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“A Lot of Things I Hide”: Understanding Disclosure in the Care of HIV-Positive Bisexual Men

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Journal of the Gay and Lesbian Medical Association

Abstract

Objective: To improve access to health care for HIV-positive bisexual men it is necessary to characterize the relationship between their identity and their health care experience. Methods: This qualitative study of 10 HIV-positive bisexual men utilized grounded theory. Taped interviews elicited information on experiences with (a) health care delivery, (b) antiretroviral therapy, (c) social identity, and (d) social environments. In response to data from the first interview, an additional prompt on childhood sexual experiences was added to the remaining interviews. Results: These bisexual men believed they had experienced discrimination or exclusion because of homophobic interactions with the health care system which often led to avoiding the health system. These experiences included being considered homosexual, breaches of confidentiality about sexual orientation, and being judged. The majority said they would not disclose sexual identity (9/10) to health providers due to prevailing attitudes in health care toward bisexuality and addiction. These participants reported injection drug use (9/10) and had experienced childhood sexual abuse (9/10). Only 3 persons took antiretroviral therapy, for which all participants qualified. Implications: When dealing with HIV-positive bisexual men (who may have histories of childhood assault), health practitioners need to be aware of the sensitive issues surrounding disclosure of sexual identity. Addressing psychosocial issues would improve care-seeking and improve adherence.

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REFERENCES

  1. Boulton M, Fitzpatrick, R. Bisexual men in Britain. In: Aggleton P, editor. Bisexualities in AIDS: International Perspectives. London: Taylor & Francis, 1997.

    Google Scholar 

  2. Doll L, Myers T, Kennedy M, Allman D. Bisexuality and HIV risk: Experiences in Canada and the United States. Annu Rev Sex Res 1997; 8:106–147.

    Google Scholar 

  3. Meyers T, Allman D, Bisexuality and HIV/AIDS in Canada. In: Aggleton P, editor. Bisexualitites and AIDS: International Perspectives. London: Taylor & Francis, 1997.

    Google Scholar 

  4. Doll LS, Beeker C. Male bisexual behavior and HIV risk in the United States: Synthesis of research with implications for behavioral interventions. AIDS Education Prevention 1996; 8(3):205–225.

    CAS  PubMed  Google Scholar 

  5. Alonzo AA, Reynolds NR. Stigma, HIV and AIDS: An exploration and elaboration of a stigma trajectory. Social Sci Med 1995; 41(3):303–315.

    CAS  Google Scholar 

  6. Morrissey M. Attitudes of practitioners to lesbian, gay and bisexual clients. Br J Nursing 1996; 5(16):980–982.

    CAS  Google Scholar 

  7. Kippax S, Connell RW, Dowsett GW, Crawfors J. Sustaining Safe Sex: Gay Communities Respond to AIDS. London: Falmer, 1993.

    Google Scholar 

  8. McLaughlin D, Long A. An extended literature review of health professionals' perceptions of illicit drugs and their clients who use them. J Psychiatr Mental Health Nursing 1996; 3(5):283–288.

    CAS  Google Scholar 

  9. O'Connor BB. Promoting cultural competence in HIV/AIDS care. J Assoc Nurses AIDS Care 1996; 7(Suppl 1):41–53.

    PubMed  Google Scholar 

  10. Sell RL, Petrulio C. Sampling homosexuals, bisexuals, gays, and lesbians for public health research: A review of the literature from 1990 to 1992. J Homosexuality 1996; 30(4):31–47.

    CAS  Google Scholar 

  11. Foucault M. The History of Sexuality: Vol. 1. An Introduction (Hurley, R, translator, editor). London: Allan Lane, 1979.

    Google Scholar 

  12. Creswell JW. Research Design—Qualitative and Quantitative Approaches. Thousand Oaks, CA: Sage, 1994.

    Google Scholar 

  13. Strauss AC, Corbin J. Basics of Qualitative Research: Grounded Therory Procedures and Techniques, Vol. 21. Newbury Park, CA: Sage, 1990.

