Does disclosure of medical records to patients influence medical care?

Disclosure of medical records to patients has been assessed, but the influence of disclosure on medical care has not been well researched. To address this situation, this study was conducted to test three hypotheses: 1) doctors think that the disclosure can influence medical care, 2) whether doctors think disclosure can influence medical care depends on how they rank medical records (for example, as evidence for diagnosis and treatment, a process to reach a diagnosis, a tool to communicate with other medical staff, etc), and on whether they think medical record disclosure could change the content of the record. Questionnaires were sent to 881 doctors who work at two hospitals affiliated with N Medical School and K Medical University. RESULTS: Four hundred eighty-eight doctors responded. The findings related to the hypotheses were as follows: 1) Those who answered that the disclosure could have an influence on medical care were 49.1% of the total. 2) There was no relation between how doctors ranked medical records and whether they thought disclosure could influence medical care. 3) Doctors who answered that there were things that they would not be able to write if medical records were disclosed accounted for 73.5% of the total. These doctors answered "yes" significantly higher to the question that the disclosure could influence medical care than others (Odds 3.6, P < 0.01). Doctors who thought they would not be able to enter the diagnosis, the name of the disease for insurance, self-evaluation, information that could be judged and subjective information answered that disclosure could influence on medical care (P < 0.05). It was assumed that disclosure of medical records to patients could change the content of the medical records and that could influence medical care. How to deal with information will become an important issue if records are disclosed.     

Factors Associated with HIV Status Disclosure to One’s Steady Sexual Partner in PLHIV in Morocco

The objective of the present study was to determine the factors independently associated with disclosure of seropositivity to one’s steady sexual partner in people living with HIV (PLHIV) who are recipients of services provided by Association de Lutte Contre le Sida, a Moroccan community-based organization (CBO) working on AIDS response. Between May and October 2011, 300 PLHIV were interviewed about their sociodemographic and economic characteristics, their sexual life and disclosure of their serostatus to their friends, family and to their steady sexual partner. A weighted logistic regression was used to study factors associated with serostatus disclosure to one’s steady sexual partner. We restricted the analysis to people who declared they had a steady sexual partner (n = 124). Median age was 36 years old, 56 % were men and 62 % declared that they had disclosed their serostatus to their steady sexual partner. The following factors were independently associated with disclosure: living with one’s steady sexual partner [OR 95 % CI: 9.85 (2.86–33.98)], having a higher living-standard index [2.06 (1.14–3.72)], regularly discussing HIV with friends [6.54 (1.07–39.77)] and CBO members [4.44 (1.27–15.53)], and having a higher social exclusion score [1.24 (1.07–1.44)]. Unemployment (as opposed to being a housewife) was negatively associated with disclosure [0.12 (0.02–0.87)]. Despite the potential positive effects for the prevention of HIV transmission and for adherence to HIV treatment, many PLHIV had not disclosed their serostatus to their steady sexual partner. Some factors shown here to be significantly associated with such disclosure will help in the development of future support interventions.     

Optimizing Disclosure of HIV Status to a Diverse Population of HIV-Positive Youth at an Urban Pediatric HIV Clinic

PurposeThe purpose of the study was to increase the proportion of youth living with HIV (YLWH) aged ≥11 years who undergo developmentally appropriate disclosure about their HIV status.MethodsA quality improvement project was initiated at an urban pediatric HIV clinic between July 2018 and March 2020. The primary outcome measure was the proportion of YLWH aged ≥11 years who were disclosed to about their HIV status. The proportion of undisclosed YLWH who had documented nondisclosure status was also assessed as a process measure. Plan-Do-Study-Act (PDSA) cycles for change included monthly clinic staff check-ins to discuss new disclosures, quarterly team meetings to discuss strategies to improve disclosure, and modifying a clinic note template to prompt providers to document disclosure status. Annotated run charts were used to analyze the data.ResultsBefore the first PDSA cycle, 26/46 (57%) of the target population of YLWH aged ≥11 years had their HIV status disclosed to them, and none of the undisclosed youth had disclosure status documented in their medical record. After 20 months and six PDSA cycles, the proportion of YLWH aged ≥11 years disclosed to about their HIV status increased to 80% and the proportion of undisclosed YLWH with documentation of their disclosure status increased to 100%.ConclusionsSeveral interventions integrated throughout the pediatric HIV care process were associated with an increase in the proportion of YLWH with developmentally appropriate HIV disclosure and documentation of disclosure status, an important psychosocial aspect of care in these individuals.     

