Ways of coping and HIV disclosure among people living with HIV: mediation of decision self-efficacy and moderation by sex

AIDS Care. 2019 Aug;31(8):1001-1010. doi: 10.1080/09540121.2019.1605045. Epub 2019 Apr 12.


Individuals living with HIV/AIDS face several stressors and use varying strategies to cope. Disclosure (or nondisclosure) of HIV serostatus is an important consideration among individuals living with HIV. However, studies examining the association between coping and HIV disclosure are lacking, and more research examining potential mediators and moderators is needed. The transactional model of stress and coping and the theory of planned behavior may help in understanding the mediating relationship between coping, decision self-efficacy, and HIV disclosure. Therefore, the aims of this study were to examine the association between coping and HIV disclosure to sexual partners, assess the mediating role of decision self-efficacy, and examine moderation by sex. Baseline data from 262 individuals living with HIV who participated in a disclosure intervention were used for analysis. Descriptive statistics were used to assess sociodemographic characteristics. Principal component analysis was used to operationalize coping. Path analysis was then used to determine the mediating role of decision self-efficacy in the association between overall, adaptive, distancing, and attack/escape avoidance coping and HIV disclosure to sexual partners. After adjusting for age and time since diagnosis, direct associations between coping and decision self-efficacy, and decision self-efficacy and disclosure behavior varied by sex. Among the overall study population, decision self-efficacy mediated the associations between adaptive coping (β = 0.064, p = 0.003), attack/escape avoidance coping (β = -0.052, p = 0.009) and disclosure behavior. Disclosure intervention programs geared towards populations living with HIV should include decision self-efficacy and adaptive coping, and attenuate attack/escape avoidance coping.

Keywords: Coping; HIV disclosure; disparities; mediation; men; women.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Acquired Immunodeficiency Syndrome
  • Adaptation, Psychological*
  • Adolescent
  • Adult
  • Anti-HIV Agents / therapeutic use
  • Decision Making
  • Female
  • HIV Infections / diagnosis*
  • HIV Infections / drug therapy
  • HIV Infections / psychology*
  • HIV Seropositivity / diagnosis*
  • HIV Seropositivity / psychology*
  • Humans
  • Male
  • Middle Aged
  • Negotiating
  • Principal Component Analysis
  • Self Disclosure*
  • Self Efficacy*
  • Sex Factors
  • Sexual Partners
  • Social Behavior
  • Stress, Psychological*
  • Truth Disclosure


  • Anti-HIV Agents