Same-Sex Behavior Disclosure and HIV Prevention among African American Men who have Sex with Men
Sun, Christina J
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Disclosure of same-sex behaviors to health care providers and female sex partners has the potential of being an important aspect of HIV prevention among men who have sex with men (MSM). Disclosure to health care providers is associated with increased HIV testing; and to female sex partners, condom use. However, very little is known about disclosure and the factors that encourage or suppress disclosure. Therefore, the purpose of this dissertation was to build on the current understanding of individual-level factors associated with disclosure and to explore the influence of the social environment on disclosure. A systematic literature review indicates that most of the research has been focused on quantifying disclosure rates. Some focus has been placed to identify individual-level correlates and there is a limited understanding of how relationship and disclosee characteristics are associated with disclosure. A quantitative analysis was conducted on data from 226 African American MSM in Baltimore, MD, individual-level and social network characteristics differentiate men who disclosed to health care providers from men who did not disclose. Men who did not disclose were more likely to identify as bisexual and engage in risky drinking. Positive serostatus, socialization with social network members, and having a social network where all members knew the participant was a man who had sex with men are positively associated with disclosure to health care providers. Two separate quantitative analyses were conducted using data from 108 dyads, reported by 62 African American men who have sex with men and women. Factors associated with disclosure are the age difference between the man and his female partners, level of trust between partners, and the male partner’s HIV status. After controlling for factors associated with disclosure, disclosure of same-sex behavior was significantly and positively associated with consistent condom use with female sex partners. Findings from this research indicate that social environmental factors, in addition to MSM factors, are associated with disclosure to health care providers and female sex partners. Interventions that promote disclosure, when appropriate, should consider targeting the social network, disclosee, and relationship.