    Google Scholar 

  14. Lincoln YS, Guba, EG. Naturalistic Inquiry. Newbury Park, CA: Sage, 1985.

    Google Scholar 

  15. Bogdan RC, Bilken SK. Qualitative Research for Education: An Introduction to Theory and Methods. Boston: Allyn & Bacon, 1982.

    Google Scholar 

  16. Field P, Morse JM. Nursing Research: The Application of Qualitative Approaches. London: Chapman Hall, 1991.

    Google Scholar 

  17. Finkelhor D. Sexually Victimized Children. New York: Free Press, 1979.

    Google Scholar 

  18. Schietinger H, Daniels EM. HIV infection. What nurses need to know. The consumer perspective. Nursing Clin North Am 1996; 31:137–152.

    CAS  Google Scholar 

  19. Whitehead CM. The specialist nurse in HIV/AIDS medicine. Postgrad Med J 1996; 72(846):211–213.

    CAS  PubMed  PubMed Central  Google Scholar 

  20. Rothblum ED. “I only read about myself on bathroom walls”: The need for research on the mental health of lesbians and gay men. J Consulting Clin Psychol 1994; 62(2):213–220.

    CAS  Google Scholar 

  21. Crawford J, Kippax S, Prestage G. Not gay, not bisexual, but polymorphously sexually active: Male bisexuality and AIDS in Australia. In: Aggleton P, editor. Bisexualities and AIDS: International Perspectives. London: Taylor & Francis, 1997.

    Google Scholar 

  22. Strathdee ST, et al. Social determinants predict needlesharing behavior among injection drug users in Vancouver, Canada. Addiction 1997; 92(10):1339–1345.

    CAS  PubMed  Google Scholar 

  23. Hauggard JJ, Repucci ND. The Sexual Abuse of Children. San Francisco: Jossey-Bass, 1988.

    Google Scholar 

  24. Kempe RS, Kempe CH. The Common Secret: Sexual Abuse of Children and Adolescents. New York: Freeman, 1984.

    Google Scholar 

  25. Fromuth ME, Burkhart BR. Childhood abuse among college men: Definitional and methodological issues. Violence Victims 1987; 2:241–253.

    CAS  PubMed  Google Scholar 

  26. Doll LS, Joy D, Bartholow A, et al. Self-reported childhood and adolescent sexual abuse among adult homosexual and bisexual men. Child Abuse Neglect 1992; 16:855–864.

    CAS  PubMed  Google Scholar 

  27. Finkelhor D, Berliner L. Research on the treatment of sexually abused children: A review and recommendations. J Am Acad Child Adolescent Psychiatr 1995; 34(11):1408–1423.

    CAS  Google Scholar 

  28. Lenderking WR, Wold C, Mayer KH, Goldstien R, Losina E, Seage GR. Childhood sexual abuse among homosexual men. J Gen Int Med 1997; 12 (April):250–253.

    CAS  Google Scholar 

  29. Zierler SF, Laufer D, et al. Adult survivors of childhood sexual abuse and subsequent risk of HIV infection. Am J Public Health 1991; (81):572–575.

    CAS  PubMed  PubMed Central  Google Scholar 

  30. Holmes GR, Offen L, Waller G. See no evil, hear on evil, speak no evil: Why do relatively few male victims of childhood sexual abuse receive help for abuse-related issues in adulthood? Clin Psychol Rev 1997; 17(1):69–88.

    CAS  PubMed  Google Scholar 

  31. Allers TA, Benjack KJ. HIV vulnerability and the adult survivor of childhood sexual abuse. Child Abuse Neglect 1993; 17:291–298.

    CAS  PubMed  Google Scholar 

  32. Sheldrick C. Adult sequelae of child sexual abuse. Br J Psychiatr 1991; 158(10):55–62.

    Google Scholar 

  33. Briere JE, Runtz M, Wall T. Symptomology in men who were abused as children: A comparison study. Am J Othopsychiatr 1988; 58:457–461.

