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By Will Boggs, MD
Reuters Health - Thu Sep 23, 2004 8:29 PM ET

NEW YORK (Reuters Health) - Whether or not HIV -infected intravenous drug users (IDUs) disclose their status to their sex partners depends on different factors, according to a report in the journal AIDS Patient Care and STDs.

"Disclosure is not an all or nothing event," Dr. Jeffrey T. Parsons from Hunter College of the City University of New York told Reuters Health. "The relationship between sexual risk and disclosure among IDUs is an important one to consider."

In the Seropositive Urban Drug Injector's Study, Parsons and colleagues used data from an ethnically diverse sample of 158 HIV-positive IDUs to examine disclosure and sexual behavior based on partner type, partner infection status, and the risk of spreading HIV.

More than half the subjects disclosed that they were HIV-positive before the first sexual contact with their primary partner, the authors report, but nearly three quarters of those reporting sex with a non-primary partner disclosed their HIV-positive status before having sex for the first time.

Altogether, 79 percent of subjects disclosed their HIV positivity when the sexual partner was known to be HIV-positive, the report indicates, but only 56 percent revealed their status when the sexual partner was HIV-negative or had an unknown infection status.

Most participants consistently disclosed their status to casual sex partners, but 4 of 26 men and 5 of 15 women only did so under certain conditions or with particular individuals.

Two men and two women reported never having disclosed their HIV-positive status to their current primary partner, the researchers note, and 13 of 36 men having sex with male or female partners and 2 of 13 women with casual partners reported never disclosing their HIV status.

Those who consistently disclosed their status were more likely to feel they had a responsibility to tell sex partners they were HIV-positive if they were not sharing needles and to believe it was more important to protect sex partners from HIV.

These "consistent disclosers," the investigators report, were more likely than others to wear condoms without resentment and to endorse the attitude that it is all right if the partner doesn't want to have sex because of the disclosed HIV-positive status.

"I think that significant efforts were made early in the epidemic to focus on safer needle sharing practices among IDUs, but issues about sexuality were essentially ignored," Parsons said. "More safer-sex information needs to be provided to IDUs in the context of secondary HIV prevention."

"In addition to using this information to potentially help IDUs disclose sooner in relationships rather than later, it's also just important for providers to be alert to potential emotional problems and mental health issues that may result from disclosure," Parsons added.

"Having peers who have successfully disclosed their status to partners could have a motivating effect on IDUs," he said. "In addition, hearing stories about disclosure situations that did not go well, but hearing how the person was able to get beyond it, could help to alleviate fears about rejection and other negative reactions to disclosure."

SOURCE: AIDS Patient Care and STDs, August 2004.