Is HIV Non-Disclosure Linked to Poorer Health?

Surprising Results as Two-Year Study Questions Consequences of Non-Disclosure

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Photograph © Daniela Vladimirova

Most studies today have shown that people who are afraid, unable or simply choose not to disclose their HIV status are at greater risk of isolation, depression and anxiety, which may in turn result in the inability to maintain the necessary levels of HIV drug adherence—particularly if the drugs need to be taken in secrecy. This reasonably presumes that many of these individuals will be unable to sustain undetectable viral loads, leading to faster disease progression and poorer overall health.

But, wait a second, is this actually the case?

In recent years, researchers have begun to take a new look at the association between HIV non-disclosure and long-term health outcomes, and discovered that many of the earlier assumptions may not be entirely correct.

Variations in the Rate of HIV Disclosure

A two-year study, conducted by researchers with the Antiretrovirals, Sexual Transmission Risk and Attitudes (ASTRA) cohort, recruited 3,258 HIV-positive participants in eight U.K. clinics. The participants included not only men who had sex with men (MSM) but both heterosexual men and women, all of whom were clinically monitored from 2009-2011.

Participants were each surveyed to determine whether they had disclosed their status to either "nobody," "some," or "most or all" of their specific social group. Disclosure to casual sex partners was not included.

Overall, MSM were found to be more likely to disclose their HIV status, with only 5% not disclosing to anyone at all.

By contrast, a larger percentage of heterosexual women and men had not disclosed to anyone (16% and 17% respectively).

A greater immediacy and social interaction about HIV issues in general may help explain why MSM were more likely to make such disclosures, with a lesser perceived "social penalty" than in other social groups.

All told, the researchers were able to identify disclosure patterns as follows (% rounded off):

Disclosed toMen Who Have
Sex With Men (MSM)
No Family40%33%39%
No Friends14%43%56%
No Work Colleagues54%84%84%
Some Family32%44%47%
Some Friends56%38%50%
Some Work Colleagues39%13%14%
Most or All Family27%20%17%
Most or All Friends30%8%17%
Most or All Work Colleagues6%3%2%

Additionally, non-disclosure to a spouse or stable partner was highest heterosexual women (13%), followed by heterosexual men (10.9%) and MSM (4.9%).

While factors such as female disempowerment and other social vulnerabilities—such violence and economic vulnerability—may explain why 1-in-8 women didn't disclose their status, the impact of perceived social penalty may, again, make HIV disclosure more difficult among heterosexuals than among MSM.

HIV Non-Disclosure and Health Outcomes

After stratifying the data by group and the rate of non-disclosure, the ASTRA researchers also considered factors such as race, age, the time of HIV diagnosis, and the person's identification with a particular religion.

These factors were then compared to health outcomes such as:

What the investigators found was that non-disclosure, in and of itself, had absolutely no impact on any of these issues—that individuals who chose not to disclose were at no greater or less risk of poor health outcomes than those who had fully disclosed.

What they did find, however, was that poor health outcomes were more associated with factors such as older age, not being on ART, a more recent HIV diagnosis, and black ethnicity. Among MSM, the identification with a religion was also considered a key factor.

While these results may suggest that many of the assumptions about HIV non-disclosure were incorrect, the more reasonable explanation would be that the efficacy of modern ART (simpler dosing schedules, lower pill burdens, fewer side effects) have better enabled people to achieve optimal response to ART even in the face of less-than-perfect adherence.

This doesn't suggest, however, that HIV disclosure is any less important than it has ever been, particularly when isolation, depression or feelings of shame can increase such associative risk factors as alcohol and substance abuse.

Furthermore, the risk of HIV transmission is invariably higher if a person's HIV-positive status is kept secret. In many cases, non-disclosure of this type is triggered by the fear of stigmatization, abandonment, discrimination, or, in the case of an unprotected sexual act, potential criminalization.

Therefore, efforts to encourage disclosure of HIV status and social support should remain central the public health and prevention message.


Daskalopoulou, M.; Lampe, F.; Phillips, A.; et al. "Non-disclosure of HIV serostatus and associations with psychological factors, ART non-adherence, and viral load non-suppression among people living with HIV in the UK." British HIV Association (BHIVA) Conference; Brighton, United Kingdom; April 22, 2015; abstract O3.

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