Non-judgemental space needed for discussion

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Health care providers need to provide a safe, non-judgmental 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, Healio reports that research has found.

“For clinicians, to know their patients’ risk behaviours, men who have sex with men (MSM), and thus who are candidates for routine HIV testing and hepatitis vaccinations, must reveal same-sex sexual behaviours and, for some, sexual identities,” Dr Nicholas Metheny and Dr Rob Stephenson, both of the School of Nursing Centre for Sexuality and Health Disparities, at the University of Michigan, wrote. “… The decision to reveal same-sex sexual behaviours 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 report says the researchers analysed 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, the report says 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 behaviours and/or sexual orientation with their clinician and sensitivity training for clinicians on appropriate ways to discuss sexuality and sexual behaviour with their patients.”

Purpose: The decision and ability of primary care clinician to make recommendations for routine human immunodeficiency virus (HIV) testing and hepatitis A virus (HAV) and hepatitis B virus (HBV) vaccines are shaped by knowledge of their patient’s risk behaviors. For men who have sex with men, such knowledge requires disclosure of same-sex sexual behavior or sexual identity.
Methods: Data were analyzed from a national survey of rural men who have sex with men (N = 319) to understand whether the disclosure of sexual identity to clinicians was associated with increased uptake of HIV testing and hepatitis vaccinations.
Results: We found that disclosure of sexual identity to clinicians was significantly associated (OR = 1.26; 95% CI, 1.08–1.47) with uptake of routine HIV testing and HAV/HBV vaccination.
Conclusion: Our finding reinforces the need for safe, nonjudgmental settings for patients to discuss their sexual identities freely with their clinicians.

Full Healio report
Annals of Family Medicine abstract

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