Lack of sexual behavior disclosure may distort STI testing outcomes

Navin Kumar,Marcus Alexander,Fan Yang,Laura Forastiere,Katherine T Li,Nicholas A Christakis,Joseph D Tucker,Tiange Zhang,Weiming Tang

doi:10.1186/s12889-020-08768-5

Abstract

BackgroundMen who have sex with men (MSM) globally have a high burden of curable sexually transmitted infections (STIs). MSM do not frequently receive rectal STI testing because of several barriers, such as not being out (disclosure of sexual behavior). We evaluate whether Chinese MSM select an STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/or receptive), and the interactions with being out.MethodsThis was a secondary analysis of data from a cross sectional MSM survey conducted at a multisite randomized controlled trial (RCT) (December 2018 to January 2019) around uptake of gonorrhea and chlamydia testing among Chinese MSM (N = 431). We collected socio demographics, relevant medical and sexual history, and disclosure of sexual behavior (outness). We estimated the decision to test and test choice, and the extent to which disclosure plays a role in decision making.ResultsAmong 431 MSM, mean age was 28 years (SD = 7.10) and 65% were out to someone. MSM who indicated versatile sexual behavior and were out to someone had a 26.8% (95%CI = 6.1, 47.5) increased likelihood for selecting the rectal test vs the ure thral test, compared to those versatile and not out. Versatile MSM out to their health provider outside of the study context had a 29.4% (95%CI = 6.3, 52.6) greater likelihood for selecting the rectal STI test vs the urethral test, compared to versatile MSM not out to their health provider.ConclusionsSexual behavior and outness may affect gonorrhea and chlamydia testing provision. Apart from clinicians, community based efforts may reduce stigma based barriers to testing.

Highlights

Men who have sex with men (MSM) globally have a high burden of curable sexually transmitted infections (STIs)
A preference for receptive anal intercourse is associated with increased likelihood of a gonorrhea and chlamydia infection [5]
The objectives of the study were to assess if MSM are more likely to select the gonorrhea and chlamydia test most representative of their sexual behavior, compared to a test less representative of their behavior; and if outness is related to the decision to select a rectal vs urethral test

Summary

Introduction

Men who have sex with men (MSM) globally have a high burden of curable sexually transmitted infections (STIs). MSM do not frequently receive rectal STI testing because of several barriers, such as not being out (disclosure of sexual behavior). We evaluate whether Chinese MSM select an STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/or receptive), and the interactions with being out. Among MSM worldwide, gonorrhea and chlamydia are the two most common. There are a variety of ways MSM engage in intercourse, some related to preference and some not. Some MSM prefer to engage in receptive anal intercourse (top), others prefer insertive anal intercourse (bottom) and some enjoy all types of intercourse (versatile) [8, 9]. A preference for receptive anal intercourse is associated with increased likelihood of a gonorrhea and chlamydia infection [5]. MSM do not frequently receive rectal STI testing because of several

Objectives

Methods

Results