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HIV disclosure rates
higher for gay men than Africans in London
19 Mar 2008- London, England-
The overwhelming majority of gay men and Africans with HIV in London
have disclosed their HIV status to at least one other person, according
to a study published in the April 1st edition of the
Journal of Acquired Immune Deficiency Syndromes. However, the
investigators found that patterns of disclosure varied significantly
between gay men and Africans, with African men and women having lower
levels of disclosure overall and also being less likely to disclose to
their current partner, family, friends, employer or work colleagues.
Disclosure of HIV status can have both benefits and risks. The benefits
include increased support and access to services, and there is even
some evidence that people who are open about their HIV status have
higher CD4 cell counts. But on the down side, disclosure can have
risks, including potential discrimination, and loss of support.
Legal issues around disclosure have changed in the UK in recent years.
In 2005 the Disability Discrimination Act was amended to provide
important protections to people with HIV. But to access these legal
benefits it is necessary for disclosure of HIV status to have taken
place. There have also been a number of convictions for the “reckless”
transmission of HIV. In all these cases the convicted individual did not
disclose their HIV infection to their sexual partner.
Despite these changes there is limited information on HIV disclosure in
the UK. Investigators from the City University in London designed a
study to find out the extent of disclosure amongst people with HIV, to
whom they disclosed, and the role of ethnicity in disclosure.
Between 2004 and 2005 a total of 1687 individuals attending HIV
outpatient clinics in north east London submitted questionnaires. As
nearly all HIV-positive patients in the UK access HIV care from
specialist NHS services the sample was broadly representative of
HIV-positive patients in the UK. The investigators restricted their
analysis to gay men and African women and African heterosexual men. The
numbers of patients from other groups were too small for analysis.
Overall levels of disclosure
Most patients (88%) had told at least one other person about their HIV
status. White gay men were the group most likely to have told at least
one person (95%) and African heterosexual men the least likely (77%).
The investigators found that African men and women were significantly
less likely to disclose to at least one person than gay men of any
ethnicity (p < 0.001).
Disclosure to partners
Of the patients who were in a relationship, 86% of white gay men and 85%
of ethnic minority gay men had disclosed to their partner. This
contrasted to 65% of African men and 60% of African women who had told
their partner that they had HIV. Once again, the differences in levels
of disclosure between gay men and heterosexual Africans was
statistically significant (p < 0.001).
Of the 46 white gay men who had not disclosed to their partner, six
reported unprotected sex with their partner in the previous three
months. One partner was reported to be HIV-negative. Of the eight ethnic
minority gay men who had not disclosed to their partner, two reported
unprotected sex with their partner. A total of 52 heterosexual African
men had not disclosed and five reported unprotected sex with their
partner, with one partner being HIV-negative. And of the 108 black
heterosexual women who had not disclosed, 17 said they had had
unprotected sex with their partner, with three of these partners being
HIV-negative and nine of unknown HIV status. The investigators’ analysis
showed that African heterosexual men and women were significantly more
likely than gay men to report unprotected sex with a partner who was
HIV-negative or of unknown HIV status to whom they had not disclosed (p
< 0.01).
Disclosure to family
White gay men were also more likely to have disclosed to at least one of
their parents (42%) than ethnic minority gay men (19%), African
heterosexual men (16%) and African heterosexual women (19%) (p < 0.001).
Factors associated with disclosure to parents included being unemployed,
number of years since diagnosis with HIV, younger age, and having
experienced HIV-related discrimination.
Gay men overall were also more likely to have disclosed to a sibling
than heterosexual African men and women (p < 0.05). Of the individuals
with children a third of gay men, 20% of African heterosexual women and
10% of African heterosexual men had disclosed their HIV status to some
or all of them. The difference between white gay men and these other
groups was statistically significant (p < 0.001).
Disclosure to friends
More white gay men (81%) had disclosed to friends than minority gay men
(67%) and African heterosexual men (22%) and women (31%). The
investigators believe that migration could be an explanation for the low
levels of disclosure amongst Africans.
Disclosure at work
Of the patients in employment, only 22% had told their employer that
they were HIV-positive. Once gain, levels of disclosure were higher
amongst white gay men (33%) than ethic minority gay men (16%) and
African heterosexual men and women (10%) (p < 0.001). These findings
were broadly similar when the investigators stratified them according to
security of immigration status.
White gay men were also more likely to have disclosed to their
colleagues than other groups (p < 0.001).
“Our investigation highlights the continuing challenge of HIV disclosure
presents, particularly for black heterosexual men and women living in
the UK, a group that reports high levels of HIV-related stigma and
discrimination”, comment the investigators.
Reference
Elford J et al. Disclosure of HIV status. The
role of ethnicity among people living with HIV in London.
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