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AIDS and Behavior, Vol. 9, No. 1, March 2005 (C
2005)
DOI: 10.1007/s10461-005-1678-z
Disclosure of HIV Status and Psychological Well-Being
Among Latino Gay and Bisexual Men
Mar´
ıa Cecilia Zea,1,2 Carol A. Reisen,1Paul J. Poppen,1
Fernanda T. Bianchi,1and John J. Echeverry1
Received November 8, 2003; revised March 2, 2004; April 12, 2004
This study examined disclosure of HIV-positive serostatus by 301 Latino gay and bisexual men
to members of their social networks and the mental health consequences of such disclosure.
The sample was recruited from clinics, hospitals, and community agencies in New York City,
Washington, DC, and Boston. Proportions disclosing differed depending on the target, with
85% having disclosed to closest friend, 78% to male main partner, 37% to mother, and 23%
to father. Although there were differences depending on the target, disclosure was related to
greater quality of social support, greater self-esteem, and lower levels of depression. More-
over, findings indicated that social support mediated the relationship between disclosure of
serostatus and both self-esteem and depression. Thus, disclosure resulted in greater social
support, which in turn had positive effects on psychological well-being. Findings demonstrate
that generally Latino gay men are selective in choosing people to whom they disclose their
serostatus and that disclosure tends to be associated with positive outcomes.
KEY WORDS: disclosure of HIV status; psychological well-being; Latino gay men; mental health.
INTRODUCTION
Self-disclosure—revealing personal information
to others—can have major consequences for a per-
son’s relationships, mood, image, and life (Derlega
et al., 2000). In this study we examined direct, verbal
disclosure of HIV-positive serostatus among Latino
gay and bisexual men to members of their social net-
works and the mental health consequences of such
disclosure. Although there are other ways to re-
veal serostatus (e.g., leaving HIV medication in plain
sight), this study addressed direct disclosure to dif-
ferent targets and explored how disclosure affects
psychological well-being, both directly and through its
impact on social support. Understanding the impact
of serostatus disclosure on social support and men-
1Department of Psychology, George Washington University,
Washington, District of Columbia.
2Correspondence should be directed to Mar´ıa Cecilia Zea,
PhD, Department of Psychology, 2125 G Street NW, George
Washington University, Washington, District of Columbia 20052;
e-mail: zea@gwu.edu.
tal health is important because of the reported asso-
ciations between these factors and sexual risk (Kelly
et al., 1993; Kimberly and Serovich, 1999; Ostrow et al.,
1994), adherence to antiretroviral regime (Holzemer
et al., 1999; Nannis et al., 1993; Singh et al., 1996), and
immune responses (Ullrich et al., 2003).
Disclosure is a complex process with potentially
widely varying consequences. For example, conse-
quences can include greater intimacy or rejection,
feelings of relief or remorse, and enhanced status or
a “spoiled image” (Baxter and Montgomery, 1996;
Goffman, 1963; Omarzu, 2000). Moreover, disclosure
can affect the target of the disclosure, who might find
the new information beneficial or distressing (Derlega
et al., 2000; Fesko, 2001; Simoni et al., 1997).
Due to the stigma associated with HIV (Cline
and McKenzie, 2000; Herek and Glunt, 1988),
disclosure of HIV-positive serostatus can be partic-
ularly difficult. Such disclosure can result in harmful
reactions as extreme as physical assault or loss of em-
ployment (Gielen et al., 1997; Grinstead et al., 2001;
Lyter et al., 1987; Simoni et al., 1997). On the other
hand, it can also produce substantial benefits in the
15
1090-7165/05/0300-0015/0 C
2005 Springer Science+Business Media, Inc.
16 Zea, Reisen, Poppen, Bianchi, and Echeverry
form of greater emotional, physical, or instrumental
support and care (Derlega et al., 2000).
Latinos and men of color in the United States
are generally less likely to disclose positive serostatus
than white men (Mansergh et al., 1995; Marks et al.,
1992; Mason et al., 1995). In comparing their HIV-
positive Latino sample with a mostly Anglo sample
studied by Hays and colleagues, Marks and colleagues
noted discrepant levels of disclosure, such as 24% of
the Latino versus 48% of the Anglo sample having
disclosed to their mothers, 8% versus 40% to their fa-
thers, and 76% versus 98% to their main sexual part-
ners. We know of only one published report of greater
disclosure to sexual partners by Latinos than by Anglo
and African American men (Stein et al., 1998). The
small number of Latinos (n=30) in this heteroge-
neous sample of injection drug users, gay men, and
heterosexual men, however, raises questions about
generalization of these findings.
Disclosure to Members of the Social Network
As is evident from the rates of disclosure re-
ported by Marks et al. (1992), disclosure of HIV status
varies depending on the target. Greater disclosure to
friends and main partners than to parents has been
consistently reported in both multiethnic (Kalichman
et al., 2003; Mansergh et al., 1995) and Latino gay sam-
ples (Marks et al., 1992; Zea et al., 2004). Moreover,
in our earlier work with a different sample of Latino
HIV-positive gay men we found that disclosure oc-
curred more frequently between committed partners
than casual partners (Zea et al., 2004). In addition,
Marks et al. (1992) noted greater disclosure to gay
than to straight friends.
