Los Angeles Times - June 2, 2003
Benedict Carey, Times Staff Writer

Despite AIDS-prevention efforts to promote more responsible sexual behavior, 13% of HIV-infected adults are not disclosing their health status to their partners before engaging in unprotected sex, a new study has found.

The finding comes from the most comprehensive survey to date of what HIV-positive men and women reveal to their sexual partners. And while public health researchers say the 13% figure is troubling, they note that it is an improvement over comparable findings in earlier, smaller surveys.

The results suggest, however, that current public health campaigns to promote openness about AIDS are not changing behaviors for everyone. Although HIV transmission rates have dropped significantly since the 1980s and early 1990s, there are still about 40,000 new cases each year in the United States. Infection rates for syphilis and some other sexually transmitted diseases have also spiked in recent years.

For most, "the message that people ought to act responsibly has gotten out well; only a minority is having risky sex without disclosing" their HIV-positive status, said Dr. Daniel Ciccarone, a researcher at UC San Francisco and lead author of the study published in the June issue of the American Journal of Public Health. "The message should be: Do tell, and, absolutely, do ask," Ciccarone said.

In previous surveys, researchers had found that as many as 50% of HIV-positive gay men reported being sexually active without disclosing their status to at least some partners; it wasn't clear how often the sex was unprotected intercourse with an uninfected person. By carefully reconstructing recent sexual behavior of nearly 1,400 HIV carriers, the new study presents a more complete picture.

The researchers from UC San Francisco and the Rand Corp. in Santa Monica found that more than 30% of the men and women were sexually abstinent. More than 40% of the gay and bisexual men in the study reported having had sex recently, with someone who didn't have the virus or whose status was unknown, without mentioning their own HIV status. But about two thirds of them took precautions to reduce the risk of transmission by wearing a condom or having only oral sex, the study found.

In all, between 10% and 13% of gay, bisexual and heterosexual people in the study reported having unprotected intercourse without first talking about HIV with a partner. As expected, most of the people put at risk were described as casual, rather than long-term, partners.

The issue of how and when to talk about HIV has been debated for years. AIDS activists say the effectiveness of new antiretroviral drug treatments in recent years has changed the perception of the disease from a death sentence into more of a chronic condition - one less likely to garner sympathy. "We know that HIV still carries significant stigma, even in the gay community," said Antony Stately, director of client services at AIDS Project Los Angeles.

Men and women who disclose being infected risk not only souring a relationship, but risk rejection in their neighborhoods and workplaces if the word gets out, he said. To change the behavior of this high-risk group, public health officials need to work harder to reduce the social stigma of HIV and target individuals acting recklessly. "I would like to know how many of these people have mental health problems, histories of trauma or sexual abuse," Stately said. "These are the kind of people for whom the risk of rejection is so high they won't disclose anything."

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