Table 1.
Characteristics of Reviewed Studies.
| Author | Country | Year | Research design & data collection | Sample characteristics | HCPs type | Disclosure measure | Proportion | Association with HIV testing |
|---|---|---|---|---|---|---|---|---|
| Arrington-Sanders et al. (2016) | United States | 2014–2015 | Quantitative design; Cross-sectional internet-based survey, recruitment in adolescent clinics, internet ads, venue-based outreach |
147 YBMSM (age: M = 21.3 years old, SD = 2.1) Criteria: Aged 15–24 years old, self-identified Black male, prior anal sex with a male, U.S. resident |
Regular medical provider | Have you disclosed your sexual orientation to your medical provider? | 61.9% | N/R |
| Bernstein et al. (2008) | United States | 2004–2005 | Quantitative design; Cross-sectional survey by CDC staff with handheld computers (NHBS project) |
452 MSM Criteria: at least 1 male sex partner in the past year |
Health-care provider | Have you told any health-care providers that you are attracted to or have sex with other men? | 61.3% | HIV test in the past year: OR = 0.98, 95% CI [0.65, 1.48] |
| Chapin-Bardales et al. (2016) | United States | 2011 | Quantitative design; Cross-sectional survey with handheld computer via CDC staff (NHBS project) |
353 MSM Criteria: >18 years old, male, ever sex with male past 12 months |
Health-care provider | Have you told your HCP that you are attracted to or have sex with men? | 49% | HIV test in past 12 months was associated with disclosure: aOR = 1.4, 95% CI [1.1, 1.7] |
| Durso and Meyer (2013) | United States | 2004–2005 | Quantitative design; Cross-sectional survey by CDC staff with handheld computer (NHBS project) |
198 GBM (age: M = 32.44 years old, SD = 8.88) | Health-care provider | Participants were asked to report the degree of disclosure of their sexual orientation to health-care providers using a scale from 1 (“out to none”) to 4 (“out to all”). | Out to health-care providers for gay men (90%) and for bisexual men (61%) | N/R |
| Fitzapatrick et al. (1994) | UK | 1991–1992 | Survey with some open-ended questions | 677 gay men including 623 registered with GPs and 102 men (age: M = 32.6 years old, SD = 10.1) Criterion: men who have had sexual contact with men in the last 5 years |
General practitioner | Did your general practitioner know that you are homosexual? | Of these registered GPs, 56% said that their GPs knew their sexuality | N/R |
| Guo, Li, Liu, Jiang, and Tu (2014) | China | 2009 | Quantitative design; Paper-based cross-sectional survey, sampling via peer outreach, informal social network, the Internet, and venue-based |
307 young migrant MSM (age: M = 23.73 years old, SD = 2.86) Criteria: 18–30 years old; ever had sex with men; migrant without a permanent Beijing local residency |
Doctor | Participants were asked to identify all the individuals who knew about their same-sex behavior, including to doctors. | 24% | Never had HIV test among open to doctors (18%) vs. no open to doctors (31%), p < .05 |
| Joseph et al. (2014) | United States | 2007–2008 | Quantitative design; Cross-section survey, recruited in multiple venues and though referrals & advertisements |
608 Hispanic/Latino MSM (age: M = 34.6 years old, SD = 9.45, range: 18–52) Criteria: 18–49 years old, sex with male partner in the past 3 months in addition to multiple sex partner |
Health-care provider | Did you disclose your sex with male to HCP? | 61.1% | Repeat/recent test: aOR = 1.97, 95% CI [1.30, 2.96]; Test avoiding (never testing or last test more than 5 years ago): aOR = 0.70 95% CI [0.46, 1.05] |
| Koch et al. (2016) | Germany | 2013–2014 | Quantitative design; Cross-sectional online survey |
1429 MSM (median age: 40 years old, range: 16–78) Criteria: had no MenC vaccination |
Physician | openness regarding sexual orientation toward their physician | 55.3% | N/R |
| Lo, Turabelidze, Lin, and Friedberg (2012) | United States | 2008 | Quantitative design; Cross-sectional survey by CDC staff with handheld computer, venue-based, time-space sampling (NHBS project) |
339 MSM (age: M = 35, range: 18–80) Criteria: >18 years old; engaged in male–male sex during the previous year |
Health-care provider | Have you ever disclosed same-sex attractions or male–male set to health-care providers? | 73% | HIV testing during previous 12 months: APR = 1.6, 95% CI [1.2, 2.0] |
| Ludlam, Saxton, Dickson, and Hughes (2015) | New Zealand | 2014 | Quantitative design; Cross-sectional self-reported survey from both community and internet |
3168 GBM Criteria: >16 years old, male, have sex with a men in past 5 years |
Usual general practitioner (GP, doctor) | Does your usual general practitioner (GP, doctor) know you are gay or bisexual or have sex with men? | 50.5% | Ever had an HIV test: aOR = 6.6, 95% CI [5.2, 8.3]; Recent HIV testing: aOR = 3.3, 95% CI [2.7, 3.9] |
| Magnus et al. (2010) | United States | 2008 | Quantitative design; Cross-sectional survey by CDC staff with handheld computers (NHBS project) |