These varied proportions of disclosure of serosta-
tus across the social network have been seen as aris-
ing from the differing risks, benefits, and motivations
relative to different targets. For example, the mo-
tivation to protect the other person may result in
disclosure to a sexual partner (Derlega et al., 2000;
Serovich and Mosack, 2003), but nondisclosure to a
parent (Mason et al., 1995; Zea et al., 2004). More-
over, because positive serostatus is often interpreted
as resulting from drug use or homosexual behavior
(Kalichman and Nachimson, 1999), infected individ-
uals are more likely to disclose to those people within
their social network who will not react negatively to
these behaviors. Indeed, Zea et al. (2004) found that
HIV-positive Latino gay men were more likely to dis-
close their serostatus to their mothers, fathers, and
friends when these targets also knew that the discloser
was gay.
Mental Health Consequences of Disclosure
High levels of self-esteem and low levels of de-
pression are conceptualized as indicators of psycho-
logical well-being (Stephen and Philpot, 1996; Tarlow
and Haaga, 1996). Moreover, social support has been
shown to affect both of these aspects of mental health
in Latino lesbians and gay men (Zea et al., 1999). Lit-
erature pertaining to the role of disclosure of positive
serostatus on psychological well-being has addressed
effects on social support and depression; however, we
are unaware of previous studies examining the asso-
ciation between disclosure and self-esteem.
Disclosure of serostatus has implications for so-
cial support, and social support, in turn, may affect
psychological well-being. Disclosure or knowledge of
serostatus has often been positively related to social
support (Kadushin, 2000; Simoni et al., 2000). Al-
though those who disclose tend to report more social
support, differences have been found in this associa-
tion depending on the target. In studies of adults, part-
ners and friends have been said to provide more sup-
port than family members, and mothers were said to
provide more support than fathers (Kalichman et al.,
2003; Petrak et al., 2001; Sachperoglou and Bor, 2001).
Moreover, the impact on psychological well-
being may vary depending on whether the reaction is
helpful or undermining. Hays et al. (1993) found that
helpful reactions from targets were negatively asso-
ciated with depression and anxiety. However, disclo-
sure of positive serostatus may elicit negative social
interactions, which can be detrimental to the men-
tal health of HIV-positive individuals (Ingram et al.,
1999; Schrimshaw, 2002; Siegel et al., 1997). Under-
mining reactions from close friends, intimate partners,
and parents have been associated with greater depres-
sion, but in the same study supportive reactions were
not significantly related to lower levels of depression
(Derlega et al., 2003).
Studies examining the relationship between dis-
closure of HIV-positive serostatus and depression
have yielded inconsistent findings. Although there is
evidence of an association between disclosure and
lower levels of depression in samples of African
American women (Armistead et al., 1999), of gay men
(Hays et al., 1993; Perry et al., 1994), and of a mixed
group of gay and straight men (Straits-Tr¨oster et al.,
1994), other studies have reported conflicting findings.
Disclosure of HIV Status and Psychological Well-Being 17
Comer et al. (2000) found a relationship between dis-
closure and depression among Latinas, but not among
African American and white women. Moreover, the
direction was opposite to that reported by Armistead
et al. (1999); in this case, higher rates of disclosure
wererelated tohigher ratesof depression.Comer et al.
(2000) concluded that their findings did not support
the theory that disclosure leads to improved mental
health, but rather suggested that the stigma connected
with HIV and the consequent negative reactions to
its disclosure can disturb the discloser’s emotional
state.
Other studies have either failed to find effects
on depression (Simoni et al., 2000) or found an as-
sociation with disclosure to certain targets, but not
others (Kalichman et al., 2003, Petrak et al., 2001).
For example, Kalichman et al. (2003) found no over-
all relationship between disclosure and depression in
a sample of HIV-positive men and women; however,
follow-up analyses with specific targets revealed an
association between disclosure to specific targets and
depression. Moreover, Petrak et al. (2001) reported
that depression was significantly related to higher
rates of disclosure of serostatus to family, but not to
friends, in a mixed race and gender sample from the
United Kingdom.
Hypotheses and Research Questions
The current study explored several aspects of dis-
closure to the social network. First of all, we provided
descriptive information about the extent to which
participants reported a variety of general or practical
consequences of disclosure of serostatus, such as
becoming active in HIV-related activities or feeling
relieved of a burden. Next, we looked at disclosure to
specific targets within the social network. In keeping
with findings from previous research, we hypothe-
sized that proportions of disclosure of HIV seropos-
itive status would differ depending on the target.
We expected that a higher proportion of men would
disclose to friends and sexual partners than to family
members. Moreover, we anticipated greater disclo-
sure to mothers than fathers. Because Latino culture
is often characterized as being high in homoneg-
ativity, we hypothesized that disclosure would be
more common to non-Latino friends than to Latino
friends.