生物医学科技论文存在的利益冲突问题及其应对措施

【目的】 探讨生物医学科技论文存在的主要利益冲突(Conflict of Interest, COI)问题及其应对措施。【方法】 通过检索Retraction Watch 数据库,收集2016—2021年生物医学期刊中因COI相关问题被撤销、更正或关注的95篇论文为研究对象。回顾性调查论文及其处理(撤稿、更正或关注)声明的主要特征、存在的COI问题及处理措施。【结果】 本研究纳入的95篇论文中,72篇被撤销,23篇被更正或关注。论文存在的主要COI问题包括COI披露不完整(46.3%)、确实存在COI(18.9%)、对已披露COI的完整性存在质疑(12.6%)、潜在的COI披露不完整(12.6%)、COI披露错误(5.3%)等;具体COI表现为作者与企业(42.1%)、其他研究者(9.7%)、其他作者(7.0%)、研究机构(6.1%),以及期刊编辑或审稿人(5.3%)等之间存在的潜在COI或COI。【结论】 生物医学期刊论文发表过程中存在多种COI问题,并且表现形式多样。建立并完善COI相关编辑政策,可预防COI相关问题的发生,从而减少发表偏倚。     

Negotiating cultures: disclosure of HIV-positive status among people from minority ethnic communities in Sydney

Because of the multiple stigma attached to HIV/AIDS, disclosure of HIV-positive serostatus is a considerable social risk for those who disclose. While HIV/AIDS-related stigma affects all HIV-positive people, for people from minority cultures additional cultural factors may play a significant role in self-disclosure. This paper draws on data from semi-structured, in-depth interviews with HIV-positive people from minority cultures in Sydney. Disclosure decisions were influenced by gender, sexual orientation, as well as cultural background. Gay men drew on both collectivist and individualist notions of interdependence and self-reliance in different socio-cultural contexts. This enabled them to accommodate the imperative to maintain harmony with the family and meet their individual needs for support. Heterosexual men who had disclosed voluntarily or involuntarily experienced discrimination and avoidance, and interdependence with family and ethnic community was disrupted. Heterosexual women disclosed to no one outside the health care system and were anxious to avoid any disclosure in the future. For all participants, voluntary and involuntary disclosure caused potential and actual disruption of relationships with their families and ethnic communities. The paper concludes by arguing for an ecological perspective of health in which decisions are not located in rational decision making alone but in the broader context of family and community.     

Women and HIV/AIDS: barriers and new challenges

Women have been placed at a vulnerable situation regarding the HIV epidemic. Recent advances in antiretroviral therapies have placed in evidence the gender disparities and the new challenges to overcome them. The mortality of AIDS has decreased dramatically in the United States and Puerto Rico as a consequence of new combination therapies. Still, women constitute the fastest growing group of AIDS cases. There are gender differences in access to treatment and care, economic income and social and personal power. Among women's barriers to care are the lack of knowledge about AIDS in women by health providers, the family responsibilities and the burden and fear of disclosure. The authors suggest the need for empowerment as strategy for attaining better health and improving the quality of life in women living with HIV.     

Psychosocial problems presented by patients with somatic reasons for encounter: tip of the iceberg?

BACKGROUND: Health-affecting psychosocial problems are inherent in general practice, present among one-third of the patients and constituting between 3 and 13% of reasons for encounter. Such problems are not always presented, and often overlooked by the doctors. OBJECTIVES: We aimed to describe the frequency of psychosocial problems presented to the doctor by patients with somatic reasons for encounter, as a proportion of the patients' existing health-affecting problems, and to explore whether characteristics of the doctor, the patient, their relationship or reason for encounter influence the presentation of problems. METHODS: A questionnaire survey of 1401 consecutive patients visiting 89 Norwegian GPs mapped the prevalence of nine commonly occurring psychosocial problems and the frequency by which they were disclosed during the consultation. RESULTS: From 21% (loneliness) to 59% (occupational stress) of problems were disclosed to the doctors. Reason for encounter was the only factor to influence the disclosure from male patients, while reason for encounter, educational level and income source of the patient, gender of the doctor, and the doctor's previous general knowledge of the patient influenced the disclosure from female patients. CONCLUSIONS: Less than half of health- affecting psychosocial problems are disclosed to GPs by patients with somatic reasons for encounter. Occupational stress is disclosed more often than other psychosocial problems. Female patients disclose non- occupational problems more often than male patients, especially if they know the doctor or if the doctor is a woman. Symptoms from the musculoskeletal system are the reasons for encounter most often preceding the disclosure of psychosocial problems.      

HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention

OBJECTIVES: This study described HIV prevalence, risk behaviors, health care use, and mental health status of male-to-female and female-to-male transgender persons and determined factors associated with HIV. METHODS: We recruited transgender persons through targeted sampling, respondent-driven sampling, and agency referrals; 392 male-to-female and 123 female-to-male transgender persons were interviewed and tested for HIV. RESULTS: HIV prevalence among male-to-female transgender persons was 35%. African American race (adjusted odds ratio [OR] = 5.81; 95% confidence interval [CI] = 2.82, 11.96), a history of injection drug use (OR = 2.69; 95% CI = 1.56, 4.62), multiple sex partners (adjusted OR = 2.64; 95% CI = 1.50, 4.62), and low education (adjusted OR = 2.08; 95% CI = 1.17, 3.68) were independently associated with HIV. Among female-to-male transgender persons, HIV prevalence (2%) and risk behaviors were much lower. Most male-to-female (78%) and female-to-male (83%) transgender persons had seen a medical provider in the past 6 months. Sixty-two percent of the male-to-female and 55% of the female-to-male transgender persons were depressed; 32% of each population had attempted suicide. CONCLUSIONS: High HIV prevalence suggests an urgent need for risk reduction interventions for male-to-female transgender persons. Recent contact with medical providers was observed, suggesting that medical providers could provide an important link to needed prevention, health, and social services.     

Disclosure of HIV infection from the perspective of adolescents living with HIV/AIDS and their parents and caregivers

The purpose of this study was to identify relevant issues in the disclosure of HIV-positive status in children and adolescents, aiming to improve the quality of their healthcare. A qualitative study included adolescents living with HIV/ AIDS and their parents and caregivers at AIDS reference services in S?o Paulo and Santos, Brazil. In-depth interviews and focus group were used. The main reasons for disclosure were: poor treatment adherence, sexual maturity, adolescent's request, and inadequate procedures by medical staff. Disclosure was a critical moment for adolescents, with a strong impact on their life plans and horizons. Adolescents infected through sexual transmission and drug use reported the most problematic scenes involved in disclosure. Despite its initial negative impact, disclosure resulted in improved healthcare and better dialogue among the adolescents, caregivers, and healthcare providers. The adolescents also requested clear, no-nonsense, honest information. The authors conclude that health services need to actively provide an adequate approach to facilitate disclosure of HIV-positive status to children and adolescents, realizing that it is a long-term process supported by the family and a multidisciplinary team.     

Do Chinese parents with HIV tell their children the truth? A qualitative preliminary study of parental HIV disclosure in China

Background With the extended lifespan of people living with human immunodeficiency virus (HIV) due to the advent of antiretroviral therapy, the disclosure of HIV serostatus to their uninfected children is becoming more critical. However, limited data are available regarding parental HIV disclosure to children in China. We explore patterns of parental HIV disclosure and the reasons for disclosure or non‐disclosure to children. Methods A preliminary study was conducted using open‐ended questions in Guangxi, China in 2011 with 39 parents living with HIV. Results A majority of participants (77%) had not disclosed their HIV serostatus to their children. Participants who voluntarily disclosed tended to be older and were more likely to disclose to their adult children. Among parents who disclosed, reasons included a need for emotional and financial support, as well as feelings of obligation to their children. Among non‐disclosing parents, primary reasons included concerns that children were too young to understand, fear of being stigmatized, and fear of increased psychological burden to children. Conclusions Few parents with HIV disclosed their HIV status to their children. These data indicate the need for future research to explore disclosure issues in relation to children's age and the implementation of developmentally appropriate interventions and support systems for parents and children affected by HIV in China.     

