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PubMed1995

Disclosure of trauma and immune response to a hepatitis B vaccination program.

This study investigated whether emotional expression of traumatic experiences influenced the immune response to a hepatitis B vaccination program. Forty medical students who tested negative for hepatitis B antibodies were randomly assigned to write about personal traumatic events or control topics during 4 consecutive daily sessions. The day after completion of the writing, participants were given their first hepatitis B vaccination, with booster injections at 1 and 4 months after the writing. Blood was collected before each vaccination and at a 6-month follow-up. Compared with the control group, participants in the emotional expression group showed significantly higher antibody levels against hepatitis B at the 4 and 6-month follow-up periods. Other immune changes evident immediately after writing were significantly lower numbers of circulating T helper lymphocytes and basophils in the treatment group. The finding that a writing intervention influences immune response provides further support for a link between emotional disclosure and health.

Adaptation, Psychological↗
PubMed1999

The parent disclosure interview.

As the number of HIV-infected women and children in the USA has increased, clinicians and researchers have debated the benefits and risks of disclosure of parental HIV status to children. Disclosure is usually ascertained through interviews of unknown reliability. Given the need to advance knowledge regarding the benefits and risks of disclosure of parental HIV status to children, a reliable and comprehensive disclosure interview is needed. The Parent Disclosure Interview (PDI) was developed for this purpose. In order to study its reliability, 29 HIV-infected mothers were administered the PDI twice, on average one week apart, by two different female interviewers. Kappa statistics indicate that the PDI is highly reliable in most content areas. Researchers may use the interview for comparing the prevalence of disclosure among different groups of HIV-infected parents. Practitioners who assist parents in making decisions about disclosure of HIV status to children may use the interview to obtain a baseline assessment of the clients' disclosure history and attitudes towards disclosure.

Adult↗
PubMed1993

Developmental differences in detection and disclosure of sexual abuse.

OBJECTIVE: This study examined the role of developmental differences in the detection and disclosure of child sexual abuse. METHOD: A random medical record review was conducted of 72 children and adolescents seen over a consecutive 3-year period for suspected sexual abuse in the emergency room of a pediatric hospital. The following data were gathered: (1) demographic information, (2) presenting symptomatology that initiated caregiver decision to seek evaluation, (3) type of disclosure (purposeful or accidental), and (4) precipitants to disclosure. RESULTS: Preschool age children were significantly more likely than school age children and adolescents to exhibit behavioral or physical symptoms that prompted caregivers' suspicion of sexual abuse. Preschool age children made disclosures accidentally and typically with an immediate precipitating event unrelated to the abuse itself. In contrast, sexual abuse disclosures from school age children were purposeful and not associated with a precipitating event. CONCLUSIONS: Practitioners need to be aware of the developmental differences in the detection of sexual abuse, including the forces that inhibit disclosure in older children.

Adolescent↗
PubMed1984

Client disclosure and psychotherapy session evaluations.

Clients' percentage of disclosure (first person, subjective utterances) was compared with evaluative session ratings by clients, therapists, and an external rater across 43 psychotherapy sessions. In contrast to observers' perceptions, participants' perceptions of session depth and value were not correlated with client disclosure. Sessions high in disclosure (relative to the client's usual level) were rated from all three perspectives as relatively rough, unpleasant, difficult, and dangerous.

Adult↗
PubMed2001

Maternal disclosure of mothers' HIV serostatus to their young children.

Mothers' disclosure of their HIV serostatus to their noninfected young children and factors associated with disclosure were investigated among 135 families. Overall, 30% of the mothers had personally disclosed their serostatus to their children. Mothers who disclosed reported higher levels of social support in their lives than mothers who did not disclose. Children whose mothers had disclosed to them displayed lower levels of aggressiveness and negative self-esteem compared to children whose mother had not disclosed. These findings indicate that for this sample, no negative effects were observed among young children to whom mothers have personally disclosed their HIV serostatus.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Disclosure and secrecy in adolescent-parent relationships.

Beliefs about parents' legitimate authority and adolescents' obligations to disclose to parents and actual disclosure and secrecy in different domains were examined in 276 ethnically diverse, lower middle-class 9th and 12th graders (Ms=14.62 and 17.40 years) and their parents (n=249). Adolescents were seen as more obligated to disclose prudential issues and less obligated to disclose personal than moral, conventional, and multifaceted issues; parents viewed adolescents as more obligated to disclose to parents than adolescents perceived themselves to be. Adolescents disclosed more to mothers than to fathers, particularly regarding personal issues, but mothers overestimated girls' disclosure. Greater trust, perceived obligations to disclose, and, for personal issues, more parental acceptance and psychological control predicted more disclosure and less secrecy.

Adult↗
PubMed1980

The effects of perceived physician competence on patients' symptom disclosure to male and female physicans.

