Sero-skeptics: discussions between test counselors and their clients about sexual partner HIV status disclosure

Abstract

Despite the current emphasis in the US on HIV testing and serostatus disclosure as HIV-prevention strategies, little is known about men who have sex with men's (MSM) perceptions of serostatus disclosure by sexual partners. This study used conversation analysis to examine recordings of HIV-test counseling sessions in order to understand how counselors and clients conceptualize and discuss sex partners’ disclosure of HIV status. Of 50 test sessions audio-recorded in four publicly funded sites in Northern California, 47 sessions included a discussion about sexual partners’ serostatus disclosure, in the vast majority of these (91.5%), counselors and clients avoided directly asserting their knowledge of partners’ serostatus. Throughout the discussions, counselors and clients co-constructed the sense of distrust, uncertainty and unknowability of partners’ serostatus. The implications of our findings for evaluating the effectiveness of HIV status disclosure as a prevention strategy are discussed.

Keywords:

• serostatus disclosure
• HIV test counseling
• MSM

Acknowledgements

The analysis for this paper was supported by the Center for AIDS Prevention Studies at UCSF, grant # P30MH062246-06, funded by the National Institute of Mental Health (NIMH) and grant #R01-HD047147-01 funded by the National Institute for Child and Human Development (NICHD). We would like to thank Dan Ciccarone and Edwin Charlebois for their helpful comments on earlier drafts of this paper. We would especially like to thank the counselors and clients who allowed us to record their HIV-test sessions.