500 MSM Criteria: self-identify as male, having had sex with another man in the last year, >18 years old, living in Washington DC, speaking English or Spanish |
Health-care provider | Have you told any health-care providers that you are attracted to or have sex with other men? | 80% | N/R |
| Marcus, Gassowski, Kruspe, and Drewes (2015) | Germany | 2013–2014 | Quantitative design; Online-survey cross-sectional by personalized invitation messages from MSM social networking and dating websites |
15297 MSM Criteria: >16 years old |
Primary health-care provider | Outness toward primary health-care provider about sexual orientation? (Responses: less than half know, half or more know, not applicable) |
40.0% | Recently test vs. distantly test aOR = 1.79, 95% CI [1.60, 2.00]; Recently tested vs. never test aOR = 4.54, 95% CI [4.02, 5.11] |
| Metcalfe, Laird, and Nandwani (2015) | UK | 2011–2012 | Quantitative design; Cross-sectional survey in electronic and paper formats |
204 MSM Criteria: >16 years old |
General practitioner | Whether your GP was aware of your sexual orientation? | 40% | N/R |
| Metheny and Stephenson (2016) | United States | N/R | Quantitative design; Cross-sectional internet-based survey via Facebook |
319 rural MSM (age: M = 30 years old, SD = 11.74) | Clinician | 7-point Liker-type, “My primary care provider definitely does not know that I am a gay” to “definitely know that I am gay and we talk about it openly” | Mean 5.7, 95% CI [4.7, 5.7], range from 1 to 7. Recoded into 81.4% | “HIV test in past 12 months and received a single HAV and HBV vaccines” coded as 1. Disclosure was associated with HIV test and HAV/HBV vaccination: aOR = 1.26, 95% CI [1.08, 1.47] |
| Ng et al. (2014) | Canada | 2008–2009 | Quantitative design; Cross-sectional self-reported survey, venue-based time-space sampling recruitment method |
925 MSM (median age: 30 years old for no disclosure group and 32 years old for disclosure group) Criteria: Identifying as men aged >19 years old, reported ever having sex with other men |
Health-care professional | Have you told a health-care professional you have male sex partners? | 23% | Ever been tested for HIV: disclosed group 91% (646/714) vs. not disclosed group 58% (122/209), p < .001; Have been tested for HIV in previous year: 76% (526/694) vs. 42%, p < .001 (83/198) |
| Oster et al. (2013) | United States | 2008 | Quantitative design; Cross-sectional survey via Interview by CDC staff with handheld computer (NHBS project) |
1734 Latino MSM (median age: 31 years old) Criteria: being male, >18 years old, U.S. resident, speaking English or Spanish, at least one sex partner during last year, had a negative or confirmed positive HIV test result, identified as Hispanic or Latino | Health-care provider | Have you ever told a health-care provider that you are attracted to or have sex with men? | 66% | HIV test in past 12 months: aPR = 1.3, 95% CI [1.2, 1.3] |
| Petroll and Mitchell (2015) | United States | 2011 | Quantitative design; Cross-sectional survey via online sampling by Facebook profile |
722 GBM representing both men of 361 male couples (age: M = 33.01 years old, SD=10.79, range: 18–68) Criteria: male, >18 years old, living in United States, had a relationship status being “in a relationship, engaged, or married,” had oral and/or anal sex previous 3 months |
Primary care provider | Does your primary care doctor know that you have sex with men? | 65.2% | N/R |
| Petroll and Mosack (2011) | United States | 2007 | Quantitative design; Self-administered, written cross-sectional survey |
271 MSM invited at a Gay Pride festival (age: M = 35 years old, range: 18–74) Criteria: Reported having seen as PCP within the prior 5 years |
primary physician, nurse practitioner, or physician assistant | Do you believe your doctor knows your sexual orientation? | 71.4% | 59% for HIV testing among disclosure group vs. 13% among not disclosure group |
| Ramirez-Valles, Dirkes, and Barrett (2014) | United States | 2006 | Quantitative design; Internet-based cross-sectional survey, sample recruited through various means, including social and health services agencies, snowballing, electronic lists |
182 self-identified as gay or bisexual (age: M = 66 years old, SD = 5.39, range: 56–82) | Regular doctor, nurse or health-care provider | Do you think your regular doctor, nurse or health-care provider knows your sexual orientation/gender identity? | 71% | N/R |
| Tang et al. (2017) | China | 2014 | Quantitative design; Cross-sectional online survey via banner in three gay dating websites |
1424 MSM Criteria: >16 years old, born male, ever having sex with a man | Health professional | Have ever disclosed sexual orientation to health-care professionals? | 16% | The odds of disclosure were greater among MSM who had ever tested HIV aOR = 3.36, 95% CI [2.50, 4.51] |
| Wall et al. (2010) | United States | 2009 | Quantitative design; Online cross-sectional survey |
