Disclosing HIV status and sexual orientation to employers.

Seropositive gay and bisexual men who reveal their sexual orientation or HIV/AIDS status to their employer risk discriminatory reprisals. However, non-disclosure may limit potential social, emotional, and tangible support. Among our sample of 389 seropositive gay and bisexual men employed in the US, 52% were 'out' to their employer and 35% had disclosed their serostatus to him or her. Among gay men, employer awareness of their sexual orientation was related to their being European American (vs Latino or African American), being HIV-seropositive for more than 4 years, and having a gay or bisexual employer. Disclosure of HIV infection in the total sample was related to being European American, HIV-seropositive for more than 4 years, symptomatic (vs asymptomatic), 'out' at work, and having a gay or bisexual employer. Men who had informed their employers of their HIV status reported consequences that were substantially more positive than those anticipated by men who had not disclosed. Policy and research implications for improving the work environment for gay and bisexual men living with HIV are considered.

Women's self-disclosure of HIV infection: rates, reasons, and reactions.

A survey of 65 ethnically diverse women at 2 outpatient HIV clinics revealed relatively low rates of disclosure of HIV-positive serostatus to extended family members, somewhat higher rates for immediate family members, and highest rates for lovers and friends. Spanish-speaking Latinas were less likely to disclose their serostatus or to discuss HIV-related worries with others than English-speaking Latinas, African Americans, and Anglo Americans. Reasons for disclosure and nondisclosure varied by target. In general, targets reacted positively to disclosure. Implications for clinicians treating women with HIV infection are discussed.

Women living with HIV: sexual behaviors and counseling experiences.

Seventy-two ethnically diverse women attending two outpatient HIV clinics in Los Angeles self-administered questionnaires. Nineteen women (26%) reported sexual activity in the two months prior to the survey; most were sexually monogamous and emotionally involved with live-in male partners. According to self-reports, 13 women (18% of the total sample and 68% of those who were sexually active) had engaged in at least one form of risky sexual activity. The majority (81%) of sexual partners were aware of the respondent's HIV infection, but most (67%) were seronegative. Post-test counseling was reportedly noncomprehensive (e.g., 47% of the respondents did not recall receiving information about using condoms correctly). Few women accessed HIV support services. Results underscore the need for more effective counseling and support interventions for this population.

Culturally sanctioned secrets? Latino men's nondisclosure of HIV infection to family, friends, and lovers.

Spanish-speaking Latino men (n = 107) were more likely than English-speaking Latinos (n = 85) and Whites (n = 206) to withhold their HIV-positive serostatus and their gay or bisexual orientation from significant others, especially family members. Similar effects were observed when Latinos were divided by birthplace and when analyses controlled for sociodemographic and medical factors. Reasons for revealing or concealing an HIV diagnosis varied across targets. Although both Latinos and Whites were more likely to withhold their diagnosis from their parents to prevent worrying them than to avoid personal rejection, this tendency was somewhat stronger among Latinos. Our findings suggest that some traditional values may deter Latinos from seeking HIV-related social support in times of need.

Anal intercourse and disclosure of HIV infection among seropositive gay and bisexual men.

Human immunodeficiency virus (HIV)-infected gay and bisexual men (n = 609) randomly selected from two HIV outpatient clinics in Los Angeles completed confidential, self-administered questionnaires at the clinics, reporting sexual activities and disclosure during the previous 2 months. Approximately 9% had engaged in unprotected insertive anal intercourse with one or more partners. This activity was 3.27 times more likely to have occurred with seropositive partners than with partners who were seronegative or whose serostatus was unknown. Fourteen men (2.3% of total sample) had engaged in unprotected insertive anal sex with 25 seronegative or unknown serostatus partners who were not informed of their risk of infection. Thirty-three men (5.4% of total sample) had engaged in this activity with 37 seropositive partners who were informed. Clinicians and other health professionals can play an important role in helping to control the HIV epidemic by discussing with seropositive patients the importance of using safer sex and informing sexual partners. Such discussion should include information about the potentially negative health effects of unprotected sex between seropositive persons.

Which lesson components mediate refusal assertion skill improvement in school-based adolescent tobacco use prevention?

Any of three components of current school-based refusal assertion training might mediate improvement of seventh grade students' ability to refuse tobacco use offers: 1) teaching students knowledge of ways to say "no," 2) engaging students in the practice of refusal assertion, or 3) motivating students to perform refusal assertion in a socially skilled way. A 3-condition true field experimental "component study" of the differential effects of these three components yielded improvement in role-played behavioral skill to refuse tobacco offers that was evident in both the Knowledge and Practice conditions but not in the Motivation condition. In these same two conditions, skills training led to a significant decrease in students' intention to use smokeless tobacco in the future but not cigarettes. A focus on engaging students in Knowledge and Practice components of refusal assertion training appears warranted.

Group counseling at STD clinics to promote use of condoms.

An intervention was developed to promote safer sex and condom use among patients seeking treatment for sexually transmitted disease (STD) at a public health STD clinic in Los Angeles, CA. The intervention consisted of a short group discussion on condom use, a presentation of a videotape portraying condom use as socially acceptable behavior, and a role-playing session concerning negotiating the use of a condom with one's sex partner. The study group was 551 persons who visited the clinic in 1988. Medical records of 426 (77 percent) were located and reviewed 7 to 9 months later. Among those, 220 had participated in the intervention and 206 were control subjects who had not participated in the intervention. The rates at which patients reacquired STD after treatment and after the intervention were compared between the intervention group and the control group. Men who participated in the intervention subsequently showed a lower rate of STD reinfection than those who did not. There was no evidence that the intervention reduced reinfection among women. The strongest predictor of reinfection was found to be a history of STD infection prior to the infection that was being treated at the time of the intervention. The results show that group interventions directed to STD patients can be effective in reducing STD reinfection among men.

Self-disclosure of HIV infection: preliminary results from a sample of Hispanic men.

We examined self-disclosure of HIV infection among 101 seropositive Hispanic men residing in Los Angeles. Results indicated that disclosure was highly selective and presumably influenced by the social, psychological, and material consequences of informing others about one's medical condition. Subjects tended to inform significant others such as parents, friends, and lovers than less significant others such as employers, landlords, and religious leaders. There was a relatively high rate of disclosure (75%) to doctors/dentists who were not treating subjects for HIV infection. Gay and bisexual subjects (89% of the sample) were more inclined to disclose their HIV serostatus to homosexual or bisexual others than to heterosexuals and to inform those who were aware of their sexual orientation. Disclosure increased with severity of disease independently of length of time since testing seropositive. Self-rated negative changes in appearance correlated with disclosure to less significant others. The role of cultural attitudes and values in self-disclosure of HIV infection is discussed.

Career destiny of 550 Americans several years after graduating from a foreign medical school.

A longitudinal study of 550 Americans who took the examination sponsored by the Educational Commission for Foreign Medical Graduates in February 1972 after or while attending a foreign medical school has been completed. Ten years following graduation from the foreign school, it was found that 70 members of the original group have never qualified for graduate medical education in the United States and an additional 61 have not become licensed practitioners.

Medical school, residency, and eventual practice location. Toward a rationale for state support of medical education.

Because of the shrinking charity dollar, a growing number of state governments are being asked to provide financial support to private medical schools. Such expenditures are more likely to appeal to legislators and to benefit medicine in the state if they can be related to existing manpower deficits.