‘Many people know the law,but also many people violate it’: Discrimination experienced by people living with HIV/AIDS in Vietnam – Results of a national study

In Vietnam, discrimination against people living with HIV/AIDS (PLHIV) is defined within and prohibited by the 2007 national HIV/AIDS law. Despite the law, PLHIV face discrimination in health care, employment, education and other spheres. This study presents the first national estimates of the levels and types of discrimination that are defined in Vietnamese law and experienced by PLHIV in Vietnam. A nationally representative sample of 1200 PLHIV was surveyed, and 129 PLHIV participated in focus group discussions (FGDs). In the last 12 months, nearly half of the survey population experienced at least one form of discrimination and many experienced up to six different types of discrimination. The most common forms of discrimination included disclosure of HIV status without consent; denial of access to education for children; loss of employment; advice, primarily from health care providers, to abstain from sex; and physical and emotional harm. In logistic regression analysis, the experience of discrimination differed by gender, region of residence and membership status in a PLHIV support group. The logistic regression and FGD results indicate that disclosure of HIV status without consent was associated with experiencing other forms of discrimination. Key programme and policy recommendations are discussed.     

Regular health care use by lesbians: a path analysis of predictive factors

BACKGROUND: Lesbians have more health risks than other women but access preventive medical care less frequently. OBJECTIVE: To test the influence of (i) provider inquiry about sexual orientation, (ii) perceived provider gay-positivity and (iii) patient disclosure of sexual orientation on regular health care use in a sample of Canadian lesbians. METHODS: A path analysis using community survey data from 489 lesbian respondents. RESULTS: 78.5% [95% confidence interval (CI): 74.7-82.0] of women reported regular health service use; 75.8% (95% CI: 72.2-79.8) of women had disclosed their sexual orientation to their provider; and 24.4% (95% CI: 20.6-28.2) of women had been asked about their sexual orientation by their provider. Of those women whose physicians had inquired about their sexual orientation, 100% (95% CI: 97.5-100.0) had disclosed. In the final path analysis, perceived provider gay-positivity and level of patient outness predicted disclosure, which, along with health status predicted regular health care use. All paths were significant at P < 0.05. CONCLUSIONS: Provider-related factors including perceived gay-positivity and inquiry about sexual orientation are strongly associated with disclosure of sexual orientation. Disclosure is associated with regular health care use. Minor changes to practice could improve access to health services for lesbians.     

Glen or Glenda: Reported Gender of Sex Partners in Two Statewide HIV Databases

Objectives. We assessed agreement of reported gender of sex partners in 2 statewide HIV databases linked by client identifiers.Methods. Counseling, testing, and referral (CTR) records on all men aged 18 to 30 years who tested newly positive for HIV in North Carolina between 2000 and 2005 were matched to data abstracted from partner counseling and referral services (PCRS) records. We compared client-reported gender of sex partners at the time of testing (CTR records) with those reported during postdiagnosis partner notification (PCRS records).Results. PCRS records appeared to be a more complete measure of the gender of sex partners. Of the 212 men who told their HIV test counselor that they had only had female sex partner or partners in their lifetime, 62 (29.2%) provided contact information for male sex partner(s) during partner notification.Conclusions. During the test counseling risk assessment, many men did not fully report the gender of their sex partners; this suggests that CTR data may not fully capture clients'' risk behaviors.To monitor trends among people testing for HIV and to inform prevention programs, the Centers for Disease Control and Prevention (CDC) funds the collection of individual-level data on all persons accessing counseling, testing, and referral (CTR) services in publicly funded test sites, including demographics, self-reported risk behaviors, and test results.¹ CTR behavioral risk assessments are usually completed in face-to-face, in-depth interviews with a trained HIV counselor as part of a client-centered, prevention-counseling approach.² Behaviors disclosed to the counselor inform the development of a behavioral change goal to reduce the client''s risk of HIV acquisition. Risk behaviors disclosed to providers influence the services offered to clients. In a study of clinics offering both confidential and anonymous HIV testing, providers admitted to “push[ing] those individuals who are at high risk of HIV infection to test confidentially,”^3(p162) presumably to aid in reporting and partner notification. Among gay and bisexual men attending a sexually transmitted disease (STD) clinic, men who disclosed a high-risk behavior (anal sex) were more like to be tested for gonorrhea than men who failed to disclose.⁴CTR data are recorded on standardized forms and submitted to the CDC quarterly for tracking of national statistics.¹ Aggregated risk behavior data are used to evaluate the effectiveness of the CTR program in providing high-risk populations with testing opportunities,⁵ to guide the development of prevention interventions, and to inform allocation of funds. For clients testing positive for HIV, the risks recorded on the CTR form may be used to determine likely mode of transmission, along with medical record review.It is likely that nonheterosexual behaviors are underreported during the CTR risk assessment. In a study of the completeness of sexual histories obtained during STD examinations, 22% of men who reported same-gender sex during a computer-assisted interviewed failed to disclose that information during a face-to-face clinician interview.⁶ Almost 40% of men surveyed in the New York City National HIV Behavioral Surveillance Project reported not disclosing same-gender sex to their health care providers.⁷ During HIV test counseling, clients may not completely report the gender of their sex partners (e.g., they may report only sex with women when they had sex with both men and women). To date, no study has quantified the completeness of disclosure of the gender of sex partners in a CTR database.There is no “gold standard” for validating self-reported risk behaviors,⁸ but other behavioral databases may be more complete in measuring the gender of sex partners than a CTR database. In North Carolina, the partner counseling and referral services (PCRS) program is part of the state Department of Health and Human Services (NCDHHS) field services office. PCRS counselors conduct voluntary, postdiagnosis interviews with clients newly infected with HIV to assist with partner notification of past sex and needle-sharing partners, counsel clients on prevention of subsequent risk behaviors, and facilitate referrals for treatment and services.^9,10 Often meeting with clients multiple times, PCRS counselors stress the importance of partner notification to provide persons exposed to HIV the opportunity to be tested, as well as to remind clients of communicable disease control laws that mandate partner notification. Consequently, PCRS interviews may be a more complete measure of the gender of sex partners than the HIV counseling risk assessment.We linked CTR records to data abstracted from PCRS records on young men newly diagnosed with HIV. We compared the client-reported genders of sex partners at the time of HIV testing (CTR records) with those reported during postdiagnosis partner notification (PCRS records), calculating measures of agreement.     

