HIV positive: who do they tell?

Sir: HIV-related stigma and discrimination have serious individual and public health consequences that contribute to a reluctance to be tested for HIV and to disclose positive test results to partners, poor treatment adherence, and increased risk of disability and drug resistance. ¹ Various studies have demonstrated that HIV-related stigma is common worldwide and occurs in a variety of contexts, including the family, community, workplace and healthcare settings.^2,3 With continuing growth in the incidence of HIV in a setting of continuing HIV-related stigma, the area of HIV medicine faces many potential challenges in controlling the epidemic.

In a comparative study of HIV antibody positive patients in Ireland and Australia, carried out between June and December 2005, the topic of HIV status disclosure was examined. ⁴ HIV antibody positive patients attending outpatient clinics in two clinics in Southern Ireland and one clinic in Sydney, Australia were administered a cross-sectional self-administered anonymous questionnaire. Informed consent was obtained and bar-coded patient information leaflets were given to each participant. Data were analysed using SPSS (Statistical Package for the Social Sciences. SPSS Inc., Chicago, IL, USA). Ethical approvals were prospectively received in both countries.

The mean age of patients in Ireland was 36.2 years compared with 45.3 years in Australia, while the mean age at diagnosis was 31 years (range: 19–58) and 34 years (range: 16–60), respectively, and the mean length of time diagnosed was five years (<1–15) and 12 years (<1–24), respectively. In Ireland 67% were male (31% = men who have sex with men [MSM]) while in Australia 98% were male (75% = MSM]). The predominant nationality in Ireland was understandably Irish (47%), with 42% African, 5% British and 5% other Western Europeans. This compared with patient nationality in Australia being 66% Australian, 16% New Zealanders, 12% UK, with a few from other countries. Overall, 87.5% of non-nationals had lived in Ireland for less than five years compared with 1.4% in Australia.

Overall, 53% in Ireland and 56% in Australia have a regular sexual partner (RSP). Non-nationals are more likely to have an RSP in both countries (64% = Ireland, 68% = Australia). RSPs had been informed by 53% and 52% of patients in Ireland and Australia of HIV-positive status. Significantly more HIV-positive patients in Ireland have not told anybody (19% [non-nationals = 24%, nationals = 11%] versus 5% [non-nationals = 2%, nationals = 6%]), P < 0.005. This may be because 78% in Ireland and 55% in Australia ‘mind’ people finding out about their HIV status. It is noteworthy that 75% (negatively = 83%) in Ireland and 63% (negatively = 73%) in Australia feel they are treated differently when people know their status. Cultural beliefs of the large African population in Ireland and traditional attitudes of Irish nationals may be the reason for large non-disclosure values in the Irish cohort. Table 1 gives a complete breakdown of HIV status disclosure.

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Table 1

HIV status disclosure

	Ireland	Australia
Who knows your HIV status:
Nationals:	37	97
Partner	21 (57%)	44 (45%)
Family	25 (68%)	62 (64%)
Friends	4 (11%)	80 (82%)
Nobody	4 (11%)	6 (6%)
Non-nationals:	54	51
Partner	27 (50%)	33 (65%)
Family	15 (28%)	33 (65%)
Friends	7 (13%)	41 (80%)
Nobody	13 (24%)	1 (2%)

All these disclosure findings are in the positive setting that 54% of the Irish cohort and 41% of the Australian cohort believe there will be a cure for HIV within the next 10 years. There is no correlation between cure beliefs and sex, age, nationality, being on highly active antiretroviral therapy (HAART), length of time diagnosed or history of HAART medication changes.

Therefore, from the findings of this study and previous studies we feel that it is extremely important that HIV patients be encouraged and supported in informing their RSPs of their HIV status. The benefits would be predominantly two-fold: safe sex practices between partners, potentially reducing infection spread and/or resistance development and provision of emotional support for HIV patients from their partners.