Associations between HIV disclosure and HIV care continuum outcomes among men who have sex with men living with HIV: systematic review and meta-analysis

ABSTRACT

The objective of this study is to synthesize the existing empirical literature and perform a systematic review and meta-analysis on the relationship between HIV disclosure and engagement in the HIV care continuum among men who have sex with men living with HIV. Twenty-three studies were included, with thirteen quantitative studies and ten qualitative studies. Meta-analytic techniques were used to compute and aggregate effect sizes (odds ratio [OR] and their confidence intervals [95%CI]) for the quantitative studies and a thematic analysis was employed for qualitative studies. Given the small number of eligible studies, meta-analysis was only conducted for the linkage to care outcome, where a positive association was observed from the pooled estimation (OR = 1.51, 95%CI [1.15, 1.99]). Regarding ART initiation, retention in care, and viral suppression outcomes, most of the individual studies revealed a positive association between HIV disclosure and these outcomes. Thematic analysis from qualitative studies complemented the quantitative findings by incorporating the approaching and avoidance motivations underlying the relationship between non-HIV disclosure and the participation in HIV care continuum. The small number of available studies limits the definitive conclusions, and more research is needed to ascertain the magnitude of effect sizes.

KEYWORDS:

• HIV disclosure
• men who have sex with men
• meta-analysis
• HIV care continuum

Acknowledgments

XY conducted the literature review, data extraction, data analysis, and drafted the manuscript; SS and XL guided the review structure and revised the manuscript critically; CZ, TJ, and FS assisted in the literature screening and data extraction; and SQ and MJB contributed to review structure and participated in the revision of the manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Additional information

Funding

This work is supported by an ASPIRE grant from the Office of the Vice President for Research at the University of South Carolina (ASPIRE I, Track II B Grant # 11540-19-50627), and National Institutes of Health (NIH/NIAID: R21AI122919 and NIH/NICHD: R01HD074221). Work by SS was supported by National Institute of Health (K23AT011173). Work by MJB was supported by the National Institute of Mental Health (K01MH115794).