Sex Without Disclosure of Positive HIV Serostatus in a U.S. Probability Sample of Persons Receiving Medical Care for HIV Infection
It is difficult to identify a more charged issue in AIDS prevention than that of nondisclosure of positive HIV status to sexual partners. As of 1999, 31 states had statutes making sexual contact without disclosure a criminal offense. Public health researchers, responding to data reporting sexual contact without disclosure by HIV-positive persons, have called for interventions to promote increased sexual responsibility and to increase rates of consistent safer sex among HIV-positive persons.
In the current study, researchers report data from the Risk and Prevention Study subset of the nationally representative probability sample of the HIV Cost and Services Utilization Study (HCSUS). The authors estimated the proportion of HIV-positive adults who have any sexual contact without disclosure and the proportion of their sexual partnerships that involve unprotected sex without disclosure.
HCSUS participants were age 18 or older with known HIV infection who made at least one visit to a nonmilitary, nonprison medical provider other than an emergency department in the contiguous United States during the first two months of 1996. The Risk and Prevention Study subset from HCSUS participated in a second follow-up interview, conducted August 1997 through January 1998. Researchers drew 1,794 individuals from this group, sampling randomly after stratifying by primary HCSUS sampling unit, type of health care provider, age, ethnicity, and self-described sexual orientation. The subsample was weighted to represent a target population of 197,063 HIV-positive adults receiving medical care in the 48 contiguous states in 1996 and surviving until 1998. Interviews assessed disclosure and sexual activities with up to five recent partners for the six months before the interview date.
Abstinence rates for women, gay or bisexual men, and heterosexual men, were fairly high and were significantly higher among heterosexual men than among gay or bisexual men. Forty-two percent of gay or bisexual men reported any sex without disclosure, compared with 19 percent of heterosexual men and 17 percent of women. Among gay or bisexual men, most sex without disclosure occurred within nonexclusive partnerships, whereas the rates of nondisclosure within exclusive partnerships were relatively low. Heterosexual men and women nondisclosers were equally likely to be in either type of partnership. Thirty-five percent of gay or bisexual men reported any sex without disclosure in a nonexclusive partnership, compared with 9 percent of heterosexual men and 9 percent of heterosexual women.
Approximately half of the sexually active gay or bisexual men (58 percent), heterosexual men (46 percent), and women (47 percent) had any serodiscordant sexual partnerships. There were no statistically significant differences between the risk groups overall. Among gay or bisexual men who had discordant partnerships, nearly all unprotected anal and vaginal sex without disclosure occurred in nonexclusive partnerships. Five percent of women reported not disclosing their HIV-positive status in serodiscordant exclusive partnerships, compared with 1 percent to 2 percent of all men. Across risk groups, most unprotected sex without disclosure in serodiscordant partnerships appeared to involve mutual nondisclosure (i.e., with a partner of unknown HIV serostatus). Of the 13.8 percent of serodiscordant gay or bisexual partnerships in which there was unprotected sex without disclosure, more than three-quarters (10.9 percent of all) involved nonexclusive partners whose HIV status was unknown, as opposed to partners known to be HIV negative. The percentage of partnerships in which unprotected sex occurred without disclosure was similar in serodiscordant and seroconcordant partnerships. No significant differences were found across risk groups.
"The results of this study indicate that sex without disclosure of HIV status is relatively common among persons living with HIV," researchers concluded. Prevention interventions "should focus on specific relationships and contexts in which disclosure is most likely to affect behavior. Further analyses of sexual risk, HIV-positive status, and disclosure among HIV-positive persons has the potential to make such interventions more effective," the authors wrote.