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PubMed2000

Helping HIV-positive persons to negotiate the disclosure process to partners, family members, and friends.

For people who have been diagnosed with a chronic illness, one inevitable issue to be addressed is whether and how to share this information with others. For persons who are HIV positive, disclosure presents an especially arduous task. The purpose of this article is to offer a strategy to assist marriage and family therapists in facilitating client disclosure of an HIV-positive status to partners, family members, and friends. In addition, suggestions for setting the stage for disclosure to occur and recommendations for client follow-up are proposed.

Adaptation, Psychological↗
PubMed2001

Overcoming the barriers to disclosure and inquiry of partner abuse for women attending general practice.

OBJECTIVES: To determine the barriers to and rates of disclosure of partner abuse by women attending GPs. METHODS: In a qualitative study, abused Melbourne women were interviewed about their experiences with GPs. Following this, adult women attending a random sample of Brisbane general practices were surveyed. Multivariate analyses were conducted on the data, using levels of disclosure and GP inquiry adjusting for cluster effect to obtain prevalence rate ratios. RESULTS: Thirty-seven per cent of the survey participants (n=1836, response rate 78.5%) admitted to having ever experienced abuse in an adult intimate relationship. One-third (36.7%) of these abused women (n=674) had ever told a GP and 87.8% had never been asked by their GP about partner abuse. Women who disclosed were almost twice as likely than women who have not: to be middle aged, have experienced combined physical, emotional and sexual abuse and be afraid of their partner. They were more than twice as likely to have been asked about abuse. A GP's good communication skills facilitated disclosure. The main barriers to disclosure were that women saw the problem as their own i.e. internal barriers. The data from the qualitative study (n=20) are used to illustrate these findings. CONCLUSION: Educational interventions that improve GPs' communication skills might result in increased disclosure and early intervention in partner abuse. GPs need sensitive attitudes, greater skills, knowledge and support to manage the consequences of disclosure.

Adult↗
PubMed2001

Variables in delayed disclosure of childhood sexual abuse.

In a study of 41 adult survivors of childhood sexual abuse, the level of childhood traumatization was found to have contributed to delayed disclosure of the abuse. Other delaying variables included: belief in the importance of obedience to grownups, mistrust of people, fear of social rejection, and fear of the criminal justice system. Variables such as media attention to similar cases and experiences of personal achievement were inversely related to the age at disclosure. Recommendations for policy are discussed.

Adolescent↗
PubMed2006

Social sharing of emotion in anticipation of cardiac surgery: effects on preoperative distress.

This study examined associations between social sharing of emotions, social support and preoperative psychological distress. Social sharing was operationalized in terms of quantity and quality. Quantity of social sharing was measured daily using a diary method. Quality of social sharing was measured with the Quality of Sharing Inventory. Participants were 157 hospitalized Greek patients. Hierarchical regression analysis showed that controlling for distress on admission, quality of social sharing was negatively related to distress one day before surgery (p < .01). No effects were found for quantity of social sharing. Results emphasize the importance of studying qualitative aspects of emotional disclosure.

Adaptation, Psychological↗
PubMed2005

Respiratory sinus arrhythmia predicts written disclosure outcome.

Research has indicated that writing about traumatic experiences is associated with beneficial health effects compared with writing about emotionally neutral topics. What remains unclear are those factors that moderate the beneficial effects associated with written disclosure. This study examined respiratory sinus arrhythmia (RSA) as a moderator of written disclosure outcome. Findings indicated that individuals with the highest RSA during the first written disclosure session benefited most from written disclosure in terms of physical health complaints and depression symptoms. As expected, RSA did not impact outcome for participants assigned to a control condition. These findings indicate that individuals who display good emotion regulation skills are best served by written disclosure.

Adaptation, Psychological↗
PubMed2006

Written disclosure of experiences with racial discrimination and antibody response to an influenza vaccine.

This study examined whether Blacks who wrote about their experiences with racial discrimination in a laboratory-based disclosure intervention would show greater levels of antibody production in response to an influenza vaccine compared with Blacks who wrote about a neutral topic. Forty-seven participants were randomized to write about their thoughts and feelings around their experiences with racism, or to write about their schedule for the week. Participants wrote on the same topic during each of three 20-min sessions. Blood was drawn prior to the intervention and at 1 and 3 months postvaccination to assess antibody production. Participants in the racism disclosure group produced significantly less antibodies to 2 of 3 viral strains. Post hoc analysis suggests that participants who were unsure about whether their events were due to racism or due to other factors had reduced levels of antibody to 1 viral strain. The attributional ambiguity sometimes associated with racism may inhibit the benefits of disclosure interventions for these types of stressors.

Antibody Formation↗
PubMed2000

Ignorance is bliss? HIV and moral duties and legal duties to forewarn.

