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PubMed1999

What date/acquaintance rape victims tell others: a study of college student recipients of disclosure.

The authors surveyed 828 college students and found that approximately one third (n = 282) of the respondents reported that one or more women had told them that they had been raped by their dates or acquaintances. The 282 respondents who knew 1 or more victims of date/acquaintance rape reported on a total of 396 victims. The number of victims identified by respondents ranged from 1 to 3 or more (1 = 73%; 2 = 19%, 3 = 5%, > or = 4 = 3%). Reactions to disclosure offered by these respondents were generally supportive of the victim. The respondents' reactions suggested that there is a continuing need to educate students about the incidence and risks associated with date/acquaintance rape and the possibility of disclosure, particularly by friends or dating partners, and brought out some possible helpful and some counterproductive reactions to such disclosures.

Adolescent↗

PubMed2001

Women's barriers to HIV-1 testing and disclosure: challenges for HIV-1 voluntary counselling and testing.

In view of the ever-increasing HIV/AIDS epidemic in sub-Saharan Africa, the expansion of HIV-1 voluntary counselling and testing (VCT) as an integral part of prevention strategies and medical research is both a reality and an urgent need. As the availability of HIV-1 VCT grows two limitations need to be addressed, namely: low rates of HIV-1 serostatus disclosure to sexual partners and negative outcomes of serostatus disclosure. Results from a study among men, women and couples at an HIV-1 VCT clinic in Dar es Salaam, Tanzania are presented. The individual, relational and environmental factors that influence the decision to test for HIV-1 and to share test results with partners are described. The most salient barriers to HIV-1 testing and serostatus disclosure described by women include fear of partners' reaction, decision-making and communication patterns between partners, and partners' attitudes towards HIV-1 testing. Perception of personal risk for HIV-1 is the major factor driving women to overcome barriers to HIV-1 testing. The implications of findings for the promotion of HIV-1 VCT programmes, the implementation of partner notification policies and the development of post-test support services are discussed.

Africa South of the Sahara↗

PubMed2005

Methamphetamine-dependent gay men's disclosure of their HIV status to sexual partners.

Disclosure of one's HIV status to a potential sexual partner has important HIV prevention implications. This paper qualitatively evaluates the social and sexual contexts that influence disclosure of HIV status among methamphetamine-dependent gay men enrolled in an outpatient drug treatment research program. As part of an open-ended, semi-structured interview, 34 HIV-positive and HIV-negative men discussed how, when, to whom and under what circumstances they reveal information about their HIV status. The four factors that influence participants' decision to disclose include: (1) an HIV-negative sexual partner's disclosure; (2) sexual venue (private versus public); (3) primary versus non-primary partner; and (4) the perceived risk of the sexual act. Sexual encounters among the men in this sample often occurred in public environments with non-primary partners, and involved use of illicit substances. In these social and sexual contexts, both HIV-positive and HIV-negative participants believed that it is HIV-negative rather than HIV-positive men who should initiate safer sex dialogue and safer sex practices. Findings are helpful in crafting HIV-prevention interventions targeting substance-using gay men whose sexual practices place them at high-risk for HIV-infection.

Adult↗

PubMed2005

HIV disclosure by men who have sex with men to immediate family over time.

Previous researchers have comprehensively documented rates of HIV disclosure to family at discrete time periods yet none have taken a dynamic approach to this phenomenon. The purpose of this study was to address the trajectory of HIV serostatus disclosure to family members. Time to disclosure was analyzed from data provided by 135 HIV-positive men who have sex with men. Results indicated that mothers remain the family member to be told in greatest proportion, yet the proportion of family members told changes over time in a different manner than presented in earlier research. Additionally, the rate at which family members are told at all time points generally does not significantly differ from each other when accounting for characteristics of participants and family members.

Adult↗

PubMed2004

Disclosure of genetic information obtained through research.

The rapid expansion of information and knowledge of genetics has implications for the question of whether, and under what circumstances, information discovered in the course of genetic research should be conveyed to research participants and/or their relatives. The aim of this paper is to propose an ethically defensible solution to a specific case example illustrating this problem. To do this we reviewed the literature to find answers to the following three questions: (1) What do current regulations, guidelines, and commentary say about the disclosure of genetic risk information obtained through research to research participants? (2) What do current regulations, guidelines, and commentary say about the disclosure of genetic risk information obtained through research to the relatives of research subjects? and (3) What do current regulations, guidelines, and commentary say about the disclosure of genetic risk information obtained through research about former research participants who are now deceased? Our conclusion is that current U.S. federal guidelines governing the use of human subjects in research, as well as much of the current literature, do not adequately address the familial dimension inherent in genetic research, are virtually silent on the issue of sharing information of relevance to family members, and do not protect the deceased. It is our belief that this omission needs to be corrected and that explicit guidance on this issue needs to be provided to institutional review boards and researchers alike.

