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Doctors Often In Dark About Patients' Sexual Behavior

Ruzanna Harutyunyan's picture

Don't ask, don't tell. That impulse may help prevent awkward conversations, but it's a losing strategy for slowing the spread of HIV. When health care providers know about their patients' sexual behavior, they can help prevent infection through testing, counseling and other services. But a new study from the Health Department suggests that those opportunities are often missed. In a survey of New York City men who have sex with other men, researchers found that 39% had not disclosed their sexual orientation to their doctors - a lapse that greatly reduced their odds of being tested for HIV. African-American, Hispanic, and Asian men who had sex with men were far less likely to disclose their sexual activities.

The study, published this month in the Archives of Internal Medicine, examined data from the 2004-2005 Centers for Disease Control National HIV Behavioral Survey, which examines risky behavior among men across the nation who have sex with other men (MSM). For the survey, men at gay bars and clubs were interviewed anonymously, tested for HIV, and offered medical and social services as needed. The Health Department analyzed data for the 452 survey participants who lived in New York City.

The study showed that men who disclose having sex with men were twice as likely as those who did not to have been tested for HIV (63% vs. 36%). The low rate of HIV testing among non-disclosers suggests that health care providers continue to practice risk-based HIV testing in New York City. This means that unless providers know that a patient has a risk factor for HIV, they are not offering the test. The current national guidelines, adopted in 2006 by the Centers for Disease Control and Prevention, call on health care providers to offer HIV tests to all patients between the ages of 13 and 64.

“Health care providers should screen patients routinely for HIV,” said Dr. Elizabeth Begier Director of HIV Epidemiology. “They should also ask their patients about behavior that may put them at risk. And New Yorkers shouldn’t hesitate to talk openly with their health care providers. Being frank about sexual behavior when you see the doctor of your choice will help you get the services and information you need to stay healthy.”

The study findings also suggest that just as doctors may hesitate to ask patients about their sexual practices, MSM are often reluctant to volunteer such information – especially if they do not regard themselves as gay. While the overall rate of disclosure was just 61% among MSM in New York City, the rate increased to 78% among those who identified themselves as homosexual. These men may have less apprehension about how their homosexuality is perceived and were more likely to tell their doctor.

“These findings show that the stigma of homosexuality can be harmful to people’s health,” said Dr. Monica Sweeney, Assistant Commissioner. “Because of the fear and discrimination that still surround coming out, we are missing opportunities to stop the spread of HIV.”

Disclosure rates also varied widely among different racial and ethnic groups. Among the MSM surveyed in New York City, blacks were three times more likely than whites to say they had not discussed their sex lives with their doctors. Disclosure was also less common among Hispanic and Asian men (see table). The findings are consistent with past studies suggesting that men of color are less likely than whites to embrace the term “gay” or deem themselves homosexual. They are more likely to call themselves bisexual or heterosexual, presumably because of the stigma associated with homosexuality in many minority communities. In the current study, 78% of the men who identified themselves bisexual were black or Hispanic – and none of them had disclosed his orientation to a health care provider.

Certain other sub-groups were also less likely to disclose their sexual practices. Men who were 28 or older were more like than younger men (69% vs. 52%) to be out to their providers. Those born in the United States were more likely than immigrant men to disclose their practices (64% vs. 52%), and those who were better educated disclosed at higher rates than the less educated.

Know Your HIV Status – Get Tested

* If you have ever been sexually active or have injected drugs (even once) you should be tested for HIV.

* Rapid tests are now available that give results in less than an hour.

* If you’re infected, you can get medical treatment that can help you feel better and live longer. You can also prevent others from becoming infected.

Protect Yourself and Others

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* Not having sex is the surest way to avoid HIV and other STDs.

* If you are sexually active, you can reduce your risk of getting or spreading HIV by having sex only in a mutually monogamous relationship with a partner you are sure is not infected.

* Always use a latex condom if you have sex – vaginal, anal, or oral. NYC Condoms are available for free. Call 311 or visit nyc.gov/condoms.

* Limit the number of people you have sex with. The more people, the higher your risk. Sex with people you do not know also increases your risk.

* Avoid alcohol and other drugs when you have sex. Being intoxicated or high makes it much harder to remember to use condoms.

Some Activities Are Riskier Than Others

According to the best available evidence:

* Receptive anal intercourse is the riskiest sexual act – it is 5 times riskier than receptive vaginal intercourse and 50 times riskier than receptive oral sex.

* Insertive anal or vaginal intercourse is 10 times riskier than insertive oral sex.

* Oral sex carries some risk for both partners, but is less risky than other penetrative sexual activities.

* Condoms greatly reduce the spread of HIV for both partners in anal, vaginal, and oral sex.

Health Department efforts to help more New Yorkers learn their status

The Health Department works rigorously to increase HIV testing, and to make it more routine. Most recently, the agency launched an effort to increase HIV testing in the Bronx. Working with dozens of medical providers and community partners across the borough, the Bronx Knows initiative aims to help all Bronx adults know their HIV status within three years, and ensure that people testing positive receive care.

The Health Department’s STD Clinics provide HIV testing six days a week at 10 different sites throughout the five boroughs. Nearly 60,000 tests were provided in 2007, double the number provided in 2002. New Yorkers can walk in, get tested, and receive results within an hour. New Yorkers can call 311 for clinic locations.