In 1997, a court in Cyprus jailed Pavlos Georgiou for fifteen months for knowingly infecting a British woman, Janet Pink, with HIV-1 through unprotected sexual intercourse. Pink met Georgiou in January 1994 whilst on holiday. She discovered that she had contracted the virus from him in October 1994 but continued the relationship until July 1996 when she developed AIDS. She returned to the UK for treatment and reported Georgiou to the Cypriot authorities. There have been a number of legal cases involving deliberate transmission of HIV, but most have involved forced exposure to infected bodily fluids for example, rape or biting, and have been dealt with using the existing legislation for rape or assault. While it is often difficult to prove responsibility for transmission in cases of forced exposure to HIV, it is even more contentious in cases like those of Janet Pink where an individual has consented to sex but claims that he/she was not forewarned of his/her partner's HIV-positive status. At present there is no specific criminal offence of having unprotected sexual intercourse without disclosing one's HIV-positive status but a prosecution could possibly be brought under any one of a number of existing offences. Perhaps a change of policy needs to be considered. The Home Office has issued a consultation document which outlines a proposal that will allow the criminalization of intentional transmission of diseases, like HIV, that are likely to cause serious harm. This revised legislation would cover all other potentially fatal diseases (including salmonella and legionnaire's disease, for instance) but seems primarily to be targeted at HIV transmission. Should transmission of HIV through consensual sex, without the HIV-positive status of the individual being disclosed, be an offence? This question, and that of whether there is a moral obligation to disclose a positive HIV status prior to having a sexual relationship is the subject of this paper.

Crime↗
PubMed1994

Negotiating sexual relationships after testing HIV-positive.

Drawing on in-depth interviews with 60 people with HIV disease and 40 of their caregivers, this article reports on the effects of HIV seropositivity on sexual interaction and relationship formation. Using a sample representing gay and heterosexual, black and white, and male and female respondents, we focus on how people in the syndrome account for, cope with, and work through problems associated with HIV. While disengagement from sexuality is common, at least initially, many respondents successfully readjusted the mutual understandings of ongoing relationships or went on to develop new ones, often with seronegative people. Further, we compare the experiences of those already in relationships when they test HIV-positive to those seeking new relationships and discuss problems of disclosure and safer sex, with notes on the responses and perceptions of HIV-negative sexual partners.

Female↗
PubMed1998

The effects of interviewer gender in mental health interviews.

Despite indications that gender can affect the disclosure of personal information, few studies examine the effects of interviewer gender in eliciting information pertaining to psychological functioning and mental health. Analysis of data collected at the Los Angeles site of the Epidemiological Catchment Area Study reveals that interviewer gender is significantly related to respondents' reports of psychiatric symptoms. Male and female respondents interviewed by women report more symptoms of depression, substance abuse, and conduct disorders than respondents interviewed by men. It is suggested that female interviewers may create conditions more conducive to disclosure and be perceived as more sympathetic than male interviewers. Although limitations of both data and analysis preclude a definitive conclusion, the findings suggest that interviewer gender may influence disclosure in mental health and related types of interviews.

Adolescent↗
PubMed1996

Managed care under siege: how an effective compliance program can protect your company.

This article discusses the current enforcement emphasis on managed care fraud and examines how managed care organizations can utilize compliance programs, including legal audits, to protect against unwarranted investigations and liability. The article reviews the elements of an effective compliance program, how to conduct an internal audit, and the risks and benefits of a voluntary disclosure in the event fraudulent activity is discovered.

Employee Performance Appraisal↗
PubMed2006

Does questionnaire format impact reported partner violence rates?: An experimental study.

Researchers assess partner violence using numerous formats, but whether questionnaire format affects obtained rates has rarely been examined. We compared paper-and-pencil versus computer administrations, and standard Revised Conflict Tactics Scales (CTS2) categories versus dichotomous (yes/no) response categories, in a 2 x 2 experiment with 160 undergraduate students. Differential validity was also examined for gender. Results provide some support for the use of all formats, although sexual coercion rates showed more measurement variability than reports of psychological aggression, physical assault, or injury. Sexual coercion effects also differed by gender. The standard CTS2 categories resulted in more disclosures than dichotomous categories for some variables. Differences between computer and paper-and-pencil formats were generally minimal. More attention to the effects of questionnaire design on disclosures of violence is urgently needed.

Adolescent↗
PubMed1988

Disclosure of sexual preference to physicians by black lesbian and bisexual women.

Physicians' ability to diagnose and treat health care problems, particularly those with a psychosocial component, is facilitated by accurate information concerning the life-styles of their patients. White lesbians have been shown to be generally reluctant to disclose sexual orientation to their physicians, but little, if anything, is known about black lesbians. Black women, self-identified as bisexuals (N = 65) and lesbians (N = 529), were asked whether they had disclosed their homosexual behavior to their physicians. In the sample, only a third of the women had. Previous sexual experiences, both heterosexual and homosexual, were also queried to illuminate patterns of gynecologic health risk factors. Nearly all of the women reported previous heterosexual experiences.

