Abstract A051: A conceptual framework for disclosure, intimacy, and sexual behaviors among Black women diagnosed with human papillomavirus
Authors: Williams Barbara , Zimmermann Kristine , Kristensen Kathleen , Moore Kayla , Miller Whitney , Hu Elise , Merrill Jamison , Kersten Marjorie , Prescod Lindsay , Mitchell Uchechi , Molina Yamilé 
Published: December 2023

Purpose: Black women suffer disproportionately from Human papillomavirus (HPV) infection and related cancers, including greater associated post-diagnosis mortality. Little research and no frameworks, of which we are aware, have characterized the experiences of patients with a positive HPV diagnosis, including which factors contribute to disclosure of one’s HPV positive status, which has specific implications for intimacy with romantic partners, sexual behaviors, and the spread of HPV.  Objective: To propose a conceptual framework regarding disclosure, intimacy with romantic partners, and sexual behaviors among Black women diagnosed with an HPV infection. Development: A working group including diverse perspectives in public health (e.g., infectious disease, women’s health, cancer health) conducted a review of eight existing public health, cancer health equity, and infectious diseases to identify frameworks relevant for our outcomes – i.e., communication about one’s disease status, partnership/relationship outcomes, and sexual health. Examples include Communication Privacy Management Theory, Politeness Theory, Objectification Theory, socioecological models, Maslow’s Hierarchy of Needs model, and models on social relationships and health, including those focused on stress processes. Framework: Our framework first characterizes HPV disclosure which is a multi-dimensional construct, representing the amount and type of information that is communicated to the partner. Multifaceted factors that contribute to disclosure include HPV knowledge, exposure to community stigma (e.g., sexual silence), self-efficacy for disclosure, and anticipated support from partner. These patient-level factors may not only contribute to disclosure, but also influence how HPV disclosure affects relationship outcomes (e.g., intimacy, sexual behaviors). Other theoretical moderators exist at multiple levels, including at the levels of the disclosure, partner, and relationship. At the level of the disclosure, the modality, amount, and type of information communicated may influence partner responsiveness and relationship outcomes (e.g., reduced intimacy, alternative sexual partners). At the partner level, knowledge of HPV, and exposure to community stigma can contribute to the partner’s response and relationship outcomes. At the relationship level, quality, values, and norms of the relationship, including trust, provision/receipt of emotional support, and communication norms, will also likely moderate the impact of disclosure on relationship outcomes. Emerging Research: This framework offers multiple venues for future cancer equity research. We will conduct participatory qualitative research to identify other relevant factors and pathways through which an HPV diagnosis may impact disclosure, intimacy, and subsequent sexual risk. We will subsequently conduct quantitative survey research to test associations and offer targets for future cancer health equity interventions.

Citation Format: Barbara Williams, Kristine Zimmermann, Kathleen Kristensen, Kayla Moore, Whitney Miller, Elise Hu, Jamison Merrill, Marjorie Kersten, Lindsay Prescod, Uchechi Mitchell, Yamilé Molina. A conceptual framework for disclosure, intimacy, and sexual behaviors among Black women diagnosed with human papillomavirus [abstract]. In: Proceedings of the 16th AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2023 Sep 29-Oct 2;Orlando, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2023;32(12 Suppl):Abstract nr A051.