The Association Of Locus Of Control, Social Support And Family Structure With Self-Disclosure Among Hiv Infected Adolescents Aged 13-21.
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Type of WorkText
DepartmentPublic Health and Policy
ProgramDoctor of Public Health
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Human Immunodeficiency Virus (HIV) continues to be a significant health issue in the United States. While there have been considerable advances in preventing vertical transmission of HIV (transmission from mother to child), there is still cause for concern regarding the HIV incidence rates of the youth and young adult population in the United States. Increasing rates of HIV/AIDS among this population is disturbing and with many perinatally infected youth living longer, the issue of disclosure of HIV status becomes important in preventing transmission of HIV/AIDS to uninfected individuals. Few studies have examined HIV-positive adolescents and the issue of self-disclosure. The present study seeks to explore the complexity of disclosure and the predictive effects, if any, of family structure, social support, and locus of control among a sample of adolescents infected with HIV/AIDS. A cross-sectional study of adolescents infected with HIV/AIDS (n=166) aged 13-21, receiving care in three urban areas in the United States, reported disclosure of HIV status, locus of control indicators, social support indicators, and demographic characteristics. HIV related data were abstracted from medical records. Prevalence and predictors of self-disclosure of HIV status to others were determined using bivariate and multivariate logistic regression analysis. Of 166 participants (99 perinatal, 67 behavioral), self-disclosure of serostatus was reported by 94 youth (57%): 69% to family, 32% to friends, and 43% of those sexually experienced to partners. Analyses showed that younger adolescents (13-17 years) were less likely to self-disclose than older (18-21 years) (p<0.001), as were gay, lesbian, bisexual, and questioning adolescents versus heterosexual adolescents (p<0.04), those taking antiretroviral medications (p<0.002) and those living away from their families (p<0.02). Adolescents who had acquired HIV infection behaviorally were more than twice as likely to have disclosed their status as those with perinatal acquisition (87% vs. 36%, p<0.001). Behavioral acquisition of HIV significantly predicted self-disclosure to others (Adjusted Odds Ratio = 1.03, 95% Confidence Interval = 0.01, 0.25, p<0.001). Self-disclosure of sensitive health information is difficult, particularly for adolescents with a stigmatized illness such as HIV/AIDS. While a number of possible factors were associated with self-disclosure of serostatus, only behavioral acquisition of HIV independently predicted willingness to self-disclose one's status. The comparative reticence of perinatally infected youth to self-disclose may be due to several factors, but since disclosure can be an important means of gaining support and preventing secondary transmission of HIV infection, interventions should focus on helping youth, including perinatally infected youth, share their status in a way that affords them the social support and clinical benefits they need. Disclosure can be an important means of preventing secondary transmission of HIV infection, interventions should focus on helping youth, including perinatally infected youth, share their status in a way that affords them the social support and clinical benefits they need.