Adult↗
PubMed2001

Utilizing disclosure in the treatment of the sequelae of childhood sexual abuse: a theoretical and empirical review.

Although disclosure is a component of many therapeutic approaches to treating the long-term symptoms associated with child sexual abuse (CSA), the ameliorative mechanisms of this approach are still unclear. This review investigates the expected benefits of disclosure in therapy by looking at the theoretical and empirical support for its effectiveness in treating the specific psychopathological sequelae associated with a history of CSA. In order to accomplish this task, a core group of sequelae associated with sexual abuse are presented. The components of disclosure as a therapeutic process are divided into three processes: disclosure-through-description, disclosure-through-rethinking, and disclosure-in-relationship. The review describes the ways in which these elements of disclosure are used within different therapeutic approaches. The treatment outcome literature is then reviewed in terms of the elements of disclosure included in the treatment approaches and the symptoms improved by treatment. In conclusion, implications are presented concerning the appropriate uses of disclosure in psychotherapy directed at alleviating the long-term sequelae associated with a history of CSA.

Adult↗
PubMed2003

Adolescent and parent perspectives on ethical issues in youth drug use and suicide survey research.

The contribution of adolescent and parent perspectives to ethical planning of survey research on youth drug use and suicide behaviors are highlighted through an empirical examination of 322 7th-12th graders' and 160 parents' opinions on questions related to 4 ethical dimensions of survey research practice: (a) evaluating research risks and benefits, (b) establishing guardian permission requirements, (c) developing confidentiality and disclosure policies, and (d) using cash incentives for recruitment. Generational and ethnic variation in response to questionnaire items developed from discussions within adolescent and parent focus groups are described. The article concludes with a discussion of the potential contributions and challenges of adolescent and parent perspectives for planning scientifically valid and ethically responsible youth risk survey research.

Adolescent↗
PubMed2004

Rates, barriers and outcomes of HIV serostatus disclosure among women in developing countries: implications for prevention of mother-to-child transmission programmes.

This paper synthesizes the rates, barriers, and outcomes of HIV serostatus disclosure among women in developing countries. We identified 17 studies from peer-reviewed journals and international conference abstracts--15 from sub-Saharan Africa and 2 from south-east Asia--that included information on either the rates, barriers or outcomes of HIV serostatus disclosure among women in developing countries. The rates of disclosure reported in these studies ranged from 16.7% to 86%, with women attending free-standing voluntary HIV testing and counselling clinics more likely to disclose their HIV status to their sexual partners than women who were tested in the context of their antenatal care. Barriers to disclosure identified by the women included fear of accusations of infidelity, abandonment, discrimination and violence. Between 3.5% and 14.6% of women reported experiencing a violent reaction from a partner following disclosure. The low rates of HIV serostatus disclosure reported among women in antenatal settings have several implications for prevention of mother-to-child transmission of HIV (pMTCT) programmes as the optimal uptake and adherence to such programmes is difficult for women whose partners are either unaware or not supportive of their participation. This article discusses these implications and offers some strategies for safely increasing the rates of HIV status disclosure among women.

Attitude to Health↗
PubMed2005

Disclosure of date/acquaintance rape: who reports and when.

OBJECTIVE: To estimates rates and correlates of disclosure of date/acquaintance rape or attempted rape and verbally coercive sex among a diverse sample of adolescent and young adult females. DESIGN: Secondary data analysis of cross sectional data. SETTING: Urban adolescent healthcare facility. PARTICIPANTS: Adolescents who were identified as having experienced rape/attempted rape (n = 86) or verbally coerced sex (n = 68) in the last 12 months from study examining sexual violence. MAIN OUTCOME MEASURES: Disclosure of forced sex (logistic regression) and the timing of disclosure (survival analysis). INTERVENTIONS: None. RESULTS: Almost 60% of victims who experienced rape/attempted rape disclosed this information to one or more individuals, whereas only 47% of those who experienced verbally coerced sex told another person. Multivariate analyses found that drinking by the partner (AOR = 4.6) and shorter dating history (AOR = 6.3) were associated with disclosure of rape/attempted rape; timing of this disclosure was facilitated by Caucasian ethnicity (RR = 3.5), having a dating partner who drank > or = 1 drinks (RR = 2.5), and the perpetrator being someone other than the victim's boyfriend or partner (RR = 2.5). With regards to verbally coerced sex, reporting no pressure to use alcohol (AOR = 10.7) was the only factor associated with disclosure. No significant predictors of timing to disclosure were detected for this type of victimization. CONCLUSIONS: Perpetrator's alcohol use and a shorter dating history are important variables associated with disclosure of rape/attempted rape as well as timing to disclosure. Factors affecting the disclosure of verbally coerced sex and the latency associated with disclosure are less well defined.

Adolescent↗