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The effects of disclosure and intervention on sexually abused children.

There has been concern that disclosure and intervention might negatively impact victims of sexual abuse. In this retrospective study, 82 children and their families were interviewed about their experiences with disclosure and intervention an average of 3.5 years later. The children and parents completed a measure of distress developed for the study which discriminated between abused and non-abused children. The children reported primarily favorable experiences and provided clinically helpful descriptions of the positive and negative aspects of intervention. More contacts with intervention professionals was associated with increased distress, placement, offender removal and testifying were not. Based on the children's comments, suggestions for improving the intervention process are made.

Age Factors↗

AIDS and sex: is warning a moral obligation?

Common-sense holds that morality requires people who know that they are infected with the Human Immunodeficiency Virus (HIV) to disclose this fact to their sexual partners. But many gay men who are HIV-positive do not disclose, and AIDS Service Organizations (ASOs) promote public-health policies based on safer sex by all, rather than disclosure by those who know that they are infected. The paper shows that the common-sense view follows from a minimal sexual morality based on consent. ASOs' seeming rejection of the view follows from their need to take seriously widespread weakness of will in the realm of sexuality. The author argues that gay men take themselves to follow the common sense view, but hold that the possibility of a partner's HIV infection is background information that need not be disclosed for sexual consent. This suggestion is criticized. The paper concludes with a consideration of HIV disclosure and sexual ethics outside of the gay community and of legal restrictions on the sexuality of the HIV-positive.

Acquired Immunodeficiency Syndrome↗

HIV risk and communication between regular partners in a cohort of HIV-negative gay men.

This paper reports on the breaking of agreements between regular partners among HIV-negative gay men in Sydney. Data were from the 1333 men completing face-to-face interviews through December 2003 for the Health in Men (HIM) open cohort of HIV-negative gay men in Sydney.822 men had a primary regular partner during the six month period before their 2003 interview. Most of these men had entered into agreements with their partners about sex either with each other or with other partners (87.2%). They most commonly agreed not to use condoms with each other (50.6%). Regarding casual sex, they most commonly agreed to always use condoms (34.2%) or to have no sex with men outside their relationships (28.6%). 48.8% reported some discomfort discussing with their partner their sex outside the relationship. Among those with agreements with their partners, 27.7% reported ever breaking those agreements. Those who found it more difficult to discuss issues of HIV serostatus and sexuality were more likely to report having broken their agreements (p<.001; p=.021 at one-year follow-up) and were more likely to have engaged in unprotected anal intercourse with casual partners (p<.001). A third of those men who broke their agreements did not inform their partner. A substantial proportion of gay men with agreements with their regular partners report some discomfort discussing sexuality and HIV serostatus with their partners. Difficulty discussing these issues may place these men at increased risk of breaking their agreements and may place both themselves and their partners at increased risk of infection.

Adult↗

Disclosure of HIV serostatus to sex partners in rural Louisiana.

To examine correlates of HIV disclosure, a convenience sample of 273 HIV-infected persons throughout rural Louisiana were interviewed. Disclosure to sexual partners at time of initial HIV-positive diagnosis and the time of the study interview was ascertained (an average of 5.76 years later). The prevalence of disclosure to past and current sex partners was 57.2% and 80.7% respectively. Those who reinitiated sex with their partner since testing positive for HIV and those who received partner notification were more likely to disclose to past partners. Non-African Americans and those with only one partner were more likely to disclose to present sex partners. Much like urban settings, disclosure is not universal, and interventions such as disclosure skills building and/or ongoing partner notification services may be needed to facilitate disclosure.

Adult↗

Toward rational criminal HIV exposure laws.

This article examines criminal HIV exposure statues that address undisclosed exposure through consensual sexual activity. Twenty-seven U.S. states have adopted some form of HIV exposure statute. Thirteen of these statutes specifically address exposure through sexual activity, while another eleven statutes could be applied to exposure through sexual activity, while another eleven statutes could be applied to exposure through consensual sexual interactions. Although the penalties for breach of these laws are often severe, the risk of actual harm posed by the many of the behaviors prescribed is minimal and in some cases virtually nonexistent. After an overview of the various types of U.S. criminal HIV exposure statutes and discussion of the risk of HIV transmission through the various sexual activities addressed in the laws, the authors highlight the tenuous relationship between proscribed activities and actual risk of virus transmission. The authors address this limitation in the law by offering a framework for the evaluation and construction of HIV exposure statutes that considers not only the intent of the HIV-positive actor but also the risk that his or her conduct poses to others.