Genetic Counseling↗

PubMed2006

Diagnosis and prognosis disclosure among cancer patients. Results from an Italian mortality follow-back survey.

BACKGROUND: The observed cultural changes in truth-telling attitudes suggest a radical change in the practice of delivering information to cancer patients, but limited research is available from countries known for their policy of non-disclosure. This study estimates the proportion of Italian who died of cancer who had received information about diagnosis and prognosis, and explores the variables associated with disclosure. MATERIALS AND METHODS: This is a mortality follow-back survey of 1271 non-professional caregivers of Italians who died of cancer in 2002, representative of the approximate 160 000 Italian annual cancer deaths. Caregivers were interviewed after the patient's death about the process of diagnosis and prognosis disclosure. RESULTS: It was estimated that 37% of people who died of cancer had received information about diagnosis and 13% about poor prognosis. A consistent proportion, although non-informed, knew the diagnosis (29%) and the poor prognosis (50%). The probability to be informed was higher for patients living in the north of Italy, young, well educated, with longer survival, and with breast or head and neck tumor. CONCLUSIONS: These findings suggest that not necessarily the observed cultural changes towards a less paternalistic approach in medical care translate into an effective change in the quantity of information delivered to the patients.

Adolescent↗

PubMed2001

The effects of selected classical music on self-disclosure.

A cognitive theory of emotion and aesthetics in music suggests that listening to music is cognitively and in turn emotionally arousing. In addition a theory of inhibition and psychosomatic disease suggests that disclosing personal and traumatic information is psychologically and physically beneficial. This study examined the effect of music within a disclosure setting on the use of cognitive and emotional language in 85 undergraduates. Participants in both the background music and no music conditions wrote or spoke into a tape recorder, about the most significant event or experience of their lives. In addition to language, self-reported moods, subject impressions about the disclosure experience, and the environment were examined. Results indicate that background music had an effect on the disclosure topics chosen, promoted cognitive suggestion and expression, and increased the enjoyment of listening to classical music.

Adult↗

PubMed2005

Brief report: parent perceptions of hypoglycemic symptoms of youth with diabetes; disease disclosure minimizes risk of negative evaluations.

OBJECTIVE: Based on a theoretical model, this study explored the effects that the disclosure of diabetes has on parental perceptions of a hypothetical child experiencing hypoglycemia. METHODS: Parents (N = 610) first read vignettes that varied in a 2 x 2 design (Male vs. Female Character x Preventative Disclosure of Illness vs. Nondisclosure) and then answered several questions regarding the hypothetical child, resulting in four subscales that were validated using confirmatory factor analysis. RESULTS: Disclosure of diabetes significantly increased perceptions of a medical problem, decreased suspicions of drug use, and presented a lower risk of parental restrictions on future contact with their child. CONCLUSIONS: Individuals who disclose their diabetes may prevent negative social consequences and restrictions on social contact. Those who choose not to disclose may risk having a hypoglycemic event perceived as a drug or alcohol problem, which may ultimately interfere with appropriate medical intervention in a hypoglycemic event.

Adolescent↗

PubMedDate not supplied

Disclosure of HIV status to medical providers: differences by gender, "race," and immune function.

OBJECTIVE: The authors used data from a larger study to explore differences by gender, self-reported racial identification, and immune function in disclosure of HIV-positive serostatus to medical providers (dentists, family doctors, and emergency room [ER] and obstetrics-gynecology [ob/gyn] providers). METHOD: The authors analyzed interview responses from a convenience sample of African American and white men and women receiving HIV medical care at urban hospitals and clinics in St. Louis. Missouri. RESULTS: Of 179 respondents using at least one of three types of providers, 124 (69%) disclosed their HIV status to all applicable types of providers, 39 (22%) disclosed to only one or two types of providers, and 16 (9%) did not disclose to any of these types of providers. "Race" and CD4 count, but not gender, were independently associated with disclosure to dentists, family doctors, and ER providers in multivariate logistic regression analyses. CONCLUSIONS: Differences in disclosure rates, especially among patients who may be asymptomatic, suggest a need for public health education of both medical providers and patients with HIV.

Adolescent↗

PubMed1994

Death from suicide and overdose among drug injectors after disclosure of first HIV test result.

OBJECTIVE: To investigate whether notifying injecting drug users (IDU) of their positive HIV serostatus contributes to suicide and overdose mortality risk. DESIGN: Members of a cohort of IDU, recruited since December 1985, who first learned their HIV serostatus after study entry but before December 1992, were studied for incidence of deaths due to suicide and overdose. METHODS: Incidence of mortality due to suicide/overdose was calculated from date of first HIV test result disclosure until the end of follow-up or diagnosis of AIDS. RESULTS: Eighty-six HIV-positive and 252 HIV-negative IDU were included with median follow-up times of 4.3 and 4.0 years, respectively. Seven suicides and 10 deaths from overdose were recorded. High suicide/overdose risk shortly after test result notification was not found among HIV-positive IDU. Only one out of eight HIV-positive IDU who died of suicide/overdose died within 6 months of first disclosure. The overall suicide/overdose mortality rate was higher for HIV-positive than HIV-negative IDU; the rate ratio being 2.46 [95% confidence interval (CI), 0.95-6.39] or 2.04 (95% CI, 0.77-5.39) after control for confounders. CONCLUSIONS: Notifying IDU of their positive HIV serostatus does not appear to lead to a sudden and substantial rise in suicide/overdose deaths. Although death from suicide/overdose is more common among HIV-positive than HIV-negative IDU, this difference is likely to result from factors other than test result disclosure. Therefore, provided that appropriate counselling is offered, we see no reason to discourage voluntary HIV test result notification for fear of inducing suicide in HIV-infected IDU.

AIDS Serodiagnosis↗

PubMed2003

Changes in levels of hope after diagnostic disclosure among Taiwanese patients with cancer.

The purposes of this study were to explore the extent to which the practice of disclosing cancer diagnoses to patients is used in Taiwan, to examine the relation between cancer diagnosis disclosure and levels of hope, and to investigate the relation between length of time since diagnosis and levels of hope. The participants in this study were 124 Taiwanese oncology inpatients and outpatients. Of these patients, 79% were informed of their cancer diagnosis. The informed patients reported significantly higher levels of hope than those who were not informed. Finally, patient levels of hope decreased as the time between cancer diagnosis and disclosure increased. The implications of this study are discussed in terms of cancer disclosure practice and enhancement of levels of hope for Taiwanese patients with cancer.

Adaptation, Psychological↗

PubMed2002

Disclosure after a sibling's death from AIDS.

The purpose of this article was to describe patterns of disclosure among adults after their sibling's death from AIDS. A descriptive study design was done by use of a cross-sectional sample including 87 adults from separate families. Sibling responses were audiotaped and content analyzed. Six categories of disclosure emerged from the data: Purposeful, "If Asked I Tell," Selective, Protective, Restricted, and Avoidant. Categories differed across three dimensions: usual method of telling, goal of method, and underlying belief about public disclosures. It was found that siblings disclose variably after their brother's or sister's death from AIDS. In bereavement contexts characterized by stigma, bereaved siblings consider many potential consequences before choosing how they will tell others their brother or sister died from AIDS.

Acquired Immunodeficiency Syndrome↗

PubMedDate not supplied

Cynical hostility and cardiovascular reactivity during self-disclosure.

Recent research suggests that hostility might contribute to the development of coronary heart disease (CHD) and other illnesses. One potential mechanism linking hostility and health is exaggerated physiological reactivity to social stressors. Given that mistrust and suspiciousness are closely related to this trait, the self-disclosure of personal information regarding a stressful experience may elicit heightened reactivity in hostile persons. To evaluate this hypothesis, undergraduate men (N = 60) classified as high or low on the Cook and Medley Hostility (Ho) Scale were randomly assigned to either a self-disclosure or a nondisclosure condition. Consistent with prediction, among subjects participating in the self-disclosure discussion task, hostile individuals displayed significantly greater blood pressure reactivity compared with subjects low in hostility. These results support the psychophysiological reactivity model of hostility and health, and underscore the potential importance of social context in the psychosomatic process.

Adult↗

PubMed1999

Disclosure of HIV status to sexual partners: predictors and temporal patterns.

BACKGROUND AND OBJECTIVES: Failure to disclose human immunodeficiency virus (HIV) infection to sexual partners interferes with risk reduction. GOAL OF THIS STUDY: The purpose of this study was to identify factors associated with disclosure and failure to disclose HIV infection to sexual partners and to describe condom use with nondisclosure. STUDY DESIGN: A longitudinal survey study of HIV seropositive persons recruited at a public STD clinic. RESULTS: Approximately 76% of the study population (n = 147) reported disclosing their HIV status to their last sex partner at baseline. Predictors of disclosure included consistent condom use and being in a monogamous relationship. Twenty-two percent of those who disclosed at baseline reported nondisclosure during follow-up. Approximately 23% reported not using a condom with a person to whom their status was not disclosed. CONCLUSIONS: These results suggest that ongoing partner notification may be necessary to increase disclosure of HIV status to sex partners over time.

Adult↗

PubMed2005

Abortion disclosure and the association with domestic violence.

