Disclosing A Positive HIV Diagnosis:

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Disclosing A Positive HIV Diagnosis

• Experiences of Young Adult
• Men Who Have Sex with Men
• David J. Reyes, MN, MPH, RN
• APHA 131st Annual Meeting
• November 19, 2003

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Disclosing A Positive HIV Diagnosis

• this is my truth now
• its a beautiful part of who I am.
• -- Tom

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Healthy People 2010 Companion Document for
Lesbian, Gay, Bisexual Transgender Health

• To prevent HIV associated illnesses
• To increase access to quality, culturally
  competent health care services, support groups
  for young adults with HIV.
• - HP 2010 Companion Document for LGBT Health,
  2001

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Study Purpose

• To describe the experiences of young adult MSM
  who have disclosed their positive HIV status to
  sex partners
• To explore the significance of telling sex
  partners and others about being HIV positive

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Study Participants

• Four young adult MSM, 22-29 years-old who had
  disclosed their positive HIV status to at least
  one male sex partner in person, were recruited
  from community-based organizations, health
  clinics and social service agencies.

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Methodology

• An exploratory methodology using semi-structured
  interview techniques was employed to identify
  salient patterns and themes associated with
  disclosing a positive HIV diagnosis.
• A self-administered demographic survey was also
  used to identify demographic characteristics and
  behavioral risks factors.

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Analysis

• Three representative case studies were developed
  from participant interviews demographic surveys
• Inductive methods were used to identify major
  codes, categories and themes associated with
  disclosing a positive HIV status to sex partners
  and others.

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Study Findings

• Two major themes emerged
• Transcendence
• Contingent Disclosure

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Transcendence

• CONSCIOUS -

• I never viewed HIV as something that defined
  meits inside me but it isnt meit just happens
  to be in me(Ed)

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Transcendence

• FOCUS -

• That ties in a lot with what Im trying to do
  for myself right now in recovery. You know,
  coming to believe in or coming to understand more
  about that part of me that wants to be honest and
  open about things(Jack)

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Contingent Disclosure

• CONSCIENCE -

• sex is something that you share between two
  people. Theres a lot more to it.when you talk
  about things that will be exchanged during the
  act you gotta be honest (Ed).

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Contingent Disclosure

• MOTIVE -

• it all comes from your motive.Is your motive
  just to go out and have a few moments of
  whatever?...But you should tell them (Tom).

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Contingent Disclosure

• SITUATION -

• I never initially start out telling them.
  Simply because my experience with relationships
  with potential partners or sex partners, most of
  them dont last more than a few days, if thatbut
  people Im potentially interested with, I want
  them to know me first because if I bring that up
  to attention right away thats defining me (Ed).

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Contingent Disclosure

• MOTIVE
• SITUATION
• CONSCIOUS

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Framework for Contingent Disclosure

• CONSCIENCE

• SITUATION

Disclosure
Non-Disclosure

• MOTIVE

• CONSCIENCE

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Implications for Healthcare Workers

• Challenge own assumptions about people living
  with HIV
• Develop a framework of continuous cultural
  competence relative to own values
• Assist people with HIV to identify own assets
  resources to cope with HIV
• Coach nurture people with HIV to develop sense
  of purpose self-esteem

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Implications for Research

• Further exploration of the disclosure process
  inclusive of the complex psychological pressures,
  social influences, and moral principles
• Evaluation research of HIV counseling and testing
  programs
• Examining social networks and other support
  systems necessary to cope with a positive HIV
  diagnosis

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Implications for Research

• Determining readiness efficacy of the HIV
  positive person to disclose HIV status
• Evaluating barriers to disclosure for the HIV
  positive person relative to the intended outcome
  of disclosure
• Examining the differences and similarities
  between disclosure of HIV status and other
  significant life-altering health events in order
  to compare and identify successful coping
  strategies.

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Conclusions

• Contracting HIV and the impacts associated with
  it represent a significant-life altering event.
• Disclosure of a positive HIV diagnosis is fraught
  with competing and conflicting interests and
  motivations.
• It is a decision that impacts both the discloser
  and the intended recipient, and can be harmful
  physically and emotionally.
• For the men in this study, disclosure was a
  positive means of finding purpose to life through
  a process of conscious introspection,
  self-reconciliation, positive action, and frame
  of mind.

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support comes from the power within and thats
kind of where I get most of my strengthits
always there for me(Tom).