The context and process of pediatric HIV disclosure

This qualitative study sought to elicit the context and process of disclosure to children living with HIV (CLHIV) on antiretroviral treatment in Nigeria. The study, nested in a larger study, involved detailed interviews with 15 parent/caregivers of children ≥6 years, who had been told they were living with HIV. Most children were disclosed to at home by their parents/caregivers. The common reason for disclosure was related to the children taking their drugs. Disclosure was mostly unplanned and a one-off event, even when it was the healthcare worker who disclosed. The conversation about the child’s HIV status took place in private between the child and parent(s)/caregiver. Where several children were living with HIV in the family, parents/caregivers would usually disclose to the children at the same time, rather than individually. Children’s reaction to disclosure ranged from no reaction to shock and crying. Some parents felt they did not have the right skills to disclose. The disclosure decision model provides some insight into the disclosure process.     

Women's Lives After an HIV-Positive Diagnosis: Disclosure and Violence

Objectives: This research addresses four questions: (1) What role do health care providers play in women's disclosure to others of their HIV-positive status? (2) What are women's concerns and experiences with disclosure? (3) What violence do women living with HIV experience? (4) How is the violence related to their diagnosis and disclosures? Methods: Participants were 310 HIV-positive women enrolled in an HIV primary care clinic in an urban teaching hospital. Women were interviewed once using both quantitative and qualitative methods. Results: Women had known they were HIV-positive for an average of 5.8 years; 22% had an HIV-positive partner; 58% had disclosed their status to more than 10 people; and 68% had experienced physical abuse and 32% sexual abuse as an adult. Fifty-seven percent of the sample reported that a health care provider had told them to disclose to their sex partners. Women who were afraid of disclosure-related violence (29%) were significantly more likely than those who were not to report that a health care provider helped them with disclosure (21% vs. 10%). Although 4% reported physical abuse following a disclosure event, 45% reported experiencing emotional, physical, or sexual abuse at some time after their diagnosis. Risk factors for experiencing abuse after diagnosis were a prior history of abuse, drug use, less income, younger age, length of time since diagnosis, and having a partner whose HIV status was negative or unknown. Conclusions: Identifying women at risk for abuse after an HIV-positive diagnosis is important for those who provide HIV testing and care. Routine screening for interpersonal violence should be incorporated into HIV posttest counseling and continuing primary care services.

