Abstract

HIV-positive men face multiple challenges when deciding whether or not to disclose their serostatus to sex partners. This survey design using repeated measures examined disclosure of HIV-positive serostatus to sex partners in an ethnically diverse population of men (N = 93) recruited from the community in O'ahu, Hawai'i. The framework guiding the research was Social Cognitive Theory (Bandura, 1987), with a specific focus on self-efficacy for disclosure decision-making and for negotiating safe sex. The aims of the research were to: (1) describe HIV serostatus disclosure to sex partners; (2) describe self-efficacy for disclosure to sex partners and self-efficacy for negotiating safer sex; (3) determine the relationships between demographic, HIV-illness, drug use history, self-efficacy and sex partner variables (relationship status, serostatus), and self-disclosure, and; (4) determine the relationships between demographic, HIV-illness, drug use history, self-efficacy, sex partner variables, self-disclosure, and condom use by the men in the sample. A convenience sample of HIV-seropositive men was enlisted through both active outreach and passive recruitment (posters and public advertisement). Survey responses were anonymous, as the subject matter being asked was sensitive in nature. Results reveal that self-disclosure to sex partners varied based on sex partner serostatus and relationship status, and was significantly influenced by perceived self-efficacy, by income, education, years since diagnosis and contextual factors including cocaine use before sex. Subjects were least likely to disclose to a sex partner whose serostatus was not discussed. An unknown partner serostatus was also significantly associated with less disclosure. The more committed the relationship, the greater the likelihood that a subject would self-disclose. The longer the time since initial HIV diagnosis the more likely a subject was to disclose to sex partners. High self-efficacy scores were associated with self-disclosure, and with condom use. Cocaine use before sex was associated with less disclosure and less condom use. Self-disclosure was significantly associated with condom use as well. Although a causal relationship is not implied, self-disclosure practices did influence safe sex behavior. Implications for nursing and for future research are discussed.