Lack of sexual behavior disclosure may distort STI testing outcomes

Abstract

Background: Men who have sex with men (MSM) globally have a high burden of curable sexually transmitted infections (STIs). MSM do not frequently receive rectal STI testing because of several barriers, such as not being out (disclosure of sexual behavior). We evaluate whether Chinese MSM select an STI test (rectal vs urethral) appropriate for their sexual behavior (insertive and/or receptive), and the interactions with being out. Methods: This was a secondary analysis of data from a cross sectional MSM survey conducted at a multisite randomized controlled trial (RCT) (December 2018 to January 2019) around uptake of gonorrhea and chlamydia testing among Chinese MSM (N = 431). We collected socio demographics, relevant medical and sexual history, and disclosure of sexual behavior (outness). We estimated the decision to test and test choice, and the extent to which disclosure plays a role in decision making. Results: Among 431 MSM, mean age was 28 years (SD = 7.10) and 65% were out to someone. MSM who indicated versatile sexual behavior and were out to someone had a 26.8% (95%CI = 6.1, 47.5) increased likelihood for selecting the rectal test vs the ure thral test, compared to those versatile and not out. Versatile MSM out to their health provider outside of the study context had a 29.4% (95%CI = 6.3, 52.6) greater likelihood for selecting the rectal STI test vs the urethral test, compared to versatile MSM not out to their health provider. Conclusions: Sexual behavior and outness may affect gonorrhea and chlamydia testing provision. Apart from clinicians, community based efforts may reduce stigma based barriers to testing.

Changes in sexual behavior among MSM during the spread of COVID-19 in China: results of an online survey

“…The HIV testing is correlated with casual sexual behavior [21]. According to our data, people who had HIV test during or before COVID-19 were prone to have casual sexual behavior.…”

Syphilis Testing as a Proxy Marker for a Subgroup of Men Who Have Sex With Men With a Central Role in HIV-1 Transmission in Guangzhou, China

“…Of note, we found that 49% of HIV-infected MSM did not know if they had STIs at the time of HIV-1 diagnosis. Several studies have shown that most persons with syphilis, including up to 44% of MSM, are unaware of their serostatus of syphilis as they may be asymptomatic for years ( 44 , 45 ) or unwilling to disclose their STI diagnosis ( 46 ) and their sexual behaviors ( 15 , 47 ). Our results also showed that MSM without syphilis screening were more likely to be highly connected in the transmission network, indicating that they may have more sexual partners.…”

Blocking and being blocked on gay dating apps among MSM attending a sexual health clinic: an observational study

“…A multivariate regression is more appropriate when numerous independent variables are associated with an outcome [ 35 ]. We conform to best practice in previous work in this area, which utilized multivariate regression [ 36 , 37 ]. Similarly, to better understand blocking and its associated covariates, we need to predict blocking instead of investigating it as an exposure which indicates sexual risk or mental health issues.…”

“…We adjusted for the following factors and intervention assignment. We decided on these factors based on guidelines established in other studies with the same population [ 36 , 37 ]. We understand the issues around more complex models vs simpler models and have selected the current variables in accordance with best practice as per our previous work in this topic [ 36 , 37 ].…”

“…We decided on these factors based on guidelines established in other studies with the same population [ 36 , 37 ]. We understand the issues around more complex models vs simpler models and have selected the current variables in accordance with best practice as per our previous work in this topic [ 36 , 37 ]. Independent variables represented sexual behavior [sexual role, number of male partners in the past three months, condom use, disclosure of MSM sexual behavior to family, disclosure of MSM sexual behavior to medical professional, prior HIV test], participant social network structure (social network degree, weighted social network degree), and sociodemographic categories (income, age).…”