Disclosure of serostatus to sex partners among HIV-positive men and women in Hawaii.

The HIV epidemic in the United States is not abating, and sexual activity is the transmission-risk factor most frequently reported among those newly infected. Many HIV-positive persons have difficulty disclosing their serostatus to sex partners (SPs) and may not use condoms consistently. The aims of the research were to explore patterns of disclosure to SPs among HIV-positive men (N = 93) and women (N = 23) living in Hawaii, and to explore factors influencing disclosure and condom use. Using a survey design, participants were asked about their sexual activity during a three-month recall period, including detailed information for up-to-three most recent SPs. A variety of demographic, HIV-illness, self-efficacy, and contextual variables were examined as potential factors influencing disclosure. A total of 278 SPs were reported with rates of disclosure and of condom use near 50% for both genders. Perceived self-efficacy (SE) for disclosure decision-making was associated with disclosure for both men and women. Not discussing a SP's serostatus was associated with nondisclosure for both men and women. Additional factors influencing disclosure for men included cocaine and marijuana use, and years since diagnosis. Being transgendered was associated with less disclosure, but the small sample size for women precludes generalization of findings. There was an association between disclosure and condom use for men but not for women. Nurses must routinely assess for client HIV transmission-risk behaviors, and encourage disclosure of serostatus to SPs. It is also essential to offer clients behavioral strategies that can enhance their intentions to use condoms.