, and doubting the veracity of disclosure. Primary facilitators included having the partner initiate discussion, developing a relationship with the partner, and having internal motivation and skills to ask.

Conclusions:
 In this analysis a minority of participants learned of their partners’ HIV statuses before sex. Among many, HIV status disclosure alone was not sufficient to affect sexual risk behaviors.

  slides (.1 MB), web cast