May 29, 2003 -- Most HIV-positive people tell their sexual partners about their infection, but new research shows a disturbing number of people don't ask and don't tell when it comes to HIV status. The study found 13% of HIV-positive adults fail to disclose their status before engaging in unprotected vaginal or anal intercourse.
Researchers say the study shows that sexual contact without disclosure of HIV status is relatively common among persons living with HIV, and the rates of non-disclosure vary greatly among different groups. For example, 42% of gay or bisexual men said they had sexual contact without disclosure, compared with 19% of heterosexual men and 17% of all women who reported nondisclosure with their nonexclusive sexual partners.
But the study also found that for gay and bisexual men, the type of relationship they were in greatly affected the likelihood of disclosure of their HIV-positive status to their sexual partners. Those who had a primary sexual partner that they considered to be their primary relationship were very likely to have disclosed their HIV-positive status to their partner. Most of the sex without disclosure occurred in nonexclusive sexual relationships.
"Our results suggest that many HIV-infected gay and bisexual men tailor their sexual activity to reduce the risk that they will transmit HIV to casual partners to whom they do not disclose," says researcher David E. Kanouse, PhD, a senior behavioral scientist at RAND Health, in a news release. "Public health messages have urged all gay men to 'act as if every partner is HIV-positive.' Such measures may have had the unintended consequence of making disclosure seem optional and non-disclosure acceptable in some encounters."
Since 1991, some states have made willful unprotected sex without disclosure a criminal offense.
The study, which appears in the June issue of the American Journal of Public Health, involved a national sample of 606 gay and bisexual men, 287 heterosexual men, and 504 heterosexual women who were all HIV-positive and asked them about their sexual activity and disclosure practices over the last six months.
Researchers say the rates of sexual contact without disclosure of HIV-positive status found in the sample translates to 43,500 gay or bisexual men, 8,000 heterosexual men, and 7,500 women nationwide, all infected with HIV, who are engaging in sex without informing their partner of their HIV-positive status.
"While the vast majority of HIV-positive individuals either abstain, disclose, or attempt to minimize risk, the worrisome number of HIV-positive people, both gay and straight, who 'don't tell' and who 'aren't asked' engaging in risky behavior, does call for new approaches," says researcher Daniel H. Ciccarone, MD, MPH, assistant professor of family and community medicine at the University of California, San Francisco, in a news release.
"The most effective mechanisms are likely to be through promoting community norms that robustly say 'do ask, do tell,'" says Ciccarone.
In addition, researchers say that because rates of HIV are higher among the homosexual community, some HIV-positive individuals may assume that sexual partners are aware of the risk of HIV transmission even if they don't disclose their HIV status.
"Barriers to disclosure of HIV status, such as stigma and fears of rejection, discrimination, and violence persist and efforts to address the problem of non-disclosure are likely to fail unless they speak to these very personal concerns," says Ciccarone.