    CAS  Google Scholar 

  34. Cavaiola AA, Schiff M. Self-esteem in abused chemically dependent adolescents. Child Abuse Neglect 1989; 13:327–334.

    CAS  PubMed  Google Scholar 

  35. Dimock PT. Adult males sexually abused as children. J Interpersonal Violence 1988; 3:203–221.

    Google Scholar 

  36. Bruckner DF, Johnson PE. Treatment of adult male victims of childhood sexual abuse. J Interpersonal Violence 1987; 68:81–87.

    Google Scholar 

  37. Briere JN, Elliott DM. Immediate and long-term impacts of child sexual abuse. Future Children 1994; 4(2):54–69.

    CAS  Google Scholar 

  38. O'Connor PG, Samet JH. The substance-using human immunodeficiency virus patient: Approaches to outpatient management. Am J Med 1996; 101(4):435–444.

    CAS  PubMed  Google Scholar 

  39. Strathdee SA, Patrick DM, Currie SL, Cornelisse PGA, Rekart ML, Montaner JSG, O'Shaughnessy MV. Needle exchanges are not enough: Lessons from the Vancouver injecting drug use study. AIDS 1997; 11:F59–F65.

    CAS  PubMed  Google Scholar 

  40. O'Donnell AE. HIV in illicit drug users. Clin Chest Med 1996; 17(4):797–807.

    CAS  PubMed  Google Scholar 

  41. BC Provincial Government. Analysis of Status Indians in British Columbia (Updated Report, 1987-1994). The BC Division of Vital Statistics Ministry of Health and Ministry Responsible for Seniors for Government of Canada, Health Canada, Medical Services Branch, 1996.

  42. Miller JR. Shingwauk's Vision, a History of Native Residential Schools. Toronto: Univ of Toronto Press, 1997.

    Google Scholar 

  43. Haverkos HW, Stein MD. Identifying substance abuse in primary care. Am Family Physician 1995; 52(7):2029–2035.

    CAS  Google Scholar 

  44. Ong LM, de Haes JC, Hoos AM, Lammes FB. Doctor-patient communication: A review of the literature. Social Sci Med 1995; 40(7):903–918.

    CAS  Google Scholar 

  45. Senak MS. Predicting antiviral compliance: Physicians responsibilities versus patient rights. J Assoc Physicians AIDS Care 1997; June 97(8):45–50.

    Google Scholar 

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Authors and Affiliations

  1. British Columbia Centre for Excellence in HIV/AIDS, St. Paul's Hospital, Vancouver, BC, p, Canada

    Arn J. Schilder, Irene L. Goldstone, Robert S. Hogg & Michael V. O'Shaughnessy

  2. Department of Dermatology, Leids University Medical Centre, Leiden, The Netherlands

    Cornelis Kennedy

  3. John Hopkins School of Public Health, Baltimore, Maryland

    Steffanie A. Strathdee

  4. School of Nursing, University of British Columbia, Vancouver, BC, Canada

    Irene L. Goldstone

  5. Departments of Health Care and Epidemiology, University of British Columbia, Vancouver, BC, Canada

    Robert S. Hogg

  6. Department of Pathology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

    Michael V. O'Shaughnessy

Authors
  1. Arn J. Schilder
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  2. Cornelis Kennedy
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  3. Steffanie A. Strathdee
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  4. Irene L. Goldstone
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  5. Robert S. Hogg
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  6. Michael V. O'Shaughnessy
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Correspondence to Arn J. Schilder.

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Schilder, A.J., Kennedy, C., Strathdee, S.A. et al. “A Lot of Things I Hide”: Understanding Disclosure in the Care of HIV-Positive Bisexual Men. Journal of the Gay and Lesbian Medical Association 3, 119–126 (1999). https://doi.org/10.1023/A:1022698802572

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  • DOI: https://doi.org/10.1023/A:1022698802572

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