Prevalence and Predictors of HIV Disclosure Among Adults Receiving Care in the United States

Background: Disclosing one’s HIV-positive status to sex partners is important for preventing HIV transmission as it allows partners to make informed decisions about how to reduce their risk. However, there are no nationally representative estimates of disclosure in the United States (U.S.). We present estimates of the number and proportion of HIV-infected adults in care who disclosed their status to all sex partners in the past 12 months, along with factors associated with disclosure. Methodology: We used interview and medical record data from the Medical Monitoring Project, which collects information from a probability sample of HIV-infected adults receiving medical care in the U.S. Participants were considered to have disclosed if they reported discussing their HIV-positive status with all sex partners in the past 12 months the first time they had sex with each partner. This analysis was limited to persons diagnosed with HIV for ≥1 year. We evaluated factors associated with disclosure using logistic regression analyses to calculate crude and adjusted prevalence ratios. All analyses accounted for clustering, unequal selection probabilities, and non-response. Results: Among an estimated 222,648 sexually-active HIV-infected adults in care in the U.S., 178,603 or 72% (95% Confidence Interval (CI) 70%-74%) disclosed their HIV status to all partners. In adjusted analyses, men who had sex with men, Blacks/African Americans, Latinos, people who experienced homelessness, alcohol and drug users, and people who reported any unprotected vaginal or anal sex were less likely to disclose their status to all sex partners in the past 12 months (Table 1). Current use of antiretroviral therapy and viral suppression were not associated with disclosure. Conclusions: Although the majority of sexually-active HIV-infected adults in care in the U.S. disclosed their status to all sexual partners in the past year, over 1 out of 4 (an estimated 69,380) did not. Disclosure was less likely among those who engaged in behaviors that increase the risk of HIV transmission (i.e., substance use and unprotected sex), highlighting the need for increased prevention efforts to encourage disclosure and receipt of risk reduction counseling among these populations.