Most importantly, this study examined the
relationship between disclosure of seropositive status
and psychological well-being. First, we addressed
direct effects of disclosure on social support, depres-
sion, and self-esteem. Based on the literature, we
hypothesized that disclosure to all targets would be
associated with greater quality of social support, but
that the relationship might be stronger for friends and
partners than family members. Because research find-
ings concerning depression have been inconsistent,
we expected that the relationship between disclosure
and depression might be evident only with some
targets. In addition, we examined the relationship
between disclosure and self-esteem. Although we
expected that disclosure of positive serostatus would
be associated with greater self-esteem, we did not
make hypotheses about specific targets due to the
paucity of previous research on this topic.
In addition to direct effects on psychological
well-being, we addressed the question of whether so-
cial support acts to mediate the effects of disclosure of
serostatus on depression and self-esteem. We hypoth-
esized that by revealing positive serostatus to mem-
bers of the social network, Latino men elicit greater
social support, which then promotes psychological
well-being.
METHOD
Participants
Recruitment of 310 participants took place in
New York City, Washington, DC, and Boston. To
ensure that all participants were seropositive with-
out conducting HIV testing, we recruited the sample
from clinics, hospitals, and community agencies serv-
ing HIV-positive Latino men. We attempted to have
referrals for screening from 100% of the Latino HIV-
positive men from each participating clinic or pro-
gram. Staff approached clients, described the study,
andasked ifthey wereinterested inparticipating. Ifso,
the potential participants could arrange to take part
in the study at the site of the clinic or program or at
another location. Criteria for participation included
being Latino/Hispanic, biological male, 18 years or
older, and having had sex with men or self-identifying
as gay or bisexual.
A few participants who categorized themselves
as heterosexual and had not had sex with men in the
last year were mistakenly referred. These men were
dropped from the sample, as were a few men whose
data appeared to be invalid (e.g., reporting 240 pills
prescribed for daily consumption). The final sample
included 301 men, 2 of whom had some missing
18 Zea, Reisen, Poppen, Bianchi, and Echeverry
data and therefore could not be included in all the
analyses.
Fewer than 10% of the participants were born
in the United States. Others immigrated from
20 Spanish-speaking countries, with the largest
concentrations coming from Puerto Rico (20%),
Colombia (17%), Mexico (11%), El Salvador (7%),
Venezuela (7%), the Dominican Republic (6%),
Cuba (5%), and Peru (5%). Immigrant participants
indicated a variety of reasons for coming to the United
States, including to improve financial situation (40%),
to live a homosexual life more openly (24%), and to
get HIV medication (20%).
Overall, the educational level of participants was
varied. Although 22% did not finish high school, a
quarter of the sample completed college or beyond.
However, income was low, with over two fifths earning
less than $400 a month, and 30% earning between
$401 and $800.
Procedure
A survey was administered using computer-
assisted self-interview technology with audio en-
hancement (Audio-CASI). Responses were indicated
by touching the computer screen; therefore, computer
skills were not required. Participants with reading dif-
ficulties could listen to the audio presentation of the
questions and responses. Participants chose to com-
plete the survey in either Spanish or English; about
four fifths responded in Spanish. Participation took
an average of 1.5 hr. Respondents received mone-
tary reimbursement of $50 for the time they spent
participating in the study, a transportation stipend,
as well as snacks. Finally, participants were pro-
vided a list of resources for HIV/AIDS services in
their area.
All new questions and measures used in the sur-
vey were translated from English to Spanish and
back-translated using the procedures suggested by
Brislin (1986) and Mar´ın and Mar´ın (1991) to ensure
language equivalence. A panel of experts from differ-
ent Spanish-speaking countries reviewed the resulting
Spanish version to identify and eliminate regional ex-
pressions that would not be universally recognized by
Spanish speakers. A similar procedure had been fol-
lowed earlier for questions and measures that we used
in our previous research. Finally, the panel of experts
examined the survey to determine level of difficulty,
and we revised the survey to render it accessible to
those with limited education.
Measures
Disclosure of seropositive status to specific targets
was assessed with questions designed for this study
which addressed several potential targets: mother, fa-
ther, closest friend, male main partner, and when ap-
plicable, female main partner. We asked “Does your
mother know that you are HIV-positive?” Responses
included (1) yes, (2) no, and (3) she suspects it, but I
am not sure she knows.Ininstances in which a partici-
pant’s mother had died after the participant’s seropos-
itivediagnosis,the samequestion wasasked inthe past
tense, but if her death preceded the seropositive diag-
nosis, this question was skipped by the Audio-CASI
program.
If the respondent answered affirmatively to the
question of mother’s knowledge of seropositive sta-
tus, he was asked “Who told your mother that you
were HIV-positive?” Responses included (1) I told
her, (2) someone else told her with my permission,
(3) someone else told her without my permission,
(4) someone else told her anonymously, and (5) she
found out some other way.These alternatives emerged
from in-depth interviews with HIV-positive Latino
gay and bisexual men, and focus group participants
subsequently considered them relevant. The first two
responses were rated as disclosure and the last three
as nondisclosure. Similar questions were used for fa-
ther, closest friend, male main partner, and female
main partner.
Disclosure of seropositive status to target groups
was assessed with two additional questions that per-
tained to disclosure to two groups of targets, rather
than to specific individuals. These two measures ag-
gregated over family members and over close friends.
They were “How many of your close friends have you
told that you are HIV-positive?” and “How many of
your family members have you told that you are HIV-
positive?” Responses included (1) none, (2) some, (3)
about half, (4) most, and (5) all. In addition, two sep-
arate questions asked, “How many of your Latino
friends have you told that you are HIV-positive?”
and “How many of your non-Latino friends have you
told that you are HIV-positive?” The response op-
tions were identical to those for other target groups,
with the addition of an option for not applicable. For
analytic purposes, responses to these two questions
were collapsed into two groups: those telling most or
all of their friends versus those telling fewer.
Depression was assessed with the short form of
the Beck Depression Inventory (Beck et al., 1988;
Beck and Beck, 1972). This is a 13-item scale in which
Disclosure of HIV Status and Psychological Well-Being 19
higher scores indicate greater depression. The short
form has been previously used with Spanish-speaking
populations (Zea et al., 1996, 1999). Internal con-
sistency reliability of this measure was .91 with this
sample.
Quality of social support was assessed with a 9-
item version of the Quality of Social Support Scale
(QSSS; Goodenow et al., 1990). This scale measures
perceptions of the quality of support received from
others. Sample questions are, “There is someone who
will take over my tasks or chores when I feel sick” and
“There is someone who will give me a hug or hold me
in their arms when I need comforting.” The Likert
scale response format ranges from (1) Never true to
(4) Always true.This scale has also been previously
used with Spanish-speaking populations (Zea et al.,
1999), and its internal consistency reliability with this
sample was .89.
Self-esteem was assessed with the Single-Item
Self-Esteem Scale (SISE; Robins et al., 2001). This
item is “I have high self-esteem,” and the Likert
scale response ranges from (1) strongly disagree to
(5) strongly agree. Robins et al. demonstrated that
the single item measurement was a viable and prac-
tical method of assessing self-esteem. The correla-
tion between the SISE and the Rosenberg (1965)
Self-Esteem Scale reported by Robins et al. (2001)
ranged from .72 to .80 in three separate studies.
The test-retest reliability over five assessment peri-
ods, each separated by a year, was .75 (Robins et al.,
2001). Moreover, the single item and the Rosenberg
Self-Esteem Scale had nearly identical correlations
with many other scales used to assess criterion
validity.
Perceived general and practical outcomes of dis-
closure of seropositive status included nine items that
were generated from focus groups with Latino HIV-
positive gay men. All items began with the statement
“Asaresult of telling others that I am HIV-positive”
and then continued with the consequences. Because
there was no reason to believe that the experience
of these consequences would covary, the items were
treated separately and not summarized in a scale.
Items covered general outcomes of disclosure (e.g.,
As a result of telling others that I am HIV-positive, I
feel free of a burden, more relaxed, relieved ) and prac-
tical outcomes (e.g., As a result of telling others that I
am HIV-positive, the possibility of staying legally in this
country is now in danger). The response scale ranged
from (1) totally disagree to (5) totally agree.
Demographic information was collected con-
cerning age, income, employment, and education.
Statistical Methods
Data were analyzed using chi-square tests, bi-
nomial tests of equal proportions, and multivariate
analysis of covariance (MANCOVA) with follow-up
analysis of covariance (ANCOVA). In addition, the
mediational model was tested using procedures de-
scribedby Baronand Kenny(1986). Theseprocedures
are described in more detail in the Results section,
where the specific results are discussed.
RESULTS
Descriptive Results
Based on issues raised in our earlier qualitative
work with Latino gay men, we asked participants
about some perceived general and practical conse-
quences that they may have experienced after dis-
closure of their positive serostatus to others. Table I
shows the percent of participants who agreed or to-
tally agreed that they had experienced a circumstance
as a consequence of disclosure. Nearly three-quarters
reported that disclosure had resulted in their feel-
ing relieved and in being able to take care of their
health openly. Negative consequences were less com-
mon, and only 15% said that they had been insulted
or threatened after disclosure.
