Too many still fail to tell sex partners of serostatus

National study shows major problem

An analysis of disclosure of HIV status, taken from the HIV Cost and Services Utilization Study, shows that many HIV-infected people fail to tell sexual partners about their status.

The study of HIV-infected people showed that 42% of men who have sex with men (MSM), 19% of heterosexual men, and 17% of women reported having had sex without disclosure of their serostatus. A total of 13% of partnerships in which one person is HIV-positive involved unprotected anal or vaginal sex without disclosure.1

"We confirmed what a lot of smaller studies on disclosure have found," says Daniel Ciccarone, MD, MPH, assistant professor of family and community medicine and anthropology, history, and social medicine at the University of California - San Francisco.

"There is sex occurring prior to disclosures between HIV-positive people and their partners," Ciccarone says.

On a positive note, most HIV-positive people receiving care are abstinent or having sex with disclosure, Ciccarone says.

When researchers further analyzed the percentage of MSM who reported a fairly high rate of nondisclosure prior to having sexual contact, they found that much of that sex was what the gay community considers lower-risk sex, such as oral sex, protected sex, and receptive sex, meaning the HIV-positive person received the anal sex, Ciccarone says.

"The context is important, because disclosure is really only a concern from a public health point of view," Ciccarone says. "Someone might say it’s a moral problem, but we’re mostly interested in disclosure that potentially leads to HIV transmission."

Too often, HIV-positive people are having sex with partners who don’t ask for their status and don’t disclose their own.

"One of the curious findings in the study is that within serodiscordant situations, many gay men have sex with someone whose status they don’t know," Ciccarone says. "This is mutual nondisclosure."

Across a large sample of gay and heterosexual HIV-positive men and women, the data showed that 13% reported having sex prior to disclosure, Ciccarone says.

Another new study notes that there is an increasing trend of high-risk sexual behavior among MSM, and investigators conclude that prevention messages should address disclosure of HIV serostatus.2

The study found that 12.7% of MSM surveyed through interviews at gay-oriented venues in San Francisco and in gay neighborhoods reported having had unprotected anal intercourse with at least two sex partners who were potentially sero-discordant.

Likewise, a study involving MSM in South Beach, a neighborhood in Miami Beach, FL, found that 15% of unmarried MSM ages 18 to 29 tested positive for HIV antibodies. Forty-five percent of those surveyed reported engaging in unprotected anal sex within the past 12 months, and 31% reported unprotected anal intercourse with a non-primary partner.3

This is where public health messages should focus, continuing to stress condom use and safer sex while also emphasizing the importance of disclosing one’s HIV status to a sexual partner, Ciccarone says.

For instance, Ciccarone says, Seattle has conducted a prevention campaign with posters showing two men wrestling while clothed. The caption reads, "Ask and Tell," and "Ask for your partner’s serostatus, and tell yours"

"If someone had not designed that campaign, I would have suggested it," he adds.

References

1. Ciccarone DH, Canoes DE, Collins RL, et al. Sex without disclosure of positive HIV serostatus in the US: Probability sample of persons receiving medical care for HIV infection. Am J Pub Health 2003; 93:949-954.

2. Chen SY, Gibson S, Weed D, McFarland W. Unprotected anal intercourse between potentially HIV-serodiscordant men who have sex with men, San Francisco. JAIDS 2003; 33:166-170.

3. Webster RD, Darrow WW, Paul JP, et al. HIV infection and associated risks among young men who have sex with men in a Florida resort community. JAIDS 2003; 33:223-231.