Those who disclose their HIV status and sexual orientation have higher CD4 cell counts

Patients who are open about their HIV infection and sexual orientation have significantly higher CD4 cell counts over time than patients who conceal their HIV status and sexuality, according to US research published in the online edition of Psychosomatic Medicine. The study’s authors do not, however, advocate disclosure as a means of boosting immune function, and observe that for some individuals’ privacy about sexuality and HIV status may have a protective effect.

Earlier research has suggested that concealment of sexual orientation by gay men is associated with faster HIV disease progression in HIV-positive individuals and a higher burden of serious illnesses such as cancer and chest infections in HIV-negative men. Although disclosure of HIV status has been previously shown to have beneficial effects, it can also be associated with stressors such as stigma and discrimination.

Investigators from Seattle hypothesise that disclosure of HIV status and sexual orientation would independently predict higher CD4 cell counts over time than concealment. They constructed a model to test this taking into account possible confounding factors such as demographics (ethnicity, partnership status and employment status), psychiatric diagnoses and injecting drug use, physical and mental health, social support, and the use of potent anti-HIV therapy. Their research involved 373 psychiatric outpatients and was conducted between 2000 and 2004 at a publicly funded HIV clinic in Seattle, which mostly serves low income patients.

After taking into account baseline CD4 cell count, the investigators found that disclosure of HIV status (p = 0.05) and sexual orientation (p = 0.05) predicted higher CD4 cell counts overtime.

“The results supported our hypothesis in that both sexual orientation and HIV-status disclosure were independently associated with improved CD4 cell counts over time compared to concealment”, write the investigators, adding, “these results were maintained when we controlled for CD4 baselines, CD4 latencies, various psychiatric diagnoses, sexual identity, income, general physical and mental health, ethnicity, marital status, employment, years of education, interpersonal functioning, history of IV drug use, and HIV treatment.”

On the basis of their findings, the investigators suggest that inhibitionary processes are the key factor in the inhibition/immune suppression link. However, they believe that it would be “premature to suggest that individuals should disclose sexual orientation and HIV status in order to be healthier”, particularly as there is evidence from earlier studies to shown that concealment can be protective for gay men who fear rejection.

The investigators call for more prospective research “in which disclosure is manipulated rather than measured.” One such study would be a randomised controlled trial of a psychosocial training course focused on building disclosure skills, and the investigators would be interested to see “whether the course actually increases disclosure, influences risk behaviours, and generates the immune results demonstrated in this study.”