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Sexual disclosure laws require reconsideration for teens with HIV

ATLANTA — Troubled adolescents with HIV infection often experience social barriers that prevent or discourage disclosure of their status to sexual partners that can lead to prosecution. Barriers among this at-risk demographic highlight the need for a review of zero-tolerance mandatory disclosure laws, according to a study presented at the CDC’s National HIV Prevention Conference.

“Skilled counseling in adolescent-friendly settings is immensely helpful in guiding infected adolescents toward maturity, self-disclosure, and a more confident future with HIV,” Bronwen Lichtenstein, PhD, professor in the department of criminal justice at the University of Alabama, told Infectious Diseases in Children. “At its best, disclosure helps to alleviate stress and break the chain of transmission to sexual partners.

“However, one-size-fits-all requirements for mandatory disclosure do not account for adolescents who suffer from mental illness, disability and trauma, and whose adverse life circumstances (eg, homelessness; domestic violence) interfere with their ability or willingness to disclose. Mandatory disclosure also leads to social rejection, discrimination, and even violence in many cases, especially in high-stigma contexts, and has been cited in refusals to be tested for HIV or to seek medical care.”

Lichtenstein and colleagues reviewed cases of HIV-infected adolescents at two specialist HIV clinics in Alabama. To determine the barriers and motivators of sexual disclosure, the researchers reviewed the sociosexual context of each case. Targeted counseling strategies were developed and implemented, and outcomes were recorded based on gains after counseling. The researchers demonstrated their results via the aggregated data of three perinatally infected teenagers and three behaviorally infected teenagers.

Study results showed that barriers to disclosure related to family and the individual included cognitive and physical delays, parental opposition to disclosure, suicidal thoughts, and trouble overcoming secrecy within family. Barriers related to social pressure included fears of rejection, physical and sexual abuse, drug use, homelessness and sexual identity issues.

The researchers noted that while barriers existed among teenagers with HIV, numerous motivators were identified. These included personal motivators, such as steady relationships and parental supports, as well as institutional motivators, including close relationships with HIV clinic staff and access to support from HIV-infected peers.

“Since adolescents are the largest cohort of newly infected people in the United States, it is vitally important to make disclosure, testing, and health-seeking easier for young people who need unfettered access to ART for lifesaving purposes and to reduce transmissibility to sexual partners,” Lichtenstein said. “HIV laws for mandatory disclosure should be reconsidered in view of this public health imperative.” – by David Costill

Reference: Lichtenstein B, et al. Abstract 1199. Presented at: National HIV Prevention Conference; Dec. 6-9, 2015; Atlanta.

Disclosure: Infectious Diseases in Children was unable to confirm relevant financial disclosures at the time of publication.