Welcome to the Acción Mutua web-seminar HIV Disclosure and Latino MSM Before we begin, a little about our format  Presentation by seminar speaker ≈ 40 min  Question and answer session ≈ 20 min Press *6 on your telephone keypad to mute your line Press *6 on your telephone keypad to mute your line If you are experiencing difficulty with your phone connection, dial *0 for the conferencing service operator If you are experiencing difficulty with your phone connection, dial *0 for the conferencing service operator Questions submitted prior to the web seminar will be addressed first Questions submitted prior to the web seminar will be addressed first For questions that arise during the presentation, please click on the “hand” icon button and type your question For questions that arise during the presentation, please click on the “hand” icon button and type your question

Acción Mutua/Shared Action (AM/SA) is a capacity building assistance (CBA) program of AIDS Project Los Angeles in collaboration with the César E. Chávez Institute of San Francisco State University Funded by the Centers for Disease Control and Prevention

HIV Disclosure & Latino MSM Maria Cecilia Zea, Ph.D. Professor Department of Psychology George Washington University

Main Topics  What is disclosure?  How does it relate to HIV prevention?  Barriers to disclosing  Benefits of disclosing  Other research findings  Areas of strength and resiliency  Tips for providers

Latinos/as And 19% of all HIV/AIDS cases Account for 14% of the U.S. population

Latino Males Living with AIDS

Large National MSM Study (N=1,767)

What is disclosure?  The act of revealing or telling someone else that one is living with HIV.

Approaches  Direct Sharing HIV test results Sharing HIV test results Telling others Telling others Included in personal ads Included in personal ads  Indirect Leaving medication visible Leaving medication visible Internet notification sites (i.e. Internet notification sites (i.e.  Degree Select number of people Select number of people Everyone Everyone

To disclose or not? “I did not want my mother to find out at my funeral that I was HIV-positive and gay, so I told her.” “I don’t want my mother to suffer because I am HIV-positive. Even if I die in ten years, those will be ten years during which she did not have to suffer.”

How does disclosure relate to HIV prevention?  Knowledge and information reduces sexual risk  Related to mental health which influences choices about sexual risk  Can help individuals obtain practical help and support from others

Mental Health Disclosure can…  Improve levels of happiness  Increase self esteem  Increase social support

Depression Non-disclosure can…  Increase levels of depression  Undermine intentions to practice safer sex

Effects of non-disclosure  Overwhelming burden “It was such sadness, I was so lonely, I didn't have the courage to tell even my own mother. The truth is that I started doing crack, I felt like the world had fallen on my shoulders... And I started doing drugs… I didn't even check the oil in my car... I became careless about everything.” “It was such sadness, I was so lonely, I didn't have the courage to tell even my own mother. The truth is that I started doing crack, I felt like the world had fallen on my shoulders... And I started doing drugs… I didn't even check the oil in my car... I became careless about everything.”

Effects of disclosure  Sense of relief “I felt like a great weight lifted off my shoulders. I got in the car, and I felt like I was flying in the car. I felt free, free from that pressure, from that secret. Because it was a secret I needed to share. I felt like a bird, I tell you, flying. And it wasn't that I was speeding, but that I felt free…” “I felt like a great weight lifted off my shoulders. I got in the car, and I felt like I was flying in the car. I felt free, free from that pressure, from that secret. Because it was a secret I needed to share. I felt like a bird, I tell you, flying. And it wasn't that I was speeding, but that I felt free…”

Barriers to disclosing  HIV Stigma Research shows Latino MSM expect rejection from family, friends, partners and society  Homophobia Compounds stigma toward being HIV-positive

Expected Negative Reactions (4 = Most Negative; 1 = Least Negative)

HIV Stigma “They called my house [to tell them I was gay and HIV+]. My father says ‘Ah, he is coming home. He is coming back, but he is going to have to leave immediately because I am throwing him out of the house.’ After my sister spoke with my parents, my father simply kept quiet, never asked anything. To this date, we don’t speak to each other; I look down (bajo la cabeza) and I feel shame.” “They called my house [to tell them I was gay and HIV+]. My father says ‘Ah, he is coming home. He is coming back, but he is going to have to leave immediately because I am throwing him out of the house.’ After my sister spoke with my parents, my father simply kept quiet, never asked anything. To this date, we don’t speak to each other; I look down (bajo la cabeza) and I feel shame.”