Proportions Disclosing to Members
of the Social Network
As hypothesized, the proportion of participants
who had disclosed that they were HIV-positive
Table I. Perceived General and Practical Consequences of
Disclosure (N=301)
As a result of telling Percent in
others that I am HIV-positive agreement
I can openly do things to preserve my health 73.8
I feel free of a burden, more relaxed, relieved 72.4
I became involved in HIV/AIDS-related
activities
63.1
I feel less lonely than before 47.2
People now assume that I’m gay 45.5
I have been rejected by potential sex partners
once they know I’m seropositive
39.5
Some people seem afraid of catching HIV
from me
34.9
The possibility of staying legally in this country
is now in danger
23.6
I have been insulted or threatened by others 15.6
20 Zea, Reisen, Poppen, Bianchi, and Echeverry
differed depending on the target. Disclosure to the
closest friend (84.7% of the 301 with closest friend)
and the main male partner (77.5% of the 187 with
a main male partner) was common, and significantly
greater than disclosure to mothers (37.1% of the 248
with mothers) and fathers (23.2% of the 185 who
had fathers), as revealed by binomial tests for equal
proportions between individual pairs of targets (all
pvalues were less than .05). Moreover, binomial
tests revealed that the proportion of respondents who
told their fathers was lower than the proportion who
told their mothers, and the proportion who told their
male main partners was lower than the proportion
who told their closest friends. These differences re-
mained when the data were examined with subsam-
ples who had both targets for each comparison (e.g.,
mother and father, or male main partner and clos-
est friend). There were only 20 men who reported
having a female main partner, and of these, 65% had
disclosed their serostatus to these women. Despite
the apparent discrepancy between this rate of dis-
closure and the rate that was found for male main
partners (78%), the difference did not achieve statis-
tical significance due to the small number with female
partners.
Disclosure to mothers and fathers was re-
lated [χ2(1, N=170) =47.8, p<.0001]: over three
fourths of participants were consistent in their dis-
closure or nondisclosure to both parents. Disclo-
sure to mothers was also associated with disclo-
sure to closest friends [χ2(1, N=248) =7.9, p<
.01], but not as strongly. There were no other sig-
nificant associations of disclosure among pairs of
targets (mothers, fathers, main partners, and closest
friends).
In addition to asking about specific individual
targets (e.g., mother, father), we also asked about
groups of targets. More than one third of respon-
dents reported that they had disclosed their serosta-
tus to most or all of their friends, while 15% had
told none. Although a similar proportion had dis-
closed to most or all of their family members,
29% reported that they had disclosed to no family
members.
We asked separate questions about disclosure
to Latino and non-Latino friends, and the two mea-
sures covaried greatly [χ2(1, N=272) =115.2, p<
.0001]. In contrast to our hypothesis, disclosure was
more common to Latino than to non-Latino friends.
The proportion who told most or all of their Latino
friends (37%) was greater than for non-Latino friends
(27%).
Disclosure and Well-Being
The two indicators of psychological well-being
that were used in this study assessed different but re-
lated constructs: depression (the negative indicator)
was correlated –.50 with self-esteem. Moreover, qual-
ity of social support was correlated with both mea-
sures of psychological well-being: −.39 with depres-
sion and .42 with self-esteem. Despite the high levels
of covariance, we expected that disclosure to different
aspects of the social network might be differentially
relatedto these constructs. Although we hypothesized
that social support would mediate the effect of disclo-
sure on psychological well-being, we also examined
the direct effect of disclosure of serostatus on social
support.
We performed separate multivariate analyses of
covariances (MANCOVAs) to test direct effects of
disclosure to specific targets (mother, father, male
main partner, and closest friend) on the three out-
comes (social support, depression, and self-esteem),
controlling for education level (trade or high school
or less versus some college and beyond) and in-
come. There were too few participants with female
main partners to perform the parallel analyses. The
MANCOVAs revealed significant effects on the set
of outcomes from disclosure to mother (Wilks’ λ=
0.96, F(3, 240) =3.21, p<.05), to male main part-
ner (Wilks’ λ=0.95, F(3, 180) =3.09, p<.05), and
to closest friend (Wilks’ λ=0.96, F(3, 293) =4.12,
p<.01), but not from disclosure to father. Follow-up
analyses of covariances (ANCOVAs) on the individ-
ual outcome measures are shown in Table II for the
three targets that were significant at the multivari-
ate level. Disclosure was related to quality of social
support for all three targets. Despite the lack of signif-
icance in the MANCOVA, disclosure to fathers was
related to quality of social support as well. Disclo-
sure to the main partner was also related to the other
two outcomes—depression and self-esteem, whereas
disclosure to mother was related to depression. In
all cases, the observed associations were in the pre-
dicted directions, with disclosure associated with less
depression but greater quality of social support and
self-esteem.
Similar analyses were performed examining the
relationship between disclosure of serostatus to the
two target groups: family members and friends. In
this case, disclosure was a continuous variable re-
flecting the extent to which the participant had re-
vealed his serostatus to members of the target groups.
MANCOVAs revealed that disclosure to family
Disclosure of HIV Status and Psychological Well-Being 21
Table II. Analyses of Covariance for Direct Effects of Disclosure to Specific Targets on
Social Support, Depression, and Self-Esteem
Social support Depression Self-esteem
Target df Fdf Fdf F
Mother (N=246)
Education 1 9.74∗∗ 1 6.43∗1 3.36
Income 1 0.62 1 0.09 1 0.46
Disclosure to mother 1 8.24∗∗ 1 4.01∗1 1.00
Error 242 (0.48) 242 (38.38) 242 (1.55)
Male main partner (N=186)
Education 1 5.91∗1 3.30 1 1.47
Income 1 0.02 1 0.34 1 0.01
Disclosure to partner 1 5.87∗1 6.35∗1 5.97∗
Error 182 (0.47) 182 (36.83) 182 (1.48)
Closest friend (N=299)
Education 1 5.87∗1 5.51∗1 3.28
Income 1 1.40 1 0.40 1 0.56
Disclosure to friend 1 7.50∗∗ 1 0.02 1 0.71
Error 295 (0.49) 295 (41.63) 295 (1.55)
Note. Numbers in parentheses are Mean Square Error values.