Communicable Disease Control↗

Determinants of disclosure of genital herpes to partners.

OBJECTIVE: To identify factors which determine whether and when patients will disclose infection with genital herpes to sexual partners. METHODS: The sample was 26 women and 24 men attending a herpes clinic in a sexually transmitted disease clinic. Semistructured interviews yielded quantitative data and also qualitative data which were subjected to content analysis. RESULTS: Characteristics of partners were very important in determining whether disclosure occurred. Respondents were less likely to tell partners regarded as casual. Perception of the likely reaction of partners was important in deciding whether to tell. Many respondents assumed that they were not infectious if they were not currently having an attack or if they were taking antiviral medication. The decision whether to tell tended to be based on considerations of likely discovery and of honesty towards the partner rather than control of transmission. Of patient characteristics only self rated depressed mood was related to disclosure to the most recent partner. CONCLUSIONS: Perception of the partner and anticipated partner response is crucially important in determining whether and when disclosure of genital herpes infection occurs.

Adult↗

Disclosing concerns of Latinas living with HIV/AIDS.

This study described the disclosing experiences of Latinas with HIV/AIDS in the San Francisco Bay Area. Limited information is available on the disclosing processes, situations and consequences. The design was a descriptive study with 19 Latinas. Content analysis was used to analyze the data. Deciding to disclose was identified as the core category. Four major categories emerged from the data. Deciding to disclose has social, psychological and economical issues. Nurses need to be aware of the disclosing issues when caring for Latinas with HIV/AIDS.

Acquired Immunodeficiency Syndrome↗

The art of truth telling: handling failure with disclosure and apology.

There are sentinel events and near misses associated with leadership and management, as well as the clinical process of health care. We should hold ourselves accountable to the same level of rigor and analysis of these events and near misses as we expect from clinicians. Research and analysis will continue to help us understand the science behind the power of truth telling and apology.

Attitude of Health Personnel↗

Disclosure of diagnostic information to cancer patients in Greece.

Truth-telling to cancer patients is controversial. The aim of the present study was to investigate oncologists', radiotherapists', and palliative care specialists' attitudes and truth-telling practices in Greece. A postal survey of a representative sample of 300 oncologists, radiotherapists, and palliative care specialists was made in February 1993. A total of 228 doctors completed and returned the questionnaires. It appears that withholding the truth from cancer patients remains very common in Greece.

Adult↗

What is meant by telling the truth: Bonhoeffer on the ethics of disclosure.

This article explores Dietrich Bonhoeffer's writings on truth telling with reference to the problem of medical error in the US, the UK, and other developed nations, with particular attention to physicians' resistance to disclosing their own mistakes to injured patients and their families. The brief essay 'What is Meant by "Telling the Truth"?' and its historical context--Bonhoeffer's imprisonment and interrogation in 1943--is proposed as a text for medical ethicists and others seeking to overcome the barrier of the 'hidden curriculum' within the culture of medicine, which encourages medical students and physicians to conceal their errors and to fear disclosure.

Attitude of Health Personnel↗

Breaking secrecy. Adult survivors disclose to their families.

With families in which incest has occurred, secrecy is the organizing principle of all family relationships. Both the testimony of survivors and the clinical literature emphasize the central role of the incest secret. Children who have been sexually abused by adults outside the family also frequently keep this secret as a result of intimidation or shame. Secrecy compounds the trauma of the sexual abuse itself by isolating the victim from others, so that her perceptions can not be validated. Often, the victim comes to doubt her own experience of reality, which is at odds with the family's version of the truth. Many, if not most, victims of child sexual abuse reach adult life still preserving the rule of secrecy.

Adaptation, Psychological↗

Donor insemination: the gifting and selling of semen.

The authors examine the implications for individuals and society of how semen is provided for use in donor insemination treatment. In particular, they focus on whether 'donors' make a gift of their semen or are paid. The role of health professionals in shaping the nature and meaning of semen provision is also explored. The currently predominant practice of buying semen is compared with other reproductive and biomedical exchanges: oocyte and embryo donation, surrogacy, and blood, organ and fetal tissue donation. The authors suggest that the commercialisation of semen determines and reflects the type of men frequently recruited to provide semen. This in turn influences the meaning that donors themselves, recipients, offspring, health professionals and society at large attribute to the provision of semen.

Age Distribution↗