March 28, 2016
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Patients need safe environment to discuss sexual identity, potential risks

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Health care providers need to provide a safe, nonjudgmental space for patients to discuss their sexual orientation and identity, which will better allow physicians to make recommendations for HIV testing and hepatitis vaccines based on potential risk factors, according to data published in the Annals of Family Medicine.

“For clinicians, to know their patients’ risk behaviors, men who have sex with men (MSM), and thus who are candidates for routine HIV testing and hepatitis vaccinations, must reveal same-sex sexual behaviors and, for some, sexual identities,” Nicholas Metheny, MPH, RN, and Rob Stephenson, PhD, both of School of Nursing Center for Sexuality and Health Disparities, at the University of Michigan, wrote. “… The decision to reveal same-sex sexual behaviors or identity to a clinician may be shaped by patients’ fears of experiencing stigma or discrimination, which may be heightened in rural areas where levels of homophobia and prejudice have found to be higher than in urban areas.”

To understand whether disclosure of sexual orientation is associated with increased HIV testing and hepatitis vaccinations among rural MSM, the researchers analyzed data collected using a sample recruited from LGBT-themed Facebook pages, with ZIP codes used to determine rural status.

The final sample included 319 rural MSM who self-reported whether they had ever received a vaccine for hepatitis A virus (HAV) or hepatitis B virus (HBV), and their most recent HIV test. In addition, participants rated their physician’s knowledge of their sexual orientation on a scale of 1 (“My primary care provider does not know that I am gay.”) to 7 (“My primary care provider definitely knows that I am gay and we talk about it openly.”).

According to the researchers, disclosure of sexual orientation with physicians was significantly associated with maintaining routine HIV tests and hepatitis vaccinations (OR = 1.26; P = .004, 95% CI, 1.08-1.47). MSM who reported being out and talking openly with physicians about their sexual orientation were nearly 26% more likely to report having been tested for HIV and receiving at least one hepatitis vaccination. However, those who reported being tested for HIV and receiving at least one hepatitis vaccination amounted to only 18.8% of the sample.

“The overall low uptake of these services highlights the need for additional clinician-focused interventions to increase uptake of hepatitis vaccination and HIV testing in this population,” Metheny and Stephenson wrote. “Potential interventions include providing patients with talking points to empower them to discuss same-sex sexual behaviors and/or sexual orientation with their clinician and sensitivity training for clinicians on appropriate ways to discuss sexuality and sexual behavior with their patients.” – by Jason Laday

Disclosure: The researchers report no relevant financial disclosures.