     

Changes in intern attitudes toward medical error and disclosure

Medical Education 2012: 46: 668–677 Context The 2000 Institute of Medicine report, ‘To Err is Human: Building a Safer Health System’, focused the medical community on medical error. This focus led to educational initiatives and legislation designed to minimise errors and increase their disclosure. Objectives This study aimed to investigate whether increased general awareness about medical error has affected interns’ attitudes toward medical error and disclosure by comparing responses to surveys of interns carried out at either end of the last decade. Methods Two cohorts of interns for the academic years 1999, 2000 and 2001 (n = 304) and 2008 and 2009 (n = 206) at a university hospital were presented with two hypothetical scenarios involving errors that resulted in, respectively, no permanent harm and an adverse outcome. The interns were questioned regarding their likely responses to error and disclosure. Results We collected 510 surveys (100% response rate). For both scenarios, the percentage of interns who would be willing to fully disclose their mistakes increased substantially from 1999–2001 to 2008–2009 (‘no permanent harm’: 38% and 71%, respectively [p < 0.001]; ‘adverse outcome’: 29% and 55%, respectively [p < 0.001]). About two thirds of fully disclosing interns in both scenarios believed ‘the patient’s right to full information’ to be the primary reason for their disclosure. Fear of litigation in response to error disclosure decreased (70% and 52%, respectively), the percentage of interns who felt that ‘medical mistakes are preventable if doctors know enough’ decreased (49% and 31%, respectively), belief that competent doctors keep emotions and uncertainties to themselves decreased (51% and 14%, respectively), and agreement with leaving medicine if one (as an intern) caused harm or death decreased (50% and 3%, respectively). Prior training about medical mistakes increased more than four‐fold between the cohorts. Conclusions This comparison of intern responses to a survey administered at either end of the last decade reveals that there may have been some important changes in interns’ intended disclosure practices and attitudes toward medical error.     

Autopsy cases of lung cancer and liver cancer among Japanese dentists--a review of the annual of the pathological autopsy cases in Japan

Dentists are exposed to carcinogenic metals during their work. It has been speculated that dentists are also at high risk for occupational exposure to bloodborne viruses such as hepatitis B and hepatitis C. We suspected that Japanese dentists were at increased risk for lung and liver cancer. To assess this question, we compared the number of pathological diagnoses of lung cancer and liver cancer among autopsy cases of male dentists (n=225) with that among autopsy cases of male medical doctors (n=1,296), based on data from the Annual of the Pathological Autopsy Cases in Japan from 1992 to 1999. We calculated the mortality odds ratio of lung cancer and liver cancer, using stomach cancer as the control. No difference between the dentist group and the medical doctor group was observed in the pathological diagnoses of lung cancer among all autopsy cases (p=0.703, Odds Ratio: 0.846, 95% confidence interval: 0.461-1.554). Liver cancer was observed less often among dentists than among medical doctors (p=0.047, Odds Ratio: 0.474, 95% confidence interval: 0.239-0.941). Based on the results of this study, we suggest that Japanese male dentists do not have a higher risk of developing lung cancer than male medical doctors, and have a lower risk of developing liver cancer.     

Silence Surrounding Hepatitis C Status in Risk Relationships Among Rural People Who Use Drugs

Hepatitis C virus (HCV) has reached epidemic proportions in rural Central Appalachia in recent years. We sought to identify demographic, behavioral, and interpersonal characteristics associated with HCV serostatus disclosure among high risk people who use drugs (PWUD) in Appalachian Kentucky. HCV antibody-positive participants (n = 243), drawn from the fifth follow-up assessment of a longitudinal study of rural PWUD, completed interviewer-administered questionnaires eliciting demographic and interpersonal characteristics, risk behaviors, and information about HCV disclosure. We assessed correlates of HCV disclosure using gender-stratified multivariate logistic regression. Participants reported having disclosed their HCV-positive status to a current sex partner (44.0%), family member (35.8%), close friend (9.5%), or past sex partner (6.6%). Of those reporting current (n = 72) or past (n = 215) injection drug use (IDU), only 2.8% disclosed to current and 0.9% disclosed to past IDU partners, respectively. Female participants were more likely than male participants to disclose to current sex partners and family member(s). In multivariate analyses, adjusting for time since testing HCV positive, older age and lifetime history of drug treatment were associated with decreased odds of HCV disclosure among females, while only lifetime history of drug treatment was associated with decreased odds of HCV disclosure among males. In summary, the almost complete absence of disclosure to current or former injection drug use partners was concerning. However, most participants (69.1%) reported disclosing their HCV status to at least one of their social referents, suggesting that family members, partners, and friends of people living with HCV could play a critical role in encouraging uptake of treatment. Although further research is warranted, it is clear that interventions are needed to encourage HCV disclosure among those most at risk of transmitting HCV.