4620 MSM Eligibility: >18 years old, U.S. resident, at least one male sex partner in the last year visited a doctor, nurse, or other HCPs in the prior 12 months |
Doctor, nurse, or health-care provider | When you visited a doctor, nurse, or health-care provider in the past 12 months, did you tell the HCP that you have sex with men? | 44.5 % | Being offered with HIV testing: OR = 19.22, 95% CI [15.79, 23.41] for Age 20 group; OR = 14.45, 95% CI [11.46, 18.21] for Age 30; OR = 10.86, 95% CI [7.06, 16.70] for Age 40; OR = 8.16, 95% CI [4.22, 15.77] for Age 50 |
| Whitehead, Shaver, and Stephenson (2016) | United States | 2014 | Quantitative design; Cross-sectional online survey via banner ads on Facebook |
477 cisgender men (age: M = 32.62 years old, SD = 13.42) Criteria: >18 years old, rural home zip code, self-identified LGBT, |
Primary health-care provider | Outness to PCP (range 1–7) | 4.52 (SD = 2.33). Recoded into 64.6% | Association between outness to PCP and health-care utilization: Regression coefficient = 0.119 (SD = 0.026, p < .001) |
| Wilkerson, Smolenski, Horvath, Danilenko, and Rosser (2010) | United States | 2005 | Quantitative design; Online cross-sectional survey |
2577 MSM Criteria: male, >18 years old, U.S. resident, have sex with men at least once during their lifetime |
Doctor or health professional | Talked with a doctor or health professional about having sex with men. | 62.1% | N/R |
| Author | Country | Conducted time | Design & data collection | Sample characteristics | Main findings | |||
| Adams et al. (2008) | New Zealand | N/R | Qualitative design via focus groups | 50 self-identified gay men | Disclosure was more likely to happen if gay men thought it was relevant to the issue they are seeing the doctor about. Because of potentially physically and emotionally risky, some gay men may hide or not reveal their sexuality to doctors. |
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| Adams, McCreanor, and Braun (2013) | New Zealand | N/R | Qualitative design with focus groups | 45 gay men, age ranged from 24 to 64 years old | Perceptions of importance or necessary may influence gay men’s disclosure decision. Some nondisclosure participants did not think disclosure as an important or significant issue. A minority of participants viewed disclosure of gay identity to doctor as needed. | |||
| Clover (2006) | UK | 2002–2003 | Qualitative design, based on semistructured interview with purposive sampling | 10 gay men aged between 60 and 70 years old Criteria: >60 years old, living in London |
Fears of a lack of understanding, discrimination, or poorer treatment led some men to choose not to disclose their sexuality to health-care providers. This choice was not related to being open about sexuality more generally; some men who were usually very open being reluctant to talk openly to health workers. | |||
| Fitzapatrick et al. (1994) | UK | 1991–1992 | Mixed methods; Survey with some opened questions |
677 gay men including 623 registered with GPs and 102 men (age: M = 32.6 years old, SD = 10.1, range: 16–71) Criterion: men who have had sexual contact with men in the last 5 years |
Men who viewed their GPs’ practice as unsympathetic toward homosexual men were less likely to have informed their general practitioner of their sexual orientation. | |||
| Malebranche et al. (2004) | United States | 2000–2001 | Qualitative design with focus group | 86 BMSM Criterion: being African American, >18 years old, English speaking, MSM |
Racial and sexual stigma toward BMSM impacts how open BMSM are with health providers about their sexuality. | |||
| Martinez and Hosek (2005) | United States | 2002–2003 | Qualitative design semistructured interview with purposive sampling | 6 young BMSM (age: M = 21.5 years old) Criterion: African American who engage in sex with other men but not identify as gay |
Trusting relationship with health provider could facilitate communication on same-sexual behavior. | |||
| Underhill et al. (2015) | United States | 2013–2014 | Qualitative design with one-on-one interview | 56 MSM (31 MSWs: median age = 27 years old, 25 MSM: median age = 39 years old) Criteria: English-speaking cisgender adult men of self-reported negative or unknown HIV status, reported condomless anal sex with a man in the past 6 months |
MSM who did not report sex work described sex with men to clinicians more often. Medical barriers and perceived discrimination impede sexual behavior disclosure to clinicians. | |||
Note. HCP = health-care provider; N/R = not reported; M = mean, SD = standard deviation; YBMSM = young black men who have sex with men; HIV+ = HIV seropositive; HIV- = HIV seronegative; NHBS = National HIV Behavioral Surveillance System; GBM = gay and bisexual men; GP = general practitioner; PCP = primary care provider; HAV = hepatitis A virus; HBV = hepatitis B virus; MSW = men who engage in sex work; OR = odds ratios; aOR = adjusted odds ratios; aPR = adjusted proportion ratios.