Abstract
BackgroundIn China, addressing disparities in the HIV epidemic among men who have sex with men (MSM) requires targeted efforts to increase their engagement and retention in prevention. In an effort to advance MSM-friendly HIV services within China, and informed by community-based partnerships, we tested whether MSM who have ever versus never disclosed their same-sex behavior to healthcare providers (HCP) differ in sociodemographic and behavioral characteristics as well as the qualities of sexual health services each group would prefer to access.MethodsWe conducted a cross-sectional survey among HIV-negative MSM who went to MSM-focused voluntary counseling and testing clinics in four cities in China. The survey was anonymous and collected information on sociodemographic characteristics, testing behaviors, sexual-health related behavior, and sexual health service model preferences.ResultsOf 357 respondents, 68.1% participants had ever disclosed same-sex behavior to HCPs when seeking advice for sexual health. Younger age (aOR = 1.04; 95% CI: 1.01-1.08), and worry of HIV acquisition (aOR = 1.39; 95% CI: 1.05–1.84) were associated with higher odds of past disclosure. The availability of comprehensive sexual health services was one of the most valued characteristics of the ideal sexual health clinic. Those who ever disclosed and never disclosed differed significantly in their ranking of the importance of three out of ten dimensions: sexual health counseling services available (M = 3.99 vs. M = 3.65, p = .002), gay identity support available (M = 3.91 vs. M = 3.62, p = .016) and clinic collaborates with a gay CBO (M = 3.81 vs. M = 3.56, p = .036).ConclusionsOur hypothesis that MSM who had disclosed versus never disclosed same-sex behavior would differ in the value they placed on different dimensions of sexual health service was partially borne out. As health authorities in China decide on implementation models for pre-exposure prophylaxis (PrEP) delivery and specifically within which institutions to integrate PrEP services, the preferences of target populations should be considered to develop comprehensive, patient-centric and LGBT-friendly services.
Highlights
In China, addressing disparities in the Human Immunodeficiency Virus (HIV) epidemic among men who have sex with men (MSM) requires targeted efforts to increase their engagement and retention in prevention
In many areas of the world where homosexuality remains illegal or stigmatized in structural and social ways, gay, bisexual and other men who have sex with men (MSM) largely decline to disclose their sexuality and same-sex behavior to healthcare providers (HCPs) [1]. This concealment protects MSM against the deleterious effects of experiencing further maltreatment [2], and means that HCPs miss opportunities to tailor sexual health services to intervene on the disproportionate burden of Sexually transmitted infections (STIs) and HIV experienced by MSM as a key population [3]
We aimed to assess two aspects of sexual health services: A) demographic and behavioral characteristics associated with disclosure of same-sex behavior to HCPs, and B) whether disclosure was associated with different priorities for sexual health services among MSM
Summary
In China, addressing disparities in the HIV epidemic among men who have sex with men (MSM) requires targeted efforts to increase their engagement and retention in prevention. In many areas of the world where homosexuality remains illegal or stigmatized in structural and social ways, gay, bisexual and other men who have sex with men (MSM) largely decline to disclose their sexuality and same-sex behavior to healthcare providers (HCPs) [1]. This concealment protects MSM against the deleterious effects of experiencing further maltreatment [2], and means that HCPs miss opportunities to tailor sexual health services to intervene on the disproportionate burden of STIs and HIV experienced by MSM as a key population [3]. Reorienting existing health services to affirm MSM sexuality, in line with the World Health Organization (WHO) definition of sexual health [12] and recommendations for sexual health service models specific to MSM [3, 13] may lessen the disproportionate burden of HIV and STIs by improving engagement and retention in services [14]
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