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PubMedDate not supplied

Psychosocial outcomes in individuals living with genital herpes.

Genital infection, a common chronic sexually transmitted infection, is associated with physical and psychosocial concerns. While recognizing that some patients are able to take advantage of medication to chronically suppress the virus, researchers have examined the role that stress and other variables play in the frequency of outbreaks a patient might experience. In this article, several theories are reviewed from the stress literature that relate to patients' experience with herpes: the adjustment issues associated with having herpes, the role of social support, and the issue of disclosure. These theories and their clinical implications are discussed within the context of nursing interventions.

Adaptation, Psychological↗
PubMed1997

Disclosure patterns of sexual abuse and psychological functioning at a 1-year follow-up.

This study describes the disclosure processes of a sample of 68 sexually abused girls, with a focus on the manner in which abuse was revealed--on purpose, accidentally, or resulting from a precipitating event. This categorization is a more descriptive conceptualization of the disclosure process than has been proposed or assessed in previous studies. The circumstances surrounding disclosure are found to be related to long term psychological functioning. Children who disclosed accidentally were younger, experienced abuse for shorter durations, and received the most therapy. At follow-up, children who purposely disclosed had greater anxiety and greater difficulties coping. Discussion focuses on ways in which identifying and encouraging the least traumatic methods of disclosure would contribute to better outcomes for victims of sexual abuse.

Analysis of Variance↗
PubMed2005

Canadian developments. Recommendations published concerning non-disclosure of HIV status.

The conclusions from an expert working group on persons who fail to disclose their HIV status were published in the 1 March 2005 edition of the Public Health Agency of Canada's Communicable Disease Report. The recommendations recognize that legal and ethical considerations must inform and guide both policy and practice as they relate to non-disclosure of HIV/AIDS. The expert working group favoured a graduated response model based on a public health approached to the issue rather than a criminal law approach.

Canada↗
PubMedDate not supplied

Primary care provider interventions for the delayed disclosure of adolescent sexual assault.

Acute sexual assault is a serious and underreported crime with the potential for causing grave physical and emotional harm to its victim. As a result of developmental and psychological factors, the adolescent victim may delay the disclosure of such an assault and therefore experience detrimental, acute, and long-term effects. By understanding the reasons for delayed disclosure and integrating this with currently established guidelines for acutely assaulted patients, primary care providers can better tailor the care they provide when faced with the delayed disclosure of adolescent sexual assault. Furthermore, based on this review, it becomes clear that standardized protocols are necessary to more efficiently care for these patients. Recommendations are provided to allow tailoring of primary care provider's interventions based on established protocols and new understandings when caring for adolescents who delay the disclosure of their sexual assault.

Adolescent↗
PubMed2001

The concealment of obsessions.

Patients' deliberate concealment from others of the content and frequency of their obsessions is a common and important aspect of obsessive-compulsive disorder (OCD). It is an overlooked manifestation of the safety behaviour that is believed to sustain OCD (e.g., neutralizing, thought suppression, avoidance behaviour, concealment). The phenomenon of concealment is understandable in terms of the cognitive theory of obsessions which states that obsessions are caused when the person attaches catastrophic personal significance to their unwanted intrusive thoughts. It is suggested that the selected, planned, suitable disclosure of obsessions can be therapeutic--presumably because it exposes the patient to alternative interpretations of the significance of the unwanted thoughts.

Deception↗
PubMed2006

Different differences: revelation and disclosure of social identity in the psychoanalytic situation.

The authors propose a taxonomy of social identities, suggesting that three different classifications of identities can be distinguished. These comprise those that are innate and visible, such as race or gender; those that are innate, but invisible, such as sexual orientation; and those that are acquired or achieved, such as marital status or political affiliation. The authors argue that each of these categories has different implications for the revelation or disclosure of aspects of the therapist's identity, as well as for transference-countertransference dynamics. These points are illustrated with brief clinical examples.

Ethnicity↗
PubMed1996

How do children tell? The disclosure process in child sexual abuse.

