1. The Relational Context of Non-disclosure in HIV Positive Women
Presenting author:
Shani Harris Peterson, PhD
Contributing authors:
Ralph DiClemente, PhD
Gina Wingood, ScD, MPH
Delia Lang, PhD
Emory University
Rollins School of Public Health
Center for AIDS Research
Department of Behavioral Science and Health Education

2. Why disclose? Limit transmission of HIV. (CDC, 2006)
Increase protective sexual behaviors. (Wenger, et al., 1994 in Ciccarone, et al., 2003)
Permit informed sexual decision making. (Chapman, 2006; O’Brien et al., 2003)
Increased social/emotional support. (Petrak, et al., 2001)

3. Disclosure Risks For women, risks include: Emotional distress.
Rupture of relationships.
Decreased sexual satisfaction.
Violence from partners.
(VanDevarter, 1999; Kitterman, 2003)

4. Patterns of disclosure in women
Majority of women disclose to their sexual partners
86.8% disclosed to current sexual partner (Simoni, et. al, 2000)
78% reported to all past sexual partners (Stein, et. al, 1998)
Rates of disclosure consistent across relationship type
Exclusive or non-exclusive
Seroconcordant or serodiscordant (Ciccarone, 2003)

5. Non-disclosure Internal Motivation Consequences
Fear partner abandonment/rejection (Derlega, et. al, 2004)
Believe partner can’t handle it
Too stressful
Need time to deal with own emotions first
(Stein, et. al, 1998)
Consequences
Emotional distress
Limited confidence in disclosing around sex
(Kalichmann, 1999)

6. Relational correlates of non-disclosure
Low spousal support
High friend support
Multiple sexual partners
(Stein, et. al, 1998; Niccolai, 1999)

7. Romantic relationships and disclosure
Women in monogamous relationships 3.2x more likely to disclose. (Stein, et. al, 1998)
Some avoid exclusive relationships to circumvent pressure to disclose. (Maticka & Tyndale, 2002)

8. PURPOSE
To determine whether relationship characteristics predict non-disclosure of serostatus in women living with HIV.

9. METHOD WiLLOW study (HIV intervention program) Sample 320 women
Average age 34 (eligible range 18-50)
80% African-American

10. METHOD Eligibility Requirements
Between 18 and 50 years
Seeking medical care for HIV/AIDS on site
Sexually active in past 6 months
Provided written informed consent
Recruited from 7 large clinics/health depts in Georgia and Alabama, U.S.

11. METHOD: Main Outcomes Disclosure Disclosure History
Have you told your main sexual partner that you are HIV+?
Disclosure History
Divided number of sex partners disclosed to by total number of sex partners since diagnosis

12. METHOD: Relationship and Individual Characteristics
Relationship faith ( =.93)
Length of relationship (months)
Partner communication ( =.86)
Partner condom response ( =.95 )

13. METHOD: Relationship and Individual Characteristics
Individual Attitudes/Behavior
Condom attitudes ( =.95)
Consistent condom use past 30 days (yes or no)
STI history (# of STIs)
Multiple sexual partners (yes or no)

14. RESULTS: Non-disclosure

15. RESULTS: Between group means

16. Bivariate Associations: Non-disclosure to main sex partner
NO YES
M M p-value
Relationship Characteristics
Faith
Length
Partner Communication
Sexual Characteristics
Partner condom response
Condom Attitudes
STI History
Other sex partners
Consistent Cndm Use

17. Correlations: Low Disclosure History
P-corr
p-value
Relationship Characteristics
Faith
.224
.000
Length
.202
.001
Partner Communication
-.146
.009
Sexual Characteristics
Partner condom response
-.161
Condom Attitudes
.159
.005
STI History
-.164
.007
Other sex partners
-.227
Consistent Cndm Use
-.016
.820

18. Multivariate Associations: Low disclosure history
PREDICTORS ß t Sig. F r2
Model
Relationship Variables
1. Rel. Faith
2. Rel. Length
3. Partner comm
4. Partner cndm rspn
Individual Variables
5. Condom Attitudes
6. STI History
7. Other sex partners
Note. N=179

19. What this tells us…
Disclosure may be promoted by exclusive relationships.
Women who do not disclose have:
shorter, less committed relationships,
more sexual partners, and
hold less faith in their main sexual relationships.

20. What this tells us…
Non/low-disclosers use condoms as frequently and consistently as women high disclosers.
Despite condom use, women who do not disclose may be at greater risk of experiencing emotional consequences of non-disclosure (depression, etc).

21. What this tells us… An Alternative Skill Set
Some women may seek out sexual relationships that enable them to avoid disclosure. (Maticka & Tyndale, 2002)
Low disclosers report greater refusal/negotiation skills and more positive responses from partners regarding condom use.

22. Future directions: Practice
Assess relationship stability/faith.
Provide access to couples counseling.
Provide access to individual counseling to address disclosure fears/avoidance.
Assess/encourage emotional support outside of intimate relationships.

23. Future directions: Research
Investigate the impact of relationship faith/security on the overall health and well-being of women living with HIV.
Determine how disclosure effects romantic relationships and identify successful strategies for managing the disclosure stress.

24. Future directions: Research
Identify alternative, protective factors that may promote the overall health of women in the absence of secure romantic relationships.
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25. Acknowledgements
The Fellowship in Research and Science Teaching (FIRST) Program, NIH Institutional Research and Academic Career Development grant, #K12 GM
Michael D. Harris, PhD, University of North Carolina, Chapel Hill, for use of his original artwork entitled “Four Women.”
Jerris Raiford, PhD, Center for AIDS Research, Rollins School of Pubic Health, Emory University.
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26. END

27. Bivariate Associations: Non-disclosure to main sex partner
Low relationship faith***
Shorter relationships*
Fewer threats of violence at request for condom use***
Greater communication about sex preferences/refusal skills**
Negative attitudes towards condoms*
*p<.10, **p<.05, ***p<.01

28. Bivariate Associations: Low disclosure history
Low faith in relationship with main sex partner***
Shorter length of relationship*
More partner communication about sex prefs/refusal skills*
More positive partner response to condom use request*
Higher lifetime incidence of sexually transmitted infections*
More likely to have multiple sexual partners***
*p<.10, **p<.05, ***p<.01