Ethnic Differences in HIV Disclosure and HIV Transmission Risk

Background: African-American Men who have Sex with Men (MSM) are less likely to disclose their MSM sexual behavior than are Whites. Less is known about disclosure of sero-status from HIV-infected MSM to their sex partners, and the relation of sero-status disclosure to HIV transmission risk.

Methods: These interview data are from the Treatment Advocacy Program (N=317), a behavioral intervention clinical trial among HIV+ MSM (White 47%, African-American 32%, Hispanic 17%). We related sero-status disclosure to HIV+, HIV-negative, or HIV-unknown status partners to HIV transmission risk: unprotected anal sex with HIV-negative/unknown partners.

Results: African-Americans were significantly less likely than Whites to disclose their sero-status to HIV+, HIV-negative, or HIV-unknown partners, X²s = (1, n=224) = 12.8, 24.9, 3.9, ps <.05. Although African-Americans were generally less likely to disclose, disclosure to their HIV+ or HIV-negative partners was associated with less transmission risk (rs= -.21 & -.29, ps<.05), whereas disclosure to HIV-unknown partners was unrelated to risk. In contrast, Whites' disclosure to HIV+ and HIV- partners was unrelated to risk; while disclosure to HIV-unknown partners was negatively related to risk (r=-.19, p=.03).

Conclusions: Sero-status disclosure by known HIV-infected MSM had mixed effects on risk. African-Americans were less likely to disclose their status, yet were safer with HIV-negative partners when they did disclose. White MSM showed an alternate pattern, suggesting cultural differences in the threshold and implications of sero-status disclosure by HIV+ men, implying that interventions targeting disclosure must consider ethnic differences.