In Hunan Province, the most common route of HIV infection is through sharing of contaminated injection paraphernalia among injection drug users (IDUs). However, a second wave of sexual transmission from IDUs to their sex partners has begun. It is important that those who are infected with HIV practice safe sex with their partners. A major barrier to practicing safer sex is lack of disclosure of HIV status to partners. In much of the world, disclosing HIV infection status to a sex partner is influenced by (i) individual level factors such as fear, depression, low self-efficacy, and internal stigma, (ii) social factors such as stigma, social support, norms, laws, and use of effective barriers (i.e. condom use), and (iii) health system related factors such as lack of an effective partner notification (PN) program. Little is known about HIV disclosure behavior in China and whether findings related to disclosure in the US and Europe are applicable in China. The purpose of this pilot study is to identify factors associated with disclosure of HIV status to sex partners in a sample of HIV infected individuals in Hunan Province. The specific aims of the study are: 1. To determine the extent of disclosure of HIV status to sex partners among a sample of HIV infected individuals in Hunan Province 2. To examine individual, social and health systems factors associated with disclosure of HIV status to sex partners among a sample of HIV infected individuals in Hunan province 3. To explore the interaction of IDU and stigma as it relates to disclosure of HIV status to sex partners in this population. We propose to use a modified version of Serovich's Consequence Theory of HIV Disclosure to guide this study. This is a mixed methods design that includes both qualitative and quantitative aspects. We will carry out qualitative interviews with 30 HIV+ individuals to solicit their views on barriers and facilitators of HIV disclosure. In addition, we will conduct 10 key informant interviews with public health and medical workers and leaders. We will conduct a cross-sectional survey of 175 HIV+ subjects in Hunan Province to determine prevalence of partner disclosure, as well as examine individual, social, and health system related factors that influence their decision. These data will inform public health officials to understand the level of partner disclosure in this province. They also will elucidate appropriateness of various disclosure theories in a Chinese context, as well as begin to inform development of an intervention. This is the first step in designing, testing, and implementing a [Chinese] culturally appropriate intervention to increase prevalence of HIV disclosure to sex partners, thereby increasing HIV testing among sex partners and promoting the adoption of safer sexual practices to reduce sexual transmission of HIV/AIDS in discordant couples in Hunan, China.
