Patient-Provider Communication Barriers and Facilitators to HIV and STI Preventive Services for Adolescent MSM.

Celia B Fisher,Kathryn Macapagal,Brian Mustanski,Adam L Fried

doi:10.1007/s10461-018-2081-x

Celia B Fisher, Kathryn Macapagal + Show 2 more

Open Access

https://doi.org/10.1007/s10461-018-2081-x

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Abstract

Adolescent males who have sex with males (AMSM) are at increased risk of contracting HIV/AIDS and other sexually transmitted infections (STIs). Healthcare providers are a critical source of HIV/STI prevention, yet little is known about AMSM patient-provider sexual health communications and services. To explore this issue, we surveyed a national sample of 198 AMSM 14-17years. Four online psychometrically validated scales indicated over half the youth avoided communicating their sexual orientation and sexual health concerns to providers due to fear of heterosexist bias, concern their sexual health information would be disclosed to parents, and a general belief that sexual minority youth do not receive equitable treatment in health care settings. Youth who reported their physicians had initiated discussion about their sexual orientation were significantly more likely to have received HIV/STI preventive services and testing. Discussion includes the importance of medical training that meets the unique sexual health needs of AMSM.

Highlights

Adolescent males who have sex with males (AMSM) continue to account for a disproportionally higher numbers of new HIV diagnoses and are more likely than their heterosexual peers to engage in high risk behaviors such as condomless sex and sex while intoxicated and to be diagnosed with a sexually transmitted infection (STI) [1,2,3,4,5]
Barriers to receiving health care reported by older MSM include fear of sexual minority stigma or rejection by healthcare providers and failure of physicians to ask about sexual attractions [15,16,17,18,19]
This study explored concerns, attitudes and experiences related to HIV/STI prevention services among sexually active adolescent MSM 14–17 years of age

Summary

Introduction

Adolescent males who have sex with males (AMSM) continue to account for a disproportionally higher numbers of new HIV diagnoses and are more likely than their heterosexual peers to engage in high risk behaviors such as condomless sex and sex while intoxicated and to be diagnosed with a sexually transmitted infection (STI) [1,2,3,4,5]. Young sexual minority males are less likely than older MSM to have received an HIV test and the least likely out of any age group to be linked to HIV care [6,7,8,9,10,11,12,13,14]. Despite research indicating that nearly half of gay and bisexual male high school students have had sexual intercourse [1] little is known about attitudinal and experiential factors facilitating or impeding youth seeking and receiving health services for prevention, detection and treatment of HIV and STIs. Barriers to receiving health care reported by older MSM include fear of sexual minority stigma or rejection by healthcare providers and failure of physicians to ask about sexual attractions [15,16,17,18,19]. This research suggests that while sexual minority relevant health information (including “safe sex” practices) has been found to be an important health concern among adolescent sexual minorities [20], a majority may postpone or avoid HIV testing and seeking other sexual health care services due to concerns their health care provider will not respect their confidentiality needs (including fear of being “outed” to guardians/parents) and negative judgment by health care providers about adolescent sexual identity, same sex sexual activity or sexual activity among teens [9, 17, 19, 21,22,23,24]

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