Although there is evidence of
increasing overall rates of HIV status disclosure among gay and bisexual men,
little is known about men's disclosure expectations and practices.
In this
study, we investigate the importance non-HIV-positive men in Australia vest in
knowing the HIV status of their sexual partners, and the extent to which they
restrict sex to partners of the same HIV status, and their HIV disclosure
expectations. Data were collected through a national, online self-report
survey.
Of the 1044 men included in the study, 914 were HIV negative and 130
were untested. Participants completed the assessment of socio-demographic
characteristics, HIV status preferences, and disclosure expectations and
practices. Participants also completed reliable multi-item measures of
perceived risk of HIV transmission, expressed HIV-related stigma, and
engagement with the gay community and the community of people living with HIV.
- A quarter (25.9%) of participants wanted to know the HIV status of all sexual partners, and
- one-third (37.2%) restricted sex to partners of similar HIV status.
- Three quarters (76.3%) expected HIV-positive partners to disclosure their HIV status before sex, compared to 41.6% who expected HIV-negative men to disclose their HIV status.
- Less than half (41.7%) of participants reported that they consistently disclosed their HIV status to sexual partners.
These findings suggest that an HIV-status divide is emerging or already exists
among gay men in Australia. HIV-negative and untested men who are most likely
to sexually exclude HIV-positive men are less connected to the HIV epidemic and
less educated about HIV risk and prevention.
Expectations of disclosure, consistent self-disclosure, and of serostatus preferences.
| Mean (SD) | Agree (%) | |
|---|---|---|
| I only have sex with someone whose HIV status I know | 2.54 (1.42) | 25.9 |
| I only have sex with someone whose HIV status is similar to mine | 2.88 (1.51) | 37.2 |
| I'd expect an HIV+ man to tell me he was HIV+ before we had sex | 4.13 (1.29) | 76.3 |
| I'd expect an HIV- man to tell me he was HIV- before we had sex | 3.14 (1.48) | 41.6 |
| I always tell my sex partner what my HIV status is before we have sex | 3.11 (1.54) | 41.7 |
In this study, we found a number of factors to be associated
with expecting disclosure from HIV-positive men. Multivariate analyses showed
that HIV-negative and untested men who expected HIV-positive men to disclose
their HIV status were more likely to live outside capital cities, were less
likely to have a university education, perceived greater risk of HIV
transmission from a range of sexual practices, expressed more HIV-related
stigma, and were less engaged with the community of PLHIV. We found that HIV-negative
and untested men who expected their HIV-negative sex partners to disclose their
HIV status were more likely to live outside capital cities, less likely to have
a university education, and perceived greater risk of HIV transmission from a
range of sexual practices. Consistent self-disclosure of their HIV status among
these HIV-negative and untested men was also associated with living outside
capital cities and perceiving greater risk of HIV transmission from a range of
sexual practices, as well as with a lower number of sexual partners in the past
year.
Perceiving greater risk of HIV transmission from
engaging in a range of sexual practices with an HIV-positive partner whose
viral load is unknown was independently associated with disclosure expectations
for HIV-positive and HIV-negative men, as well as with consistent
self-disclosure. This association between HIV status disclosure expectations
and practices and perceived risk suggests a strong association between concern
about HIV and identifying and avoiding potential sexual partners who are HIV
positive. The association between expectations of HIV-positive status
disclosure and both greater HIV-related stigma and less engagement with the
community of PLHIV, suggests broad social exclusion and provides further
evidence of a serostatus divide among gay men.
These findings of high expectations of
HIV-positive men to disclose, and strong preferences among some men to exclude
HIV-positive men as sex partners indicate the paradox of disclosure for
HIV-positive men. They are expected to disclose their HIV status, and yet doing
so may result in being rejected as a potential partner. Also, although the
dramatic increases in disclosure of HIV status to sex partners documented over
the past decade may have been influenced by the increasing adoption of
risk-reduction strategies such as serosorting, our findings provide evidence of
high expectations to disclose HIV-positive status in general. These findings
also suggest, as we have argued elsewhere, that HIV-related stigma is a
continuing issue among gay men, especially in the area of sex and relationships
(de Wit et al., 2013). Such stigmatizing
practices may also have a negative effect on current strategies that encourage
men to undertake more frequent HIV testing.
Full article at: http://goo.gl/4E1uAw
By:
aCentre for Social Research in Health, UNSW,
Sydney, Australia
bNational Drug Research Institute, Curtin
University, Melbourne, Australia
cDepartment of Social and Organizational
Psychology, Utrecht University, Utrecht, The Netherlands
dAustralian Federation of AIDS
Organisations, Sydney, Australia
* Corresponding author. Email: ua.ude.wsnu@yhprum.d
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