Children's disclosure of sexual abuse has been described as a quasi-developmental process that includes stages of denial, reluctance, disclosure, recantation, and reaffirmation (Sorenson & Snow, 1991, Summit, 1983). It has been reported that nearly 75% of sexual abuse victims initially deny abuse, and that nearly 25% eventually recant their allegations (Sorenson & Snow, 1991). The present study examined disclosures in 234 sexual abuse cases validated by Protective Services in El Paso, Texas. Denial of abuse occurred in 6% of cases, and recantation in 4% of cases in which a child had already disclosed abuse. Four of the eight victims who recanted appeared to do so in response to pressure from a caretaker. The Child Sexual Abuse Accommodation Syndrome described by Summit (1983) seems to be infrequent among the types of cases seen by child protection agencies. The present findings do not support the view that disclosure is a quasi-developmental process that follows sequential stages.

Adolescent↗
PubMed2003

Making schools safer and healthier for lesbian, gay, bisexual, and questioning students.

This article describes some of the special health and safety concerns that many lesbian, gay, bisexual, and questioning youth face in schools. Among these problems are increased drug and alcohol use, sexually transmitted infections and pregnancy risks, depression and suicidality, and increased likelihood of being a victim of harassment or assault. School nurses can play a unique role in the lives of these students. A needs assessment is reviewed that describes school nurses' perceived professional responsibility and their actual practice with regard to lesbian, gay, bisexual, and questioning youth. Five barriers to optimal health care for these students are discussed. Methods that encourage students to view the school nurse as an ally, as well as issues surrounding disclosure or "coming out," are discussed. Special considerations of confidentiality, community agency referral, and family disclosure are discussed. Appropriate interventions at school and ways to begin to change the school climate are also presented.

Adolescent↗
PubMed2006

Lesbian disclosure: disrupting the taken for granted.

The purpose of this interpretive inquiry was to generate understandings about the experience of lesbian disclosure. The inquiry relied on Gadamerian hermeneutic and feminist philosophical thought and was situated in women's health. In a feminist understanding of women's health, experiences of health are inseparable from the everyday experiences of an embodied life and are constituted within each woman's social, material, and discursive realities. The study was informed by conversations with 15 women who self-identified as lesbian for the purpose of the inquiry, accounts of women in the media, and the researcher's reflective journals. The findings move us towards new understandings about the multiple meanings of "lesbian." They challenge nurses to consider the binary categories of homosexual and heterosexual as inadequate signifiers for the reality of women's lives, to consider the particular arrangements of each woman's life, and to disrupt assumptions of heterosexism in order to reduce the negative impact of social exclusion, isolation, discrimination, and stigmatization as social determinants of health.

Adult↗
PubMed2006

HIV-disclosure in the context of vertical transmission: HIV-positive mothers in Johannesburg, South Africa.

HIV-disclosure among childbearing women remains poorly understood, particularly in sub-Saharan Africa. This paper chronicles disclosure experiences of 31 women attending prevention of mother-to-child HIV transmission services in Johannesburg. Data collection entailed repeat in-depth interviews over a nine-month period. Virtually all women (93.5%) had told at least one person (usually a partner), most voluntarily and within a week of the test result. Secondary disclosure was most likely with female family members, through indirect means and involuntary. Confidentiality breach by primary targets likely contributed to the observed high rates of involuntary secondary disclosure and negative secondary disclosure experiences. For most mothers, voluntary disclosure was driven by the desire to ensure adequate infant care and avoid vertical HIV transmission. The impact of disclosure was not always clear-cut. While most primary disclosure experiences were ultimately constructive, secondary disclosure more likely led to rejection, stigmatization and the withholding of financial support. Our data illustrate the influence of social contextual factors on disclosure patterns and impact. For these mothers, socio-cultural norms, the current media and political environment surrounding HIV/AIDS, household composition and social networks and childbearing status shaped disclosure experiences; sometimes constraining disclosure circumstances and sometimes creating a safe space to disclose. Programmatic implications are also discussed.

