In a recent review article published in the Journal of Sex ResearchResearchers explored the existing literature on disclosure of sexually transmitted infections (STIs), highlighting the emotional complexities and strategies involved in the disclosure process.
They concluded that relational factors significantly influence disclosure decisions. However, there remains a need for more research into the experiences of people who receive STI disclosures to better inform future education and intervention efforts.
Study: Disclosure of sexually transmitted infections to sexual partners: a systematic critical review of the literature. Image credit: Tutatamafilm/Shutterstock.com
Background
In 2018, the Centers for Disease Control (CDC) estimated that 67.6 million people in the United States had an STI, with 26.2 million new cases reported that year. Emerging adults (ages 18-29) are most at risk and fear contracting STIs.
Given that STI rates have remained high and continue to rise, particularly in the context of the coronavirus disease 2019 (COVID-19) pandemic, a review of the literature on STI disclosure is timely and necessary . The CDC recommends various methods of STI prevention, including disclosure to sexual partners.
However, existing research on STI disclosure often lacks guiding frameworks and robust methodology and often excludes the perspectives of disclosure recipients. Fear of stigma, quality of relationships, and symptoms are all factors known to influence the decision to disclose one’s STI status.
Methods
This review aimed to systematically and critically evaluate STI disclosure research using the Health Disclosure Decision Making Model (DD-MM), identify research limitations, propose future research directions and to provide information on sexual health education, practice and policy.
The DD-MM framework was chosen for its comprehensive approach to health-related disclosures, focusing on information evaluation, recipient evaluation, and disclosure. efficiency. An important goal of the review was to improve the DD-MM to address the complexities of STI disclosure.
The researchers conducted a systematic critical literature review (SCLR) using methods modeled on previous research and followed a clear, replicable strategy that involved four steps.
This included identifying relevant peer-reviewed articles from medical and scientific databases, screening abstracts, reviewing full texts, extracting data and carrying out critical evaluation and d an analysis of the articles.
Results
The review included 32 studies on STI disclosures, with a mix of quantitative (34.4%), qualitative (46.9%), and mixed methods (18.7%) research. The studies varied in their design, with cross-sectional being most common for quantitative and mixed methods studies, while Grounded Theory was frequently used in qualitative research.
Most studies were conducted in the United States, and convenience sampling and purposive sampling were often used. The studies included predominantly white samples with wide age ranges that made it impossible to disaggregate results for emerging adults.
The thematic synthesis revealed several key themes that align with and expand on the DD-MM model, particularly regarding feelings about disclosure, reasons for and against disclosure, and strategies used.
Emotions such as fear, anxiety, guilt and anger were predominant, with fear being the most common, often linked to anticipated negative reactions from the partner.
Despite negative emotions, many disclosed their STI status due to their belief in honesty, moral obligations, concern for their partner’s health, and maintaining the integrity of their relationship.
Conversely, nondisclosure was often motivated by fear of emotional and behavioral reactions, rejection, and the belief that disclosure was unnecessary in casual relationships. Some also cited privacy, shame and logistical obstacles as reasons for non-disclosure.
Disclosure strategies included priming messages, direct approaches, and different framing of the STI, while nondisclosure strategies included “passing” as uninfected, slowing relationship progression, or scheduling sexual activity based on the presence of symptoms.
The timing of disclosure varied, with many believing it should take place before sexual activity, although actual practices varied. Relationship factors played an important role, with disclosures more likely in committed, long-term, high-quality relationships. Transitions in levels of relationship commitment often triggered disclosures.
Although the DD-MM was found to be useful, the review highlighted its limitations and the complexity of STI disclosure decisions influenced by emotional, relational, and situational factors.
Conclusions
This review systematically examined the literature on STI disclosure, identified gaps, and suggested improvements to the DD-MM. The analysis revealed that previous studies are largely qualitative and lack theoretical grounding.
The authors recommend increasing DD-MM by taking into account pre-diagnosis beliefs, diagnosis-related emotions, and self-evaluation processes, which play a crucial role in disclosure decisions.
Additionally, the nature and stages of relationships significantly influence disclosure, prompting suggestions to expand the model to include these factors.
The review identifies methodological improvements for future research, highlighting the need for diversity in population samples and better demographic reporting, including sexual orientation and gender inclusion.
Further research should also focus on the experiences of disclosure recipients and relational dynamics. The distinction between “disclosure” and “partner notification” is essential for greater clarity in research.
Implications for education and intervention include the need for comprehensive sexual health education and counseling to improve the effectiveness of disclosure. Addressing misconceptions about STI transmission and improving practitioner-patient interactions can promote better disclosure practices. The review highlights the need to destigmatize conversations about sexual health and address health inequalities that impact disclosure.
Limitations of the study include the exclusion of literature on HIV disclosure, potential bias related to the use of the DD-MM framework, and the restriction of English language publications.
Despite this, the findings offer valuable insights into STI disclosure processes, highlighting the need for continued research and improved education and intervention strategies.