Same-sex behavior disclosure to health care providers associated with greater awareness of pre-exposure prophylaxis

Sexual and preventive behaviors associated with HAV, HBV, and HPV vaccine hesitancy among men who have sex with men in France

Vaccination coverage against hepatitis A virus (HAV), hepatitis B virus (HBV), and human papillomaviruses (HPV) is insufficient among men who have sex with men (MSM), partly because of their high prevalence of vaccine hesitancy (VH) specific to these vaccines. This study aimed to investigate determinants of specific VH in MSM, focusing on characteristics of their sexual activity, propensity to use prevention tools and medical care, disclosure of sexual orientation to health care professionals (HCPs), and perceived stigmatization. A cross-sectional electronic survey (February - August 2022) collected perceptions of HBV, HAV, and HPV, and of their respective vaccines among 3,730 French MSM and enabled the construction of a specific VH variable. Using agglomerative hierarchical cluster analysis, we constructed a typology of MSM sexual and prevention practices. We identified three MSM clusters (low- (C1, 24%), moderate- (C2, 41%), and high- (C3, 35%) "sexual activity/medical engagement") that showed an increasing gradient in the use of medical prevention with regular medical care and exposure to high-risk sexual practices. A multiple ordinal logistic regression showed that overall specific VH was higher in the C1 cluster and in men who had not informed their physician of their sexual orientation. This typology could usefully help to adapt vaccination communication strategies for MSM prevention program according to patients' profiles. HCPs should be encouraged and trained to ask men about their sexual practices and to provide appropriate vaccination recommendations nonjudgmentally.

Patient sexuality disclosure experience and associations with clinical sexual health outcomes among HIV-negative men who have sex with men in Mexico

Many men who have sex with men (MSM) do not disclose their sexuality to their healthcare provider, despite potential health benefits. Data from the 2017 Encuesta de Sexo Entre Hombres online survey of 13,277 HIV-negative or unknown status MSM in Mexico were used to explore MSM patients' sexuality disclosure experience on sexual health outcomes using multivariable Poisson models with robust variance estimation to estimate adjusted prevalence ratios (aPR). Sexual health outcomes included Hepatitis B (HepB) and human papillomavirus (HPV) vaccination, and lifetime and past year HIV testing. Overall, 53.9% (n/N) disclosed their sexuality to their healthcare provider, and of those 6.4%, 62.9%, and 30.7% reported a negative, neutral, or positive disclosure experience, respectively. In comparison to no disclosure, neutral and positive disclosure experiences were associated with HepB vaccination (aPR[95% Confidence Interval (95% CI)] = 1.17[1.09, 1.25], p < 0.001; aPR[95% CI] = 1.35[1.25, 1.46], p < 0.001, respectively) and positive disclosure experiences were associated with HPV vaccination (aPR[95% CI] = 1.46[1.24, 1.71], p < 0.001). Those who disclosed their sexual behavior were more likely than those who did not disclose their sexual behavior to have received an HIV test in their lifetime (negative: aPR[95% CI] = 1.51[1.43, 1.60], p < 0.001; neutral: aPR[95% CI] = 1.61[1.56, 1.66], p < 0.001; positive: aPR[95% CI] = 1.64[1.58, 1.69], p < 0.001) and an HIV test in the past year (negative: aPR[95% CI] = 1.89[1.70, 2.10], p < 0.001; neutral: aPR[95% CI] = 2.09[1.98, 2.20], p < 0.001; positive: aPR[95% CI] = 2.24[2.12, 2.37], p < 0.001). There is a need to implement trainings for healthcare providers that focus on sexual health risk assessments and creating a space that encourages MSM patients and healthcare providers to discuss sexual health.

Non-disclosed men who have sex with men within local MSM HIV-1 genetic transmission networks in Guangyuan, China

Background

Most men who have sex with men (MSM), especially those with HIV infection, do not disclose their same-sex behaviors in China due to Chinese family values and fear of stigmatization, rejection, or prejudice. However, disclosure of same-sex behaviors to healthcare providers (HCPs) can be beneficial for reducing viral transmission and promoting their physical and mental health. In this study, by combining phylogenetic analysis with traditional epidemiological approaches, we tried to identify the MSM who do not disclose to HCPs in transmission networks and explored the factors related to the non-disclosed behaviors.

Method

Phylogenetic analysis was conducted using HIV pol sequences obtained from the drug-resistant surveillance program, which was collected as part of routine clinical care since 2012. Sequences were linked to the demographic data collected in the Chinese HIV/AIDS Comprehensive Response Information Management System (CRIMS). First, male patients in whom genetic sequences were within the molecular transmission clusters involving self-reported MSM were identified as potential MSM (pMSM). Then, a cross-sectional survey was conducted to supplement behavioral information and attitudes toward MSM.

Results

Our sample consisted of 190 pMSM patients. In total, 43.16% of the patients were likely to conceal same-sex behaviors during the first-self-report, and 14.73% of patients might continue to conceal a history of same-sex behaviors even after receiving medical care. The pMSM who concealed their same-sex behaviors were reluctant to accept medical services such as Voluntary Counseling and Testing (VCT) and had a lower likelihood of condom use. In addition, the related factors for non-disclosed behavior were associated with current address, income before diagnosis, and attitudes toward MSM.

Conclusion

Non-disclosure of same-sex behaviors to HCPs may be a major obstacle for certain medical services for MSM who exhibit risky sexual behaviors. The pMSM from developing areas, with high monthly income, and with neutral or un-supportive attitudes toward MSM may represent non-disclosure of their same-sex behaviors. Thus, policies facilitating MSM to disclose their same-sex behaviors are recommended, such as legislations protecting homosexual rights on employment, education, marriage, and so on.