Homophobia José: "…I've been escondido (closeted); today I am talking to you like this, but I feel very ashamed if people find out about....well, the truth is that nobody knows..." Int.: "Nobody knows…" José: "About me. For me it is shameful if my family finds out...." Int.: "Finds out…" José: "Yes." Int.: "Your family knows that you are HIV-positive but they think that…" José: "Yes. They think I am a man."

Benefits of disclosure  Enhanced STD/HIV prevention  Informed decision about whether to engage in unprotected sex  Avoid new infections among serodiscordant couples  Improved self esteem which supports better choices  Receive emotional support from partners, family & friends

Family Support “My father said to me, ‘We know you are gay and we don’t care, but be careful with the virus.’ He also said ‘I would love to have friends like your friends…’ My father did not have a credit card, but he got one so that I could charge things to his card while I was in the U.S. It is so beautiful to feel that love…” “My father said to me, ‘We know you are gay and we don’t care, but be careful with the virus.’ He also said ‘I would love to have friends like your friends…’ My father did not have a credit card, but he got one so that I could charge things to his card while I was in the U.S. It is so beautiful to feel that love…”

Consequences (positive outweigh negative) + I can openly do things to preserve my health 74 + I feel free of a burden, more relaxed, relieved 72 + I became involved in HIV/AIDS-related activities 63 + I feel less lonely than before 47 - I have been rejected by potential sex partners once they know 40 - Some people seem afraid of catching HIV from me 35 - The possibility of staying legally in this country is now in danger 24 - I have been insulted or threatened by others 16  People now assume that I'm ga46  People now assume that I'm gay 46 As a result of telling others that I am HIV-positive: % Agree (HIV+ Latino MSM; N=301) (HIV+ Latino MSM; N=301)

Other Research Findings on Disclosure  Compared to Anglos  Social network  Sexual orientation  Sex partner status  Length of time in US (recently immigrated disclose less)

Disclosure (compared to Anglos) Percent of respondents who disclosed HIV to:

Disclosure (to Social Network)

Sexual Orientation and HIV

Disclosure (by sex partner status)

Sexual behavior and disclosure Latino MSM are…  Not necessarily protected from engaging in unprotected sex when HIV status information is exchanged  More likely to engage in unprotected sex with someone who has the same HIV status  More likely to engage in unprotected anal intercourse (UAI) with their main partner than with casual partners even if they are sero-discordant

Substance abuse and disclosure Crystal meth use can increase…  Sexual risk behavior as well as HIV sero-conversion  Disclosure among users (possibly an attempt to serosort rather than prevent unprotected sex)

Areas of Strength and Resiliency  Family Support  Community Involvement  Social Activism  Healthy Sexuality

What can providers do? Agencies can incorporate disclosure into all HIV prevention programs and services to help Latino MSM…  Determine the possible benefits or drawbacks of disclosing to others  Develop skills on disclosing to whom, when, and how  Develop strategies to disclose to specific individuals and offer support regarding outcomes  Prepare to deal with negative reactions such as rejection or hostility  Obtain support for disclosure and dealing with the possible consequences by providing mental heath referrals

Interventions Healthy Relationships  CDC sanctioned HIV prevention intervention  Adapted for use with the Latino population  Core elements Disclosing to family and friends Disclosing to family and friends Disclosing to sexual partners Disclosing to sexual partners Building healthier and safer relationships Building healthier and safer relationships  Skills building through Modeling Modeling Role-play Role-play Feedback Feedback For more information and technical assistance on this and other interventions, please refer to

For more information or to learn how to receive CBA services, contact us at: www.accionmutua.org Thanks for Your Participation Future Acción Mutua web seminars Please register at: For questions about today’s seminar Please contact Maria Cecilia Zea: