Disclosure of HIV-status to male and female sexual partners by HIV-positive men who have sex with men and women (MSMW)

Background: For MSMW, disclosure of HIV-positive status presents unique problems with male and female sexual partners. A common concern within HIV prevention is that MSMW may not disclose to female partners who may thus be at increased risk for HIV. The present study extends discussion of variation in patterns of disclosure by examining selective disclosure to male and female partners.

Methods: Data were collected on most recent male and/or female primary partner and four most recent casual partners. This produced observations of 150 MSMW (50 African American, 50 Latino, 50 White) who had relationships with 640 partners (32% female; 68% male). Disclosure was coded as nondisclosure, disclosure before protected sex, before unprotected sex, and after unprotected sex. Logistic regression was conducted to evaluate effects of respondent characteristics; internalized homonegativity, disclosure responsibility and self-efficacy; partner characteristics; and HIV disease progression.

Results: In bivariate and multivariate analyses there were no significant differences in odds of disclosure to male and female partners at all levels of the outcome. Disclosure before unprotected sex did vary by other partner characteristics: relationship type and partner's HIV status. Disclosure before protected and unprotected sex was greater to known HIV-positive and HIV-negative partners compared to unknown/untested partners. Stronger gay identification, greater involvement in gay/bisexual community, and decreased homonegativity were associated with greater perceived responsibility to disclose and disclosure before sex.

Conclusion: MSMW disclose to male and female partners at similar rates; however, decisions of whether and when to disclose reflect broader relationship and social contexts and ethical obligations.