Self-disclosure of HIV diagnosis to sexual partners by heterosexual and bisexual men: Vera Paiva I ; Aluisio C.
In interviews, we investigated disclosure of serostatus to partners, correlating disclosure to characteristics of relationships. Fear of rejection led to isolation and distress, thus hindering disclosure to current and new partners.
Heterosexual caracteristicas requires trust and was more frequent to steady partners, to partners who were HIV-positive themselves, to female partners, and by heterosexuals, occurring less frequently with commercial sex workers. Most interviewees reported consistent condom use. Unprotected sex was more frequent with seropositive partners. Suggestions to enhance comprehensive care for HIV-positive men included stigma management, group activities, and human rights-based approaches involving professional education in care for sexual health, disclosure, and care of "persons living with HIV".
A maioria usava preservativos consistentemente, embora menos frequentemente com parceiros soropositivos. Disclosure of HIV-positive serostatus has been defined as a process of communicating potentially stigmatizing information that had previously been kept hidden in order to increase one's psychological well-being, and in the case of disclosure to sexual partners, to preserve the quality of relationships.
Disclosure is thus not a simple act. It involves careful consideration of "to whom" and "when" and depends on preparation and a personal decision. When people discover they are HIV-infected, many isolate themselves due to fear of rejection and abandonment, when they think of disclosing their serostatus 1,2,3,4. Studies on the issue with samples of persons living with HIV in countries of the Americas, Europe, and Asia with access to treatment have indicated that one's HIV diagnosis decreases stress and isolation, Heterosexual caracteristicas social support, and favors adaptation to medication intake and negotiation of safer sex in various inter-subjective contexts, with an impact on controlling the spread of the epidemic.
Meanwhile, the combined stigmas associated with HIV homophobia, sexism, and racism increase the difficulties "Heterosexual caracteristicas" self-disclosure 5,6. Persons also tend to disclose their status more readily with steady and regular sexual partners, in the context of longer-lasting and marital relations, than to persons with whom they have casual encounters; for people living with HIV, having sex without disclosing one's diagnosis to partners is common 7.
In their study, those that adopted this way of disclosing their felt that veiled messages met the moral imperative of communicating seropositive status; others considered such approaches morally unacceptable, a half-lie. In contexts of anonymous or casual sex heterosexual or homosexualsilencing on seropositive status was viewed as more acceptable; speaking about infection in these situations was perceived as anti-erotic.
On the other hand, more lasting relationships assume or require trust in order to be establish, and non-disclosure could perpetuate mistrust; meanwhile, disclosure to one partner could help build the confidence what would tend to stimulate disclosure to others.
The few Brazilian studies on this theme that include men discuss disclosure of the diagnosis "to" persons with HIV, rarely "by" persons living with HIV to significant others, even though they recognize that this question has an important impact on health and quality of life 9, This article describes the disclosure of HIV diagnosis in the context of the affective and sexual lives of heterosexual and bisexual men living with HIV and discusses how health services could contribute to this process.
The study was conducted in two stages, according to a design that has been presented elsewhere 6,11,12, The principal outcome for this study was the patient's report of having disclosed his seropositive status to sexual partners men and women. The study included patients in good health condition, 18 years old or older, and who reported having sexual contact with women. Considering that experiences with disclosure of seropositive status can occur differently in distinct groups of men living with HIV, a disaggregated data analysis was conducted according to self-reported skin color and sexual behavior.
As proposed in studies on the impact of racism in healthcare in Brazil 14for the "skin color" variable, "blacks" were defined as the sum of self-identified "blacks" and "browns", and "non-blacks" were defined as the sum of whites, Asian-descendents, and indigenous. Based on reported sexual practices, bisexual was defined as a man who reported having had sexual relations with another man anytime in his life, besides sexual relations with women.
In addition, we aimed at characterizing the sexual life of the men included in Heterosexual caracteristicas study, on the assumption that disclosure of seropositive status Heterosexual caracteristicas be Heterosexual caracteristicas with variables related to their sexual partnerships. We thus asked interviewees to list the persons with whom they had had sexual relations in the six months prior to the interview. Next, for each listed partner, the interviewees specified: For purposes of analysis, we defined "main partner" as the partner female or male listed first by the interviewee.
Heterosexual caracteristicas comparison of the target variables extracted from the answers to the questionnaire between the various groups blacks, non-blacks; homosexuals, bisexualswe used the chi-square test using For the second stage of the study, we invited all the interviewees who at the end of the interview had shown interest in participating in group activities. The chosen themes included: The number of participants in the four sessions organized in a focus group format varied from 14 to 18 men.
All the meetings were Heterosexual caracteristicas by a psychologist, assisted by two members of the research team, and lasted approximately two hours each, were taped and transcribed. In this article we analyze the recordings of the 4 th session group, in which the issue Heterosexual caracteristicas disclosure of HIV diagnosis emerged, and in which 14 men participated.
The analysis sought to explore lines of meaning, practical significance, values and feelings related to disclosure of Heterosexual caracteristicas diagnosis to sexual partners. The interviewees' responses to the open questions on their affective-sexual life after disclosing their seropositive status were also analyzed, after the responses Heterosexual caracteristicas the open questions were categorized by two evaluators The study design and informed consent process guaranteed confidentiality in data processing and were approved by the Institutional Review Boards of the two participating centers.
A more in-depth "Heterosexual caracteristicas" of adaption process in the affective and sexual life as a person living with HIV carriers is essential for contextualizing the dilemmas involved in disclosing their diagnosis to sexual partners.
We found important differences in this experience when comparing bisexual and heterosexual men. Table 1 shows the distribution of study subjects by age, income, work situation, schooling, marital status, number of children, and religion.
The mean time since the last homosexual contact was 4 years median 2 years. There was difference in the proportion of bisexuals between blacks and non-blacks.
The comparison between heterosexuals and bisexuals showed differences.
Among heterosexuals, there were likely to be unemployed and fewer had formal jobs with signed work papers. As for HIV infection, time since diagnosis varied from 1 month to 17 Heterosexual caracteristicas mean 5. A high proportion of interviewees Sexuality and its relationship to disclosure of diagnosis.
Table 2 summarizes the data for all the women and men that were listed by the sexually active interviewees as their sexual partners in the six months prior to the interview and about whom the "Heterosexual caracteristicas" provided data. These characteristics, discussed next, were well-represented in relations with the persons chosen as the "main partner". Disclosure and condom use with the main partner. We found no differences between interviewees in the disclosure of seropositive status to the main partner when comparing different age groups, schooling, religion, or blacks and non-blacks data not shown.
Comparing those that disclosed their serostatus to the main partner versus those that did not Table 3the proportion of interviewees that disclosed their diagnosis was higher in the case of female partners or partners that were also HIV-positive.
There was also a significant difference in the frequency of disclosure as a function of the type of relationship with the partner more with steady partners and condom use during anal sex. Importantly, seven men failed to disclose their HIV-positive status and were not using condoms: Meanwhile, the proportion of safer sex with the main partner was quite high, both for vaginal sex Difficulties in disclosing the diagnosis to male and female partners and condom use were explored in the open questions, the source of the quotes below.
Twenty male interviewees reported varying degrees of difficulty in starting Heterosexual caracteristicas new relationship because of the need to reveal their HIV status.
Last week I met a woman, and when I was putting the condom on she asked why. I Heterosexual caracteristicas everything and she accepted me " Participant U. Meanwhile, some preferred to strengthen the emotional link first and reveal one's diagnosis later.