Adaptation, Psychological↗
PubMed2003

Adolescent homosexuality and concerns regarding disclosure.

Development of sexual identity in middle childhood and early adolescence is a natural process. However, it is more stressful for homosexual adolescents. Society continues to stigmatize and marginalize homosexuality. To avoid rejection and hostility, homosexual adolescents are pressured to hide their sexual identities. This fact compounds the anticipated normal developmental concerns of adolescence, and can create unique problems for the homosexual adolescents. Homosexuality can place them at risk for social stigmatization, isolation, depression, suicide, abuse, and rejection by their families and friends. During this exceptionally stressful time, both adolescent students and their families need anticipatory guidance and support. In providing anticipatory guidance, this article discusses critical roles played by professionals who work with adolescents in community or school settings. Included are insights into development of this normal variant of sexual attraction and orientation, risks that homosexual adolescent students may face as well as their disclosure concerns, and possible reactions families may have following disclosure. Supporting homosexual adolescents and their families is emphasized with regard to sensitively providing information, disclosure decisions, coping with stigmatization, and resiliency factors.

Adaptation, Psychological↗
PubMed1998

Staff response to abuse histories of psychiatric inpatients.

OBJECTIVE: In the context of numerous studies demonstrating that a significant proportion of psychiatric inpatients have been sexually or physically abused at some point in their lives this study ascertained the responses of staff in a psychiatric inpatient unit to knowledge that patients had been subjected to sexual or physical abuse, in childhood or adulthood. METHOD: The medical records of 100 consecutive admissions were examined. Staff response was measured in terms of: (i) acquiring information about previous treatment for, or disclosure of, abuse; (ii) providing information, support or counselling during hospitalisation; (iii) reporting to legal authorities; and (iv) referring for ongoing abuse counselling. RESULTS: Of the 32 patients who were documented as having disclosed abuse 11 files included documentation of previous treatment or disclosure; none were reported to have received support, counselling or information while in hospital; and three referrals were made for ongoing counselling. None of the 52 separate instances of abuse were reported to the authorities. Demographic, diagnostic, clinical and treatment variables, as well as the four abuse categories, were analysed for possible linkage to probability of staff response in each of the four response categories. CONCLUSIONS: It was hypothesised that the low staff response rate is not unique to the particular unit evaluated here. Recommendations are offered regarding the need for unit policies ensuring routine abuse inquiry and for staff training about how to respond to abuse disclosures.

Adult↗
PubMed1998

Relationship history and relationship attitudes in gay males and lesbians: attachment style and gender differences.

OBJECTIVE: The objective of the present study was to assess the applicability of attachment theory to the relationships of gay males and lesbians, with particular emphasis on parental relationships, relationship satisfaction, sexual attitudes and 'coming out' as being homosexual. METHODS: Gay males (n = 77) and lesbians (n = 100) completed questionnaires assessing attachment style, working models of attachment, early relationships with parents and relationship history, status and functioning. A comparison sample of heterosexual participants completed measures of attachment style and relationship history. RESULTS: Relative frequencies of attachment styles were similar for homosexual and heterosexual samples. Contrary to previous research using largely heterosexual respondents, no link between early parenting and attachment style was found. However, homosexual males reported more positive early relationships with mothers than did females. Associations of attachment style with working models, relationship variables and sexual attitudes largely supported those based on heterosexual samples. Gender and attachment style differences were found in reported effects of 'coming out' on relationships with parents. CONCLUSIONS: Overall, the results suggest that insecure attachment may not be over-represented in gay and lesbian samples, but that insecurity is associated with less relationship satisfaction and with problems related to the disclosure of sexual orientation. The implications of these findings for research and clinical practice are addressed.

Adult↗
PubMed2002

When the face reveals what words do not: facial expressions of emotion, smiling, and the willingness to disclose childhood sexual abuse.

