Depression and HIV Serostatus Disclosure to Sexual Partners Among Newly HIV-Diagnosed Men Who Have Sex with Men

Abstract

HIV disclosure to sexual partners facilitates joint decision-making and risk reduction strategies for safer sex behaviors, but disclosure may be impacted by depression symptoms. Disclosure is also associated with disclosure self-efficacy, which in turn may also be influenced by depressive symptoms. This study examined the relationship between depression and HIV disclosure to partners following diagnosis among men who have sex with men (MSM), mediated by disclosure self-efficacy. Newly HIV-diagnosed MSM (n = 92) who reported sexual activity after diagnosis completed an assessment soon after diagnosis which measured depressive symptoms, and another assessment within 3 months of diagnosis that measured disclosure self-efficacy and disclosure. Over one-third of the sample reported elevated depressive symptoms soon after diagnosis and equal proportions (one-third each) disclosed to none, some, or all partners in the 3 months after diagnosis. Depressive symptoms were negatively associated with disclosure self-efficacy and disclosure to partners, while disclosure self-efficacy was positively associated with disclosure. Disclosure self-efficacy partially mediated the relationship between depression and disclosure, accounting for 33% of the total effect. These findings highlight the importance of addressing depression that follows diagnosis to enhance subsequent disclosure to sexual partners.

HIV Disclosure and Transmission Risks to Sex Partners Among HIV-Positive Men

“…These findings are consistent with previous studies that have identified factors associated with nondisclosure of HIV, which include poor retention in care and depression. 37,38 Over the course of 28 days, men recorded 1412 days during which they engaged in condomless vaginal and anal intercourse, of which half involved nonconcordant partners. As shown in the results among men with nondisclosed nonconcordant partners, 541 of the 819 days (66%) in which they recorded sexual activity were with nonconcordant partners.…”

Attitudes to disclosure of HIV-serostatus to new sexual partners and sexual behaviours among HIV-diagnosed gay, bisexual and other men who have sex with men in the UK

“…Since the introduction of widespread antiretroviral therapy (ART), evidence on the association between non-disclosure and condom use among HIV-diagnosed MSM has been mixed; certain studies found that nondisclosure was associated with higher prevalence of condomless sex or condomless sex with HIV-serodifferent partners (CLS-D) (Cook, Valera, & Wilson, 2015;Hirsch Allen et al, 2014;Klitzman et al, 2007;Morin et al, 2005;Parsons et al, 2005;Simon Rosser et al, 2008;Wilson et al, 2016), others found no evidence of an association (Kalichman, DiMarco, Austin, Luke, & DiFonzo, 2003;Marks & Crepaz, 2001;Poppen, Reisen, Zea, Bianchi, & Echeverry, 2005;Przybyla et al, 2014;Simoni & Pantalone, 2004;van Kesteren, Hospers, van Empelen, van Breukelen, & Kok, 2007), while some reported that non-disclosure was linked to condom-protected sex (Abler et al, 2015;Klitzman et al, 2007;Serovich et al, 2018;Simon Rosser et al, 2008). Studies that examined levels of disclosure to sexual partners showed that those who disclose to some partners tend to report higher levels of condomless sex compared to those who disclose to none or most/all partners (Abler et al, 2015;Brown, Serovich, Kimberly, & Umasabor-Bubu, 2015;Durham et al, 2013;Parsons et al, 2005;Simon Rosser et al, 2008). Only two studies from the UK (2008-09) (Elford, Ibrahim, Bukutu, & Anderson, 2008;Fox et al, 2009) showed prevalence estimates of disclosure to sexual partners, but none examined associations between disclosure and condomless sex.…”

HIV serostatus knowledge and serostatus disclosure with the most recent anal intercourse partner in a European MSM sample recruited in 13 cities: results from the Sialon-II study

“…A substantial body of literature on the enabling and hindering factors for HIV status disclosure between MSM has been published, identifying the following factors associated with disclosure of HIV serostatus: disclosure is more likely between steady partners compared to non-steady partners; and for non-steady partners, disclosure depends on the setting where the partners have met. HIV positive status disclosure is negatively associated with perceived HIV-related stigma, depressive symptoms, and increasing age (if older than 50 years) [ 4 , 9 – 18 ].…”