Disclosure of sexual orientation to health professionals in China: results from an online cross‐sectional study

Abstract

Background: Many men who have sex with men (MSM) in China are “in the closet.” The low rate of disclosure may impact sexual behaviours, testing for HIV and other sexually transmitted infections (STIs), and diseases transmission. This study examines factors associated with overall sexual orientation disclosure and disclosure to healthcare professionals. Methods: A nationwide cross-sectional online survey was conducted from September 2014 to October 2014 in China. Participants completed questions covering socio-demographic information, sexual behaviours, HIV/STI testing history, and self-reported HIV status. We defined healthcare professional disclosure as disclosing to a doctor or other medical provider. Results: A total of 1819 men started the survey and 1424 (78.3%) completed it. Among the 1424 participants, 62.2% (886/1424) reported overall disclosure, and 16.3% (232/1424) disclosed to healthcare professionals. In multivariate analyses, the odds of sexual orientation disclosure were 56% higher among MSM who used smartphone-based, sex-seeking applications [adjusted odds ratio (aOR) = 1.56, 95% CI: 1.25–2.95], but were lower among MSM reporting sex while drunk or recreational drug use. The odds of disclosure to a healthcare professional were greater among MSM who had ever tested for HIV or STIs (aOR = 3.36, 95% CI: 2.50–4.51 for HIV, and aOR = 4.92, 95% CI: 3.47–6.96 for STIs, respectively) or self-reported as living with HIV (aOR = 1.59, 95% CI: 0.93–2.72). Conclusion: Over 80% of MSM had not disclosed their sexual orientation to health professionals. This low level of disclosure likely represents a major obstacle to serving the unique needs of MSM in clinical settings. Further research and interventions to facilitate MSM sexual orientation disclosure, especially to health professionals, are urgently needed.

MSM Behavior Disclosure Networks and HIV Testing: An Egocentric Network Analysis Among MSM in China

“…This finding is consistent with other non-network based survey studies in China [15] and in the US [50]. Disclosure to healthcare professionals is important for provider-driven HIV testing [14,50,51].…”

“…These disclosure targets can offer MSM support, provide access to information, and potentially facilitate HIV testing [13,14]. Disclosing to others, especially to health professionals, is positively correlated with HIV testing across different settings [14,15].…”

Provider Perspectives on the Application of Patient Sexual Orientation and Gender Identity in Clinical Care: A Qualitative Study

“…Patients with sexual or gender minority identities or behaviors may face disclosure barriers due to internalized homophobia or transphobia, concern of stigma or discrimination, legal impacts, and lack of comfort with the provider. [27][28][29][30][31] Reback and Larkins 23 found that heterosexually identified men who have sex with men engaged in distancing strategies because they saw their behaviors as incongruent with their identity, which brought up feelings of shame and disgust for many of them. Lack of disclosure to healthcare providers has been found to decrease recommendations for appropriate health services, including HIV testing services.…”

Adolescent and non-consensual anal sexual debut among Chinese men who have sex with men: a cross-sectional study

“…Before 2008, the main settings where Chinese MSM identi ed male partners were public parks, bars, or bathhouse. (26) Considering that many Chinese MSM reported discomfort with visiting gay bars or bathhouses due to fears of being identi ed in public as a gay man, (27) challenges identifying potential male partners may have delayed their age at sexual debut. However, the rise in popularity of the internet and social media (i.e., gay dating apps) sites for MSM in China has reduced challenges associated with sexual partner seeking, potentially facilitating sex initiation at earlier ages.…”