1. Disclosing A Positive HIV Diagnosis: Experiences of Young Adult Men Who Have Sex with Men David J. Reyes, MN, MPH, RN APHA 131 st Annual Meeting November 19, 2003

2. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Disclosing A Positive HIV Diagnosis “…this is my truth now… it’s a beautiful part of who I am.” it’s a beautiful part of who I am.” -- ‘Tom’

3. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Healthy People 2010: Companion Document for Lesbian, Gay, Bisexual & Transgender Health  To prevent HIV & associated illnesses  To increase “access to quality, culturally competent health care services, & support groups for young adults with HIV.” - HP 2010: Companion Document for LGBT Health, 2001

4. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Study Purpose To describe the experiences of young adult MSM who have disclosed their positive HIV status to sex partners To explore the significance of telling sex partners and others about being HIV positive

5. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Study Participants Four young adult MSM, 22-29 years-old who had disclosed their positive HIV status to at least one male sex partner in person, were recruited from community-based organizations, health clinics and social service agencies. Four young adult MSM, 22-29 years-old who had disclosed their positive HIV status to at least one male sex partner in person, were recruited from community-based organizations, health clinics and social service agencies.

6. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Methodology An exploratory methodology using semi-structured interview techniques was employed to identify salient patterns and themes associated with disclosing a positive HIV diagnosis. A self-administered demographic survey was also used to identify demographic characteristics and behavioral risks factors.

7. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Analysis Three representative case studies were developed from participant interviews & demographic surveys Inductive methods were used to identify major codes, categories and themes associated with disclosing a positive HIV status to sex partners and others.

8. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Study Findings Two major themes emerged:  Transcendence  Contingent Disclosure

9. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Transcendence CONSCIOUS - “…I never viewed HIV as something that defined me…it’s inside me but it isn’t me…it just happens to be in me…(Ed)”

10. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Transcendence FOCUS - “…That ties in a lot with what I’m trying to do for myself right now in recovery. You know, coming to believe in or coming to understand more about that part of me that wants to be honest and open about things…(Jack)”

11. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Contingent Disclosure CONSCIENCE - “…sex is something that you share between two people. There’s a lot more to it….when you talk about things that will be exchanged during the act you gotta be honest (Ed).”

12. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Contingent Disclosure MOTIVE - …it all comes from your motive….Is your motive just to go out and have a few moments of whatever?...But you should tell them (Tom).”

13. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Contingent Disclosure SITUATION - …I never initially start out telling them. Simply because my experience with relationships with potential partners or sex partners, most of them don’t last more than a few days, if that…but people I’m potentially interested with, I want them to know me first because if I bring that up to attention right away that’s defining me (Ed).”

14. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Contingent Disclosure MOTIVE MOTIVE SITUATION SITUATION CONSCIOUS CONSCIOUS

15. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Framework for Contingent Disclosure Disclosure Non- Disclosure

16. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Implications for Healthcare Workers Challenge own assumptions about people living with HIV Develop a framework of continuous cultural competence relative to own values Assist people with HIV to identify own assets & resources to cope with HIV Coach & nurture people with HIV to develop sense of purpose & self-esteem

17. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Implications for Research Further exploration of the disclosure process inclusive of the complex psychological pressures, social influences, and moral principles Evaluation research of HIV counseling and testing programs Examining social networks and other support systems necessary to cope with a positive HIV diagnosis

18. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Implications for Research Determining readiness & efficacy of the HIV positive person to disclose HIV status Evaluating barriers to disclosure for the HIV positive person relative to the intended outcome of disclosure Examining the differences and similarities between disclosure of HIV status and other significant life-altering health events in order to compare and identify successful coping strategies.

19. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 Conclusions Contracting HIV and the impacts associated with it represent a significant-life altering event. Disclosure of a positive HIV diagnosis is fraught with competing and conflicting interests and motivations. It is a decision that impacts both the discloser and the intended recipient, and can be harmful physically and emotionally. For the men in this study, disclosure was a positive means of finding purpose to life through a process of conscious introspection, self- reconciliation, positive action, and frame of mind.

20. David J. Reyes, MN, MPH, RN APHA 131st Annual Meeting November 19, 2003 “…support comes from the power within and that’s kind of where I get most of my strength…it’s always there for me…(Tom).”