∗p<.05. ∗∗ p<.01. ∗∗∗ p<.001.
members [Wilks’ λ=0.93, F(3, 293) =7.40, p<
.0001] and to friends [Wilks’ λ=0.95, F(3, 293) =
5.27, p<.01] was significantly associated with the set
of well-being outcomes. Table III shows results from
the follow-up separate analyses for social support, de-
pression, and self-esteem. Again, those who disclosed
to more family members and to more friends reported
greater quality of social support. In addition, disclo-
sure to both groups of targets was associated with
greater self-esteem. Disclosure of HIV-positive sta-
tus to these target groups within the social network
was not related to depression.
In addition to the direct effects of disclosure of
serostatus on the indicators of well-being, we also ex-
Table III. Analyses of Covariance for Direct Effects of Disclosure to Target Groups on Social
Support, Depression, and Self-Esteem
Social support Depression Self-esteem
Target group df Fdf Fdf F
Family members (N=299)
Education 1 7.33∗∗ 1 5.44∗1 2.71
Income 1 1.56 1 0.44 1 0.80
Disclosure to family 1 19.16∗∗∗∗ 1 0.27 1 5.19∗
Error 295 (0.47) 295 (41.59) 295 (1.53)
Friends (N=299)
Education 1 6.18∗1 5.22∗1 2.17
Income 1 1.15 1 0.41 1 0.67
Disclosure to friends 1 11.70∗∗∗ 1 0.35 1 6.87∗∗
Error 295 (0.48) 295 (41.58) 295 (1.52)
Note. Numbers in parentheses are Mean Square Error values.
∗p<.05. ∗∗ p<.01. ∗∗∗ p<.001. ∗∗∗∗ p<.0001.
amined the question of whether social support medi-
ated the effects of disclosure of serostatus on depres-
sion and self-esteem. Four conditions are required to
support a mediational model according to Baron and
Kenny (1986): (1) disclosure must predict the indica-
tor of psychological well-being (either depression or
self-esteem); (2) disclosure must predict social sup-
port; (3) social support must predict the indicator of
psychological well-being; and, finally (4) when social
support is included as a predictor in the model used
in step (1), the impact of disclosure on the indicator
of psychological well-being must be reduced.
Requirement (1) was met for depression by
the significant effects of disclosure to mother and
22 Zea, Reisen, Poppen, Bianchi, and Echeverry
Table IV. Analyses of Covariance Testing Mediational Effect of
Quality of Social Support
Depression Self-esteem
Target or target group df Fdf F
Mother (N=246)
Education 1 2.31
Income 1 0.00
Disclosure to mother 1 1.11
Quality of social support 1 32.84∗∗∗∗
Error 241 (33.83)
Male main partner (N=186)
Education 1 0.76 1 0.03
Income 1 0.34 1 0.00
Disclosure to partner 1 2.67 1 2.28
Quality of social support 1 37.57∗∗∗∗ 142.69∗∗∗∗
Error 181 (30.67) 181 (1.20)
Family members (N=299)
Education 1 0.41
Income 1 0.20
Disclosure to family 1 0.38
Quality of social support 1 51.57∗∗∗∗
Error 294 (1.30)
Friends (N=299)
Education 1 0.30
Income 1 0.19
Disclosure to Friends 1 1.91
Quality of social support 1 51.43∗∗∗∗
Error 294 (1.30)
Notes. Analyses are reported only for those models that met the
first three requirements for mediation. Blank areas reflect models
that did not meet these requirements. Numbers in parentheses are
Mean Square Error values.
∗p<.05. ∗∗ p<.01. ∗∗∗ p<.001. ∗∗∗∗ p<.0001.
disclosureto male main partner (see Tables IIand III).
Requirement (2) was met in all cases (disclosure to
mother, father, male main partner, closest friend, fam-
ily network, and friends network; see Table II), and
requirement (3) was met for both depression and self-
esteem (see the first paragraph of this section for cor-
relations). Although disclosure to all the targets met
requirements (2) and (3), for the outcome variable
of depression, only disclosure to two targets (mother
and male main partner) met requirement (1). There-
fore, the final requirement was tested on those two tar-
gets. The results shown in Table IV suggest that social
support mediated the effect of disclosure to mother
and male main partner on depression, because in both
cases disclosure lost its significance in the model in-
cluding social support.
In testing whether social support mediated the
effect of disclosure on self-esteem, although require-
ments (2) and (3) were met as above, requirement (1)
was achieved only for disclosure to male main partner
(see Table II) and to family and friend social net-
works (see Table III). Therefore, requirement (4) was
only tested in these cases. As can be seen in Table IV,
the mediational hypothesis was supported, as disclo-
sure was no longer significant when social support was
included in these models. Thus, it seems that disclo-
sure to the male main partner, family social network,
and friend social network increases social support,
which then acts to alleviate depression and augment
self-esteem.
