Disclosure of HIV/AIDS to Partners, Family, and Friends in the Black Community in North Philadelphia

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Haverford College. Independent College Programs
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Black Americans comprise 12% of the population in the United States, yet 49% of Americans infected with HIV are Black. Many of these individuals struggle with disclosing their HIV-status to partners, family, friends, and others. However, disclosure of HIV/AIDS to partners is important in HIV prevention and treatment promotion, which aims to decrease risky behaviors (e.g. unprotected sex) and provide testing, prevention counseling, and treatment to partners who may be infected with HIV. The benefits of disclosure include increased social support, increased intimacy, improved sexual function, a feeling of acceptance and security, an improved self-image, and relief from the guilt and stress that many experience by not disclosing their status and possibly infecting their partners. Disclosure also provides access to better information and education, governmental programs and assistance, and increased utilization of health care services. Therefore, an important step in helping people who have been infected is to encourage them to fully disclose their HIV-status. The potential negative consequences of disclosure include rejection, abandonment, social stigmatization, a loss of support, a loss of intimacy, a loss of privacy, and in some cases physical, emotional, and sexual abuse. Thus, despite the benefits, the decision whether or not to disclose is a complex one, based on multiple factors. This thesis extends the existing literature on disclosure to partners through analyses of quantitative and qualitative data collected from a sample of 121 patients to determine correlates of disclosure and reasons for and against disclosure. In the single variable analysis, female patients (OR=2.393, p=0.043), those younger than 50 years (OR=0.378, p=0.027), and those with current sexual partners (OR=3.192, p=0.004) were more likely to disclose their HIV-status. Other predictors included knowledge of partner’s HIV-status (OR=22.881, p<0.001) and disclosure to non-partners (OR=7.486, p<0.001). However, in the multivariable analysis, gender (OR=1.778, p=0.418) and having a current partner (OR=2.153, p=0.194) became less significant, and disclosure to non-partners was significant at the 90% confidence level (OR=4.083, p=0.085). Individuals younger than 50 years of age were still significantly more likely to disclose (OR=0.221, p=0.038), and knowledge of a partner’s HIV-status was strongly correlated with disclosure (OR=23.647, p<0.001). The most common reason why patients disclosed their status was a sense of moral obligation or personal responsibility. The most common reason for not disclosing was fear of rejection. Interested in the correlation between disclosure to partners and disclosure to non-partners, I performed qualitative interviews with seventeen of these patients to look at the relationship between disclosure to partners and disclosure to family and friends, and found that disclosure is highly dependent on the nature of the partnership and the support system. Furthermore, I conclude that patients with stronger support systems may not be more likely to disclose their HIV-status; disclosure does not necessarily increase condom use; the issue of disclosure is really about giving the partner of an HIV-positive person an informed choice; disclosure may not play a major role in preventing new HIV infections. Strategies to increase disclosure rates must address the widespread stigma that still surrounds HIV/AIDS, and effective HIV prevention strategies must address the underlying inequalities, which are driving the HIV/AIDS epidemic.