OBJECTIVE: To estimate the rate at which women disclose abortion to their partners and examine the association between domestic violence and partner disclosure. METHODS: A cross-sectional cohort study was performed on women presenting for elective termination of pregnancy to a single clinic in Houston, Texas. Subjects were offered an anonymous, self-administered questionnaire. The 15-question survey addressed disclosure of abortion to the partner, reasons for nondisclosure if applicable, and physical and sexual abuse using a modified Abuse Assessment Screen. RESULTS: Of 960 patients, 85.2% completed the survey, for a final sample size of 818. Overall, 139 (17.2%) of subjects chose not to disclose the abortions to their partners, and 14% of patients reported abuse within the past year. Physical or sexual abuse or both was twice as common among nondisclosers (23.7% compared with 12.0%, P = .001). Among nondisclosers, 63 (45.3%) said the relationship with the partner had no future, 52 (37.4%) did not feel obliged to notify their partners, 29 (20.9%) said the partner would oppose the abortion, and 11 (7.9%) said disclosure would result in physical harm. CONCLUSION: In this urban, racially and socioeconomically diverse population, 17.2% of women concealed pregnancy terminations from their partners. Although relationship instability and personal choice were cited as the most frequent reasons for nondisclosure, the rate of domestic abuse was twice as high in this group and may have adversely affected open communication. Of greatest concern, a subset of nondisclosers reported the direct fear of personal harm as the primary reason for nondisclosure.

Abortion, Induced↗

PubMed2005

Guarded self-disclosure predicts psychological distress and willingness to use psychological services among East Asian immigrants in the United States.

This study examined the relationship between guarded self-disclosure, psychological distress, and willingness to use psychological services if distressed among 170 (88 male, 82 female) East Asian immigrants in the United States. Participants were administered a battery of psychometrically established measures. Participants who endorsed overall guarded self-disclosure, self-concealment (i.e., unwillingness to reveal affect to others), or conflict avoidance (i.e., maintenance of harmony via suppression of feelings) were significantly more likely to report psychological distress and were significantly less likely to report willingness to use psychological services. While conflict avoidance was a significant independent predictor of psychological distress, self-concealment was a significant independent predictor of willingness to use psychological services. These findings point to the importance of assessing multiple facets of guarded self-disclosure, which appear to be differentially associated with psychological distress and willingness to use psychological services.

Adult↗

PubMed2001

Experiences of genetic risk: disclosure and the gendering of responsibility.

The question of 'who owns genetic information' is increasingly a focus of ethical inquiry. Applied to predictive testing, several recent critiques suggest that persons with a genetic disorder have a moral duty to disclose that information to other family members. The justification for this obligation is that genetic information belongs to and may benefit not only a single individual, but also members of a biological kinship. This paper considers this issue from a different vantage point: How does gender intersect with the moral duty to disclose genetic information? Scholars have argued that gender is partly comprised of distinct assignments and assumptions of responsibility. Thus, there is a danger that gendered patterns of socialization will make women feel that they should take primary responsibility for disclosing genetic information to others. This article explores issues of responsibility and disclosure of risk information by drawing on an empirical study of women and men who have undergone genetic testing for hereditary breast/ovarian cancer. The research study suggests that disclosure of genetic information is a gendered activity, with both the benefits and burdens of this task falling primarily on women. It also illustrates that when disclosure is understood contextually, it is a far more complicated matter than when viewed through a theoretical lens. The article considers the relevance of these findings on ethical debate and genetic counselling practices.

Breast Neoplasms↗

PubMed2003

'Hitting you over the head': oncologists' disclosure of prognosis to advanced cancer patients.

The disclosure of prognosis to terminally ill patients has emerged as a recent concern given greater demands for patient involvement in medical decision-making in the United States. As part of the informed consent process, American physicians are legally and ethically obligated to provide information to such patients about risks, benefits, and alternatives of all available treatment options including the use of experimental therapies. Although not legally required, the disclosure of terminal prognosis is ethically justified because it upholds the principle of self-determination and enables patients to make treatment decisions consistent with their life goals. To understand oncologists' attitudes about disclosing prognostic information to cancer patients with advanced disease, we interviewed fourteen oncologists and conducted one focus group of medical fellows. Although oncologists reported to disclose prognosis in terms of cancer not being curable, they tend to avoid using percentages to convey prognosis. Oncologists' reported reluctance to disclosing prognosis was conveyed through the use of metaphors depicting the perceived violent impact of such information on patients. Oncologists' reluctance to disclose prognosis and preserve patient hope are held in check by their need to ensure that patients have 'realistic expectations' about therapy. We discuss these data in light of the cultural, ethical, and legal dimensions of prognosis disclosure, patient hope and the doctor-patient relationship, and recommend ways to enhance the communication process.

Attitude of Health Personnel↗