DISCUSSION
In this paper, we examined rates of disclosure of
serostatus to various targets, as well as the relation-
ship between disclosure of serostatus and psychologi-
cal well-being. Furthermore, we investigated whether
social support mediated these effects of disclosure on
self-esteem and depression.
Disclosure to Targets Within the Social Network
Consistent with previous research (Kalichman
et al., 2003; Mansergh et al., 1995; Marks et al., 1992;
Zea et al., 2004), we found that the proportion of men
who had disclosed their positive serostatus varied de-
pending on the target. Disclosure to the closest friend
was most common, and in this study even more com-
mon than to the main partner. Previous studies have
reported other patterns, either no difference (Zea
et al., 2004) or higher disclosure rates to main part-
ners than to closest friends (Mansergh et al., 1995).
As in the literature, we found less disclosure to family
members than to friends and partners, and less disclo-
sure to fathers than mothers. In general, there were
higher rates of disclosure in our sample of Latino gay
men than in the Marks et al. (1992) Latino male sam-
ple. The difference may well be due to changes in
societal attitudes about HIV during the intervening
decade between the two studies, and may indicate that
HIV infection does not carry the stigma once associ-
ated with it. The relatively low occurrence of negative
consequences after disclosure among our participants
suggests that an HIV-positive diagnosis is less stigma-
tized than in the past.
The different proportions of disclosure of
serostatus to different targets imply that people are
selective when deciding to whom they will reveal
the fact that they are HIV-positive. Moreover, with
the four targets used here, there does not appear to
be a generalized tendency to be a “discloser” or a
Disclosure of HIV Status and Psychological Well-Being 23
“nondiscloser.” Disclosure to various targets was un-
related, except for disclosure to mother and father
and disclosure to mother and closest friend. It appears
that individuals consider the potential target, and then
decide whether disclosure to that person would be
advisable.
Such decisions may reflect differential assess-
ments concerning the targets’ probable reactions
to the information. Because of the association be-
tween HIV and homosexuality, disclosure of posi-
tive serostatus may also raise the issue of sexual ori-
entation. Friends—either gay or straight—may be
more accepting of gay sexual orientation than par-
ents, and therefore easier targets for disclosure of
serostatus. In addition, friends have been reported
to respond in a supportive manner more commonly
than parents (Kalichman et al., 2003; Petrak et al.,
2001; Sachperoglou and Bor, 2001), who may be dis-
approving, rejecting, or so distressed as to create an
additional burden. Thus, the motivation to disclose
as a means to obtain support would be greater with
friends.
Considering the anticipated reactions to disclo-
sure of HIV-positive status, we had hypothesized that
there would be more disclosure to non-Latino than
to Latino friends, due to the stigma associated with
homosexuality in traditional Latino culture. Contrary
to our hypothesis, however, participants reported dis-
closing to a higher proportion of Latino friends than
non-Latino friends. It is possible that this finding
is due to participants having predominantly Latino
close friend networks and predominantly non-Latino
peripheral friend networks, in which case greater dis-
closure of serostatus to Latino friends would be highly
likely. Unfortunately, we cannot determine this from
our data. It is also possible that the stigma of homo-
sexuality in Latino culture is less prevalent than in the
past. Cultures are not static, and attitudes change: the
stigma may be diminished, both in Latino countries
and among acculturated Latinos in the United States.
Disclosure and Well-Being
As hypothesized, disclosure was related to
greater quality of social support with all individual tar-
gets (mother, father, closest friend, main partner), as
well as with the two target groups of family members
and friends. These findings that disclosure was asso-
ciated with social support are consistent with previ-
ous studies (Kadushin, 2000; Simoni et al., 2000). The
causal direction is not clear, however, and it is possi-
ble that the relationship between social support and
disclosure is bidirectional. Those who disclose may
elicit more support, and those with more supportive
networks may disclose more.
As in the literature (Kalichman et al., 2003;
Petrak et al., 2001), our results concerning the re-
lationship between disclosure and depression were
inconsistent. We found an effect on depression for
disclosure to the individual targets of mothers and
male main partners, but failed to find an effect with
fathers, close friends, or the two target groups of fam-
ily and friends. It is possible that mothers and main
partners are the most important members of our par-
ticipants’ social networks. Traditionally, mothers are
greatly loved and esteemed in Latino culture, and
main partners represent the persons with whom these
men are emotionally and sexually intimate (in many
cases, a life partner). It could be presumed that disclo-
sure of serostatus allowed an openness and deepened
the intimacy of these relationships, thereby alleviat-
ing negative feelings and depression. In addition, an
inability to disclose over time to these important peo-
ple may have psychological costs, such as depression.
Prospective studies could test these interpretations.
