Delay in disclosure about sexual orientation to health-care professionals among men who have sex with men in Brighton, UK: a qualitative analysis

Abstract

BackgroundMen who have sex with men (MSM) are at risk of poor sexual health and can benefit from preventive health interventions, such as vaccination and screening. For these interventions to be most effective, it is crucial that men can openly discuss same-sex sexual behaviours with health-care professionals at the beginning of their sexual activity. This study aimed to explore the barriers and facilitators to disclosure of sexual orientation among MSM. MethodsThe study involved four focus groups (five participants each) and 13 one-to-one interviews with self-identified MSM from Brighton, UK, between Nov 20, 2014, and March 15, 2015. Participants were recruited from community-based lesbian–gay–bisexual–transgender venues and organisations. Discussions were recorded, transcribed verbatim, and analysed with framework analysis. Ethics approval was granted from Brighton and Sussex Medical School. Findings33 men (mean age 25 years, SD 5, range 18–40) took part. Eight themes were identified. MSM reported that the attributes of a doctor and the characteristics of a clinic or surgery were important when judging the relevance of sexual orientation in their health care. Men who had negative experiences talking about their sexuality or did not associate themselves with the gay culture were less likely to reveal same-sex practices. Some men acknowledged that having a support network and feeling confident as a gay man enabled them to be open about sexual orientation. Questionnaires and direct face-to-face questions were perceived as acceptable ways to reveal sexual orientation. Almost all men admitted that they had waited until they felt it was important, safe, or worthwhile to discuss sexual orientation. InterpretationMost participants had delayed disclosure of sexual orientation until they perceived it to be relevant to health care and felt certain about confidentiality. To encourage MSM to discuss their health and wellbeing with health-care professionals, services need to inform MSM about the benefits and acceptance of disclosing sexual behaviours. Future studies should explore strategies to remove barriers and to communicate a welcoming approach to stigmatised sexual minorities. FundingThis work was funded through a competitive PhD scholarship from the University of Brighton.