How well are U.S. primary care providers assessing whether their male patients have male sex partners?

• Published in: Preventive medicine 2018-02, Vol.107, p.75-80
• Main Authors: Chávez, Pollyanna R.G., Wesolowski, Laura G., Peters, Philip J., Johnson, Christopher H., Nasrullah, Muazzam, Oraka, Emeka, August, Euna M., DiNenno, Elizabeth
• Format: Article
• Language: English
• Subjects: Cross-Sectional Studies; Female; Health Personnel - statistics & numerical data; HIV Infections - diagnosis; HIV Infections - prevention & control; HIV Infections - transmission; HIV testing; Homosexuality, Male; Humans; Internet; Male; Middle Aged; Primary care physicians; Primary Health Care - methods; Risk Factors; Sexual Behavior; Sexual minorities; Sexual Partners; Surveys and Questionnaires
• ISSN: 0091-7435; 1096-0260
• DOI: 10.1016/j.ypmed.2017.11.006

Identifying patients at-risk for HIV infection, such as men who have sex with men (MSM), is an important step in providing HIV testing and prevention interventions. It is unknown how primary care providers (PCPs) assess MSM status and related HIV-risk factors. We analyzed data from a panel-derived web-based survey for healthcare providers conducted in 2014 to describe how PCPs in the U.S. determined their patients' MSM status. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to describe PCP characteristics associated with systematically determining MSM status (i.e., PCP used “a patient-completed questionnaire” or “routine verbal review of sex history”). Among the 1008 PCPs, 56% determined MSM status by routine verbal review of sexual history; 41% by patient disclosure; 39% by questions driven by symptoms/history; 23% by using a patient-completed questionnaire, and 9% didn't determine MSM status. PCPs who systematically determined MSM status (n=665; 66%) were more likely to be female (aPR=1.16, CI=1.06–1.26), to be affiliated with a teaching hospital (aPR=1.15, CI=1.06–1.25), to routinely screen all patients aged 13–64 for HIV (aPR=1.29, CI=1.18–1.41), and to estimate that 6% or more of their male patients are MSM (aPR=1.14, CI=1.01–1.30). The majority of PCPs assessed MSM status and HIV risk factors through routine verbal reviews of sexual history. Implementing a systematic approach to identify MSM status and assess risk may allow PCPs to identify more patients needing frequent HIV testing and other preventive services, while mitigating socio-cultural barriers to obtaining such information. •2 out of 3 PCPs determine if their male patients have sex with men by using a systematic method.•PCPs using a systematic method were more likely to assess HIV risk factors or behaviors.•Using a systematic method is associated with PCP gender, perceptions, and practices.•Societal/cultural norms might affect the assessment of same-sex sexual behavior of male patients.