Qiao Shan, Zhou Guangyu, Li Xiaoming
1 Department of Health Promotion, Education, and Behavior & South Carolina SmartState Center for Healthcare Quality (CHQ), University of South Carolina Arnold School of Public Health, Columbia, SC, USA.
2 School of Psychological and Cognitive Sciences and Beijing Key Laboratory of Behavior and Mental Health, Peking University, Beijing, China.
Am J Mens Health. 2018 Sep;12(5):1197-1214. doi: 10.1177/1557988318784149. Epub 2018 Jun 27.
To promote HIV-testing and offer optimal care for men who have sex with men (MSM), health-care providers (HCPs) must first be aware of their patients' sexual behaviors. Otherwise, HCPs may overlook MSM's risks for HIV infection and their special health-care needs. For MSM, reporting their same-sex behaviors to HCPs (disclosure to HCPs) may promote their linkage to HIV prevention and treatment cascade and improve their health outcomes. No literature review has been conducted to examine the relationship between disclosure to HCPs and uptake of HIV-testing among MSM. The current study reviewed and synthesized findings from 29 empirical studies published in English by 2016. We summarized the rates of MSM's disclosure to HCPs, investigated the association between disclosure and HIV-testing among MSM, identified potential facilitators and barriers for disclosure, and discussed the implications of our findings in research and clinical practices. The disclosure rates varied across subgroups and study settings, ranging from 16% to 90% with a median of 61%. Disclosure to HCPs was positively associated with uptake of HIV-testing. African American MSM were less likely to disclose to HCPs. MSM who lived in urban settings with higher education attainment and higher income were more likely to disclose. MSM tended to perceive younger or gay-friendly doctors as safer targets of disclosure. Clinics with LGBT-friendly signs were viewed as safer contexts for disclosure. Having previous communications about substance use, sex, and HIV with HCPs could also facilitate disclosure. The main reasons for nondisclosure included lack of probing from HCPs, concerns on confidentiality breach and stigma, and perceived irrelevance with services. Providing appropriate trainings for HCPs and creating gay-friendly clinical settings can be effective strategies to facilitate disclosures of same-sex behaviors among MSM and meet their specific medical needs. Interventions to promote disclosure should give priorities to MSM from the most marginalized subgroups (e.g., MSM in rural areas, MSM of ethnic minorities).
为了促进男男性行为者（MSM）的HIV检测并为其提供最佳护理，医疗服务提供者（HCPs）必须首先了解患者的性行为。否则，HCPs可能会忽视MSM感染HIV的风险及其特殊的医疗需求。对于MSM而言，向HCPs报告其同性性行为（向HCPs披露）可能会促进他们与HIV预防和治疗环节的联系，并改善其健康状况。目前尚未进行文献综述来研究向HCPs披露与MSM进行HIV检测之间的关系。本研究回顾并综合了2016年之前发表的29项英文实证研究的结果。我们总结了MSM向HCPs披露的比例，调查了MSM中披露与HIV检测之间的关联，确定了披露的潜在促进因素和障碍，并讨论了我们的研究结果在研究和临床实践中的意义。披露率在不同亚组和研究环境中有所不同，范围从16%到90%，中位数为61%。向HCPs披露与HIV检测的接受呈正相关。非裔美国MSM向HCPs披露的可能性较小。居住在城市地区、受教育程度较高且收入较高的MSM更有可能披露。MSM倾向于将年轻或对同性恋友好的医生视为更安全的披露对象。带有LGBT友好标志的诊所被视为更安全的披露环境。之前与HCPs就药物使用、性行为和HIV进行过沟通也有助于披露。不披露的主要原因包括HCPs缺乏询问、对保密性被侵犯和耻辱感的担忧以及认为与服务无关。为HCPs提供适当培训并营造对同性恋友好的临床环境，可能是促进MSM披露同性性行为并满足其特定医疗需求的有效策略。促进披露的干预措施应优先考虑最边缘化亚组的MSM（例如，农村地区的MSM、少数民族MSM）。