One hundred and ninety-two subjects (128 male and 64 female) rated their willingness to disclose symptoms of a personal nature, general nature, and mental illness nature to a male or female physician who had been described as being either high or low in technical competence and either high or low in social competence or "beside manner." In addition, subjects were given a photograph of the physician which had been pretested for either high or low physical attractiveness. Increased willingness to disclose all types of symptoms was related to (a) perceived high technical competence, (b) high social competence, and (c)male patients. Neither the sex of the physician nor the physical attractiveness of the physician influenced symptom disclosure. Implications are drawn concerning physician-patient diagnostic effectiveness and the management of unfavorable first impressions through patient training.

Attitude↗
PubMed2006

Conflicting messages: how criminal HIV disclosure laws undermine public health efforts to control the spread of HIV.

Twenty-three U.S. states currently have laws that make it a crime for persons who have HIV to engage in various sexual behaviors without, in most cases, disclosing their HIV-positive status to prospective sex partners. As structural interventions aimed at reducing new HIV infections, the laws ideally should complement the HIV prevention efforts of public health professionals. Unfortunately, they do not. This article demonstrates how HIV disclosure laws disregard or discount the effectiveness of universal precautions and safer sex, criminalize activities that are central to harm reduction efforts, and offer, as an implicit alternative to risk reduction and safer sex, a disclosure-based HIV transmission prevention strategy that undermines public health efforts. The article also describes how criminal HIV disclosure laws may work against the efforts of public health leaders to reduce stigmatizing attitudes toward persons living with HIV.

Criminal Law↗
PubMed1999

Do people with HIV/AIDS disclose their HIV-positivity to dentists?

This study documents behaviours of people with HIV/AIDS regarding the disclosure of their HIV-positivity when seeking dental care. An anonymous survey was conducted in Québec, Canada, from 1993 to 1995, using a sample of 463 people with HIV/AIDS recruited from different sources. Over 80% of respondents reported having sought dental care since becoming aware of their positivity. Of these, 54% reported having always disclosed their HIV-positivity to dentists, while 25% reported never having disclosed this information to dentists. However, 83% of all respondents preferred that the dentist be aware of their HIV status. Respondents gave reasons related to the sociopathological impact of HIV infection to explain their behaviours. The predictors of disclosure of HIV-positivity to the dentist were: gender, main source of payment for dental care, prior disclosure of HIV status to family members, prior disclosure of HIV status to co-workers, and trust in the maintenance of confidentiality by the dentist. These results emphasize the need to use universal precautions in the dental office and to promote dentist-patient relations free of discrimination, so that people with HIV/AIDS are not reluctant to disclose their health status and are confident that such disclosure will lead to care best adapted to their condition.

Acquired Immunodeficiency Syndrome↗
PubMed1999

Exploring the links between interpersonal trust and the reasons underlying gay and bisexual males' disclosure of their sexual orientation to their mothers.

This paper examines the role that interpersonal trust plays in gay and bisexual males' accounts of the factors that led them to decide to reveal or to withhold their sexual identities from their mothers. Fifty men completed a questionnaire about their coming out experiences in the context of their relationships with their mothers. As part of this questionnaire, they indicated whether or not they had disclosed their sexual orientation to their mothers and explained the basis for their decision in this regard. A content analysis of the explanations offered supports findings from previous research which suggest that a considerable range of motivations underlie the decision to disclose (or not to disclose). More importantly, consistent with expectations that the mother's trustworthiness would emerge as a principle concern in participants' responses, several of the classes of explanation identified in disclosers' and non-disclosers' decision accounts suggest that the move toward disclosure is guided in part by the climate of trust existing in individuals' relationships with their mothers.

Adolescent↗
PubMed1987

The measurement of substance use among adolescents: when is the 'bogus pipeline' method needed?

The use of objective measures to assess cigarette smoking among adolescents has become commonplace in research studies in recent years. This trend is based on evidence that this so called pipeline methodology can increase the disclosure of socially proscribed behaviors in a setting where adolescents might otherwise feel pressure to deny that they smoke. This paper examines the effects of the pipeline methodology alone and in combination with procedures designed to ensure anonymity on the disclosure of tobacco, alcohol, and marijuana use by young adolescents. The data indicate that the pipeline procedures significantly increase disclosure of tobacco and marijuana use when students are promised confidentiality but not anonymity. However, when anonymity was assured, disclosure of cigarette use was just as high without the pipeline; for marijuana use, disclosure was higher without the pipeline. No effects were observed for alcohol disclosure. These data are interpreted for their implications for prospective and cross sectional studies.

Adolescent↗
PubMed2003

Prevalence and correlates of HIV serostatus disclosure.