For survivors of childhood sexual abuse (CSA), verbal disclosure is often complex and painful. The authors examined the voluntary disclosure-nondisclosure of CSA in relation to nonverbal expressions of emotion in the face. Consistent with hypotheses derived from recent theorizing about the moral nature of emotion, CSA survivors who did not voluntarily disclose CSA showed greater facial expressions of shame, whereas CSA survivors who voluntarily disclosed CSA expressed greater disgust. Expressions of disgust also signaled sexual abuse accompanied by violence. Consistent with recent theorizing about smiling behavior, CSA nondisclosers made more polite smiles, whereas nonabused participants expressed greater genuine positive emotion. Discussion addressed the implications of these findings for the study of disclosure of traumatic events, facial expression, and the links between morality and emotion.

Adolescent↗
PubMed2004

Domestic violence. Making a fist of it.

The poor reputation of the NHS in dealing with domestic violence is not helped by a lack of evidence on effective approaches to it. Screening programmes modestly increase disclosure of abuse but few studies measure outcome. Healthcare professionals should be alert to the possibility of domestic violence if the path to homelessness is to be avoided.

Battered Women↗
PubMed2006

Delayed disclosure of alleged child abuse victims in Israel.

This study identifies characteristics of alleged child abuse victims that are associated with delayed disclosure of abuse. The database includes all alleged victims investigated in Israel between 1998 and 2004. Analyses suggest that most children delay disclosure and that delay is associated with type of abuse, child's age and gender, relationship to suspect and characteristics of abusive event.

Adolescent↗
PubMed2004

Don't ask, don't tell: patterns of HIV disclosure among HIV positive men who have sex with men with recent STI practising high risk behaviour in Los Angeles and Seattle.

OBJECTIVES: A high incidence of HIV continues among men who have sex with men (MSM) in industrialised nations and research indicates many MSM do not disclose their HIV status to sex partners. Themes as to why MSM attending sexually transmitted infection (STI) clinics in Los Angeles and Seattle do and do not disclose their HIV status are identified. METHODS: 55 HIV positive MSM (24 in Seattle, 31 in Los Angeles) reporting recent STI or unprotected anal intercourse with a serostatus negative or unknown partner from STI clinics underwent in-depth interviews about their disclosure practices that were tape recorded, transcribed verbatim, coded, and content analysed. RESULTS: HIV disclosure themes fell into a continuum from unlikely to likely. Themes for "unlikely to disclose" were HIV is "nobody's business," being in denial, having a low viral load, fear of rejection, "it's just sex," using drugs, and sex in public places. Themes for "possible disclosure" were type of sex practised and partners asking/disclosing first. Themes for "likely to disclose" were feelings for partner, feeling responsible for partner's health, and fearing arrest. Many reported non-verbal disclosure methods. Some thought partners should ask for HIV status; many assumed if not asked then their partner must be positive. CONCLUSIONS: HIV positive MSM's decision to disclose their HIV status to sex partners is complex, and is influenced by a sense of responsibility to partners, acceptance of being HIV positive, the perceived transmission risk, and the context and meaning of sex. Efforts to promote disclosure will need to address these complex issues.

Adult↗
PubMed1995

Harnessing the heightened public awareness of celebrity HIV disclosures: "Magic" and "Cookie" Johnson and HIV testing.

This article investigates the impact NBA basketball star Earvin ("Magic") Johnson's HIV disclosure had on changes in demand for HIV counseling and testing services in New York State's 61 Anonymous HIV Counseling and Testing sites. Interrupted time-series analyses were conducted on weekly data from over 34,000 clients seeking anonymous HIV counseling and testing services from January 1991 to June 1992, to determine whether demand for these services changed as a result of the disclosure. Results indicated that immediately following the HIV disclosure, there was a substantial increase in service demand, which transcended all sex, race, age, and most HIV risk-related boundaries. Seven months later, demand had not returned to pre-disclosure levels. The strong impact on females, coupled with additional data analyses in obstetrical settings, suggests that previous research has been too narrow in focus, and that the effect of Johnson's HIV disclosure has been enhanced, in part, by the publicity surrounding his wife and baby. The importance of harnessing the heightened public awareness of celebrity HIV disclosures is discussed.

AIDS Serodiagnosis↗