Abstract
OBJECTIVES: Men who have sex with men (MSM) report challenges to accessing appropriate health care. We sought to understand the relationship between disclosure of same-sex sexual activity to a health care practitioner (HCP), sexual behaviour and measures of sexual health care.
METHODS: Participants recruited through community venues and events completed a questionnaire and provided a blood sample. This analysis includes only individuals with self-reported HIV negative or unknown serostatus. We compared participants who had disclosed having same-sex partners with those who had not using chi-square, Wilcoxon Rank Sum and Fisher’s exact tests and used logistic regression to examine those variables associated with receiving an HIV test.
RESULTS: Participants who had disclosed were more likely to have a higher level of education (p<0.001) and higher income (p<0.001), and to define themselves as “gay” or “queer” (p<0.001). Those who had not disclosed were less likely to report having risky sex (p=0.023) and to have been tested for HIV in the previous two years (adjusted odds ratio 0.23, 95% confidence interval: 0.16–0.34). There was no difference in undiagnosed HIV infection (3.9% versus 2.6%, p=0.34). Individuals who had disclosed were also more likely to have been tested for gonorrhea and syphilis, and more likely to have ever been vaccinated against hepatitis A and hepatitis B (p<0.001 for all).
CONCLUSIONS: While generally reporting lower risk behaviour, MSM who did not disclose same-sex sexual activity to their HCP did have undiagnosed HIV infections and were less likely to have been tested or vaccinated. Strategies to improve access to appropriate sexual health care for MSM are needed.
Key Words: HIV, reproductive health, homosexuality, male, disclosure
Résumé
OBJECTIFS: Les hommes ayant des relations sexuelles avec des hommes (HARSAH) disent avoir du mal à accéder à des soins de santé appropriés. Nous avons cherché à comprendre le lien entre la divulgation des relations homosexuelles à un professionnel de la santé (PS), le comportement sexuel et les indicateurs de soins de santé sexuelle.
MÉTHODE: Les participants, recrutés dans des lieux et lors d’activités communautaires, ont rempli un questionnaire et fourni un échantillon de sang. Notre analyse n’a porté que sur les sujets ayant déclaré être séronégatifs pour le VIH ou ignorer leur état sérologique. À l’aide du test du khi-carré, du test de Wilcoxon et de la méthode exacte de Fisher, nous avons comparé les participants ayant divulgué le fait d’avoir des relations sexuelles avec d’autres hommes à ceux qui n’avaient pas divulgué leurs relations homosexuelles à un PS; au moyen d’une analyse de régression logistique, nous avons examiné les variables associées au fait d’avoir reçu un test de dépistage du VIH.
RÉSULTATS: Les participants ayant divulgué leurs relations homosexuelles étaient plus susceptibles d’avoir un niveau de scolarité plus élevé (p<0,001) et un revenu plus élevé (p<0,001) et de se définir comme étant «gais» ou «queer» (p<0,001). Ceux qui n’avaient pas divulgué leurs pratiques homosexuelles à leur PS étaient moins susceptibles d’avoir eu des relations sexuelles à risque (p=0,023) et d’avoir été dépistés pour le VIH au cours des deux années antérieures (rapport de cotes ajusté de 0,23, intervalle de confiance de 95 %: 0,16–0,34). Il n’y avait pas de différence dans les infections à VIH non diagnostiquées (3,9 % c. 2,6 %, p=0,34). Les sujets ayant divulgué leurs relations homosexuelles étaient aussi plus susceptibles d’avoir été dépistés pour la gonorrhée et la syphilis et d’avoir été vaccinés contre l’hépatite A et l’hépatite B (p<0,001 pour tous).
CONCLUSIONS: Bien qu’ils déclarent en général des comportements à moindre risque, les HARSAH qui n’avaient pas divulgué leurs relations homosexuelles à leur PS avaient parfois des infections à VIH non diagnostiquées, et ils étaient moins susceptibles d’avoir été dépistés ou vaccinés. Des stratégies pour améliorer l’accès aux soins de santé sexuelle adaptés aux HARSAH sont nécessaires.
Mots Clés: VIH, santé génésique, homosexualité masculine, Divulgation
Footnotes
Conflict of Interest: None to declare.
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