BACKGROUND AND OBJECTIVE: A study of HIV-positive individuals in New Orleans, Louisiana, found that the majority of patients disclosed to their main partners and family members, but less than one fourth disclosed to any casual sex partner. Older age and lower CD4 cell counts were associated with disclosure. GOAL: The goal was to describe patterns of HIV serostatus disclosure among a diverse sample of patients at an HIV outpatient clinic in New Orleans, Louisiana. STUDY DESIGN: A convenience sample of HIV-seropositive patients provided information about disclosure of seropositivity, demographics, date of HIV diagnosis, CD4 cell count, mode of HIV acquisition, and sexual activity since HIV diagnosis. RESULTS: The 269 persons disclosed their HIV status to people in the following categories: main sex partner (74.2%), casual sex partner (24.8%), immediate family member (69.8%), other relative (27.0%), or friend (26.4%). Adolescents were less likely than adults to disclose to a main partner, immediate family member, or a friend. Immunosuppressed persons were more likely than nonimmunosuppressed persons to disclose to a main partner, immediate family member, or another relative. CONCLUSION: Many HIV-infected individuals delay disclosure until their disease has progressed. Interventions such as partner notification and skill-building to facilitate appropriate HIV disclosure are needed.

Adolescent↗
PubMed2006

Correlates of sex without serostatus disclosure among a national probability sample of HIV patients.

We examined potential correlates of sex without HIV disclosure within a sample of 875 participants from the HIV Cost and Services Utilization Study. Interviews with each participant assessed sexual activities with up to six recent partners, and this study included both respondent and partnership characteristics. Compared with marriage and/or primary same-sex relationships, occasional partnerships and one-time encounters were associated with sex with disclosure, and shorter relationships were more likely to involve sex without disclosure. Knowledge of partner serostatus was also associated with sex without disclosure. Women were less likely to have sex without disclosure than men having sex with men. We found an association between the perceived duty to disclosure to all partners and sex without disclosure, while we found no association in multivariate analyses between outcome expectancies and sex without disclosure.

Adult↗
PubMed2006

Sexual negotiation, HIV-status disclosure, and sexual risk behavior among Latino men who use the internet to seek sex with other men.

As part of a wider study of Internet-using Latino men who have sex with men (MSM), we studied the likelihood that HIV-negative (n=200) and HIV-positive (n=50) Latino MSM would engage in sexual negotiations and disclosure of their HIV status prior to their first sexual encounters with men met over the Internet. We also analyzed the sexual behaviors that followed online encounters. Our results showed that both HIV-negative and positive men were significantly more likely to engage in sexual negotiation and serostatus disclosure on the Internet than in person. Those who engaged in sexual negotiations were also more likely to use condoms for anal intercourse. Compared to HIV-negative MSM, HIV-positive MSM were significantly less likely to disclose their serostatus, and 41% of them acknowledged having misrepresented their serostatus to a prospective sexual partner met over the Internet. Although similar proportions of HIV-positive and negative men had condomless anal intercourse, HIV-positive MSM were more likely to report lack of intention to use condoms. Pleasure was the reason most frequently cited for lack of condom use. Cybersex was reported by only one-fifth of the sample. We conclude that the Internet, an understudied milieu of sexual networking, may present new possibilities for the implementation of risk reduction strategies, such as the promotion of sexual negotiation prior to first in-person encounter and serostatus disclosure.

Adult↗
PubMed1996

Evaluation of the effectiveness of Project Trust: an elementary school-based victimization prevention strategy.

This study employed a Posttest-Only Control Group Design to assess the effects of a victimization prevention program, Project TRUST, on elementary school students' knowledge of general prevention concepts, knowledge of difficult-to-acquire prevention concepts, anxiety, and reporting of abuse. A selected subgroup of experimental subjects was also assessed for retention of acquired concepts over time. Students exposed to Project TRUST demonstrated significantly greater knowledge of maltreatment prevention information, as well as difficult-to-acquire concepts, than control group students. A 3-month delayed reassessment of the experimental subgroup showed no loss in acquired prevention information. No differences in anxiety scores existed between experimental and control groups. First-time student abuse disclosures were greater in the experimental than in the control group. These findings support the effectiveness of Project TRUST as a strategy to increase prevention knowledge and generate abuse disclosures without creating student anxiety.

Analysis of Variance↗
PubMed2002

AIDS and sex: is warning a moral obligation?

Common-sense holds that morality requires people who know that they are infected with the Human Immunodeficiency Virus (HIV) to disclose this fact to their sexual partners. But many gay men who are HIV-positive do not disclose, and AIDS Service Organizations (ASOs) promote public-health policies based on safer sex by all, rather than disclosure by those who know that they are infected. The paper shows that the common-sense view follows from a minimal sexual morality based on consent. ASOs' seeming rejection of the view follows from their need to take seriously widespread weakness of will in the realm of sexuality. The author argues that gay men take themselves to follow the common sense view, but hold that the possibility of a partner's HIV infection is background information that need not be disclosed for sexual consent. This suggestion is criticized. The paper concludes with a consideration of HIV disclosure and sexual ethics outside of the gay community and of legal restrictions on the sexuality of the HIV-positive.

Acquired Immunodeficiency Syndrome↗