The HIV revelation model: predicting the disclosure of HIV seropositivity during casual sex between men

Abstract

Background: The disclosure of HIV seropositivity during casual sex between men is uncommon, and disclosure interventions typically ineffective. To guide future interventions, this study aimed to produce an empirically supported, theoretically informed, model of disclosure. Objectives were: (1) evaluate the predictive quality of the Theory of Planned Behaviour (TPB); (2) evaluate the predictive quality of the Revelation Risk Model (RRM); (3) combine the results of these evaluations with exploratory analyses in the development of a new model. Methods: Longitudinal survey data were collected online from 333 HIV-positive men who have sex with men (MSM). Measures assessed were attitudes, norms, efficacy, control, intentions, HIV-related stigma, sexual exclusion, relationship consequences, responsibility, health and transmission optimism, privacy concerns, sexual compulsivity, self-esteem, anxiety and depression, and social desirability. Analysis was conducted using Bayesian structural equation modelling. Results: Models based on the TPB and the RRM were an extremely poor fit to the data (PPP < .01). Informed by the TPB and RRM, the HIV Revelation Model (HRM) was developed through exploratory analyses. The HRM was an excellent fit to data (PPP = .50), accounted for a moderate amount of the variance in disclosure (R2 = .44), and was parsimonious, using just 4 factors to predict disclosure behaviour – stigma, depression, responsibility, and efficacy. Discussion: This study advances understanding of the disclosure of HIV seropositivity at a time when new diagnoses among MSM are rising. The HRM highlights the continued stigmatisation of HIV, and future interventions should seek to reduce the distress of disclosure.