Self-disclosure of HIV-1 antibody test results: the San Francisco General Hospital Cohort.

We followed 93 subjects from the San Francisco General Hospital Cohort for one year after notifying them of their HIV-1 antibody test results in order to examine self-disclosure, reactions, and concerns regarding disclosure. By one year post-notification, 92% of gay friends, 82% of primary sexual partners, 56% of new sexual partners, 46% of co-workers, 71% of physicians, 37% of dentists, 57% of psychotherapists, and 37% of family members had been told. Subjects were twice as likely to tell primary sexual partners, and more likely to self-disclose to all categories of persons (except physicians and dentists) than anticipated prior to notification. Least favorable reactions to seropositivity were from male family members and primary sexual partners, while seronegative subjects experienced unfavorable reactions only from some family members. Subjects were most concerned about health insurance (71%) and stigmatization (61%), but the latter declined (to 36%) at 12 months. Although encouraging, these findings suggest that self-disclosure should be discussed in both pre- and post-test counseling sessions.

Results of a one year longitudinal study of HIV antibody test notification from the San Francisco General Hospital cohort.

We examined the psychological impact of HIV antibody testing in 107 homosexual men in San Francisco. Seventy-eight percent of the seropositives but only 43% of the seronegatives correctly anticipated their results. Twelve months after notification (but not earlier), notified seropositives reported significantly greater increases in total distress than nonnotified controls. However, notified seronegatives demonstrated significantly lower levels of hopelessness than nonnotified controls at every follow-up assessment. Thus, knowledge of HIV antibody status appears to dispel a sense of gloom in persons who incorrectly believe themselves to be infected with HIV, but does not appear to induce significant distress in those whose expectation of a positive result is confirmed. Both groups reported lower distress than men with ARC or AIDS, suggesting that distress was related more to symptomatology than knowing antibody status. These results suggest the benefits of HIV testing for the considerable proportion of seronegative subjects believing themselves to be seropositive and should be weighted against the more limited induction of distress in seropositives who receive confirmation of their test result expectation. The benefits of testing are also supported by increasing knowledge of the usefulness of early intervention in HIV disease.

Time of exposure and risk of HIV infection in homosexual partners of men with AIDS.

We interviewed, and tested for HIV antibody, 117 homosexual men who had been regular sexual partners of men who developed acquired immunodeficiency syndrome (AIDS); 85 tested seropositive. Receptive anal intercourse with the index AIDS case and number of different sexual partners with whom subjects were anally receptive were both risk factors. Controlling for the number of partners with whom subjects were anally receptive, we found that the odds ratio of receptive anal intercourse with the case was infinite (95% confidence intervals, 3.3-infinity) if sexual contact continued up to or beyond the time of diagnosis, while the odds ratio was 1.0 (95% CI 0.3-3.2) if contact ceased before the case's AIDS diagnosis. Risk was not associated with the duration or frequency of contact. Our data suggest that the potential for sexual transmission from an HIV-infected person may be greater close to or after the onset of disease.