Our findings also supported the view that the
effect of disclosure to mothers and main partners on
depression was mediated by social support. Thus, dis-
closure of HIV-positive serostatus to mothers and
main partner may have resulted in greater social
support from these targets, which in turn alleviated
negative mood. Previous research has indicated that
after disclosure of serostatus, partners tend to provide
much social support; and, although mothers provide
less than partners and friends, they are seen as more
supportivethan fathers(Kalichman et al.,2003; Petrak
et al., 2001; Sachperoglou and Bor, 2001). This social
support may help the person living with HIV to cope
with challenges presented by the disease, and there-
fore maintain a more positive mood.
We also found that disclosure of serostatus to the
male main partner was associated with greater self-
esteem. Revealing positive serostatus to a main sexual
partner may be a perceived obligation, which allows
the partner to make an informed decision about the
relationship and joint sexual behaviors (Serovich and
Mosack, 2003). Fulfilling this obligation by disclosing
may enhance self-esteem. It is also possible that the
causal path of this observed association is in the op-
posite direction, that is, having more self-esteem may
enable one to disclose positive serostatus to a partner,
even at the risk of rejection.
The extent to which participants disclosed pos-
itive serostatus to the target groups of family and
24 Zea, Reisen, Poppen, Bianchi, and Echeverry
friends was also associated with self-esteem. Again,
a bidirectional relationship between self-esteem and
disclosure seems likely. Self-esteem may be enhanced
by the act of disclosure, but disclosure may be more
feasible for individuals with high self-esteem. More-
over, it is possible that there are feedback loops: as
individuals disclose their self-esteem increases, which
then allows for disclosure to additional people.
Our findings supported the interpretation that
social support mediated the effect of disclosure on
self-esteem. It appears that disclosure to the main
partner and to a larger proportion of the social net-
works of family and friends leads to greater quality
of social support, which then leads to greater self-
esteem. Emotional and instrumental social support
may demonstrate to the recipient that he is valued by
others, which in turn may promote self-esteem.
Perceived General and Practical
Consequences of Disclosure
This study also included descriptive information
about perceived general and practical consequences
of disclosure of positive serostatus. In a set that
was fairly evenly divided between negative and pos-
itive outcomes, the most commonly endorsed items
(feeling more relaxed; being able to take care of
health openly; and becoming involved in HIV/AIDS-
related activities) were all positive developments. Our
participants’ reports of being better able to take
care of their health after disclosure suggest that in-
terventions helping individuals to disclose serosta-
tus to appropriate targets could result in increased
adherence to medical care and healthier behaviors.
Although negative consequences were reported less
commonly, they are not unimportant, and they may
indeed cause distress (Hays et al., 1993; Ingram et al.,
1999; Schrimshaw, 2002). Certainly, real-life conse-
quences such as threatened immigration status would
be antithetical to psychological well-being.
CONCLUSIONS
As we have noted throughout our discussion, the
cross-sectional nature of this study limits our ability
to interpret causal direction in the findings. Another
limitation of this study is that we did not ask when dis-
closure occurred with each of these partners. Further-
more, there may be a different impact of disclosure
in the period immediately following the disclosure
than that occurring later. It is possible that disclo-
sure can create a significant but transitory change in
well-being, which then dissipates over time. For exam-
ple, revealing serostatus to one’s mother may result in
feelings of relief and improved mood state for a short
time. These changes may not persist, and factors such
as health status, adaptation to medication, and other
life events may override the initial effect of disclosure.
In contrast, other effects of disclosure may be
long-lasting. For example, after hearing that a loved
one is seropositive, many friends and relatives will
provide emotional and instrumental support in a sus-
tained manner, which would then lead to an enduring
highquality ofsocial support.This lasting support may
serve to lessen depression and increase self-esteem
gradually over time, and this scenario is consistent
with the mediational model that we have proposed.
It is also possible, however, that depression and self-
esteem may be transitory responses that occur soon
after the disclosure, whereas quality of social support
is more lasting. In this case, the stronger association
between disclosure and social support may be due to
the sustained nature of the support, while the weaker
and less consistent associations with depression and
self-esteem may result from their being more tran-
sient reactions. A longitudinal study with recently di-
agnosed participants would be the ideal paradigm to
further explore the process of disclosure; its impact
on social support, self-esteem, and depression over
time; and the role of social support as a mediator
between disclosure of positive serostatus and psycho-
logical well-being.
This study provided evidence that past disclosure
of HIV-positive serostatus is associated with current
positive well-being. Although there were differences
depending on the target, disclosure was related to
greater quality of social support, greater self-esteem,
and lower levels of depression. Moreover, findings
support the view that disclosure of serostatus leads
to greater social support, which in turn, increases
self-esteem and decreases depression. These findings
suggest that Latino, HIV-positive, gay men typically
choose wisely the people to whom they tell their
serostatus; receive emotional and instrumental sup-
port in response to their disclosure; and have positive
mental health outcomes as a result.
ACKNOWLEDGMENTS
Funding for this study was supported by a grant
from the National Institute of Mental Health: R01
Disclosure of HIV Status and Psychological Well-Being 25
MH 60545, Mar´ıa Cecilia Zea, P.I., Paul J. Poppen,
and Carol A. Reisen, co-investigators. The authors
thank the men who participated in this study.
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