The MSM (Non)Identity: Toward Understanding Sexual Behavior and Identity in Health Research and Practice with Straight Men Under the Umbrella

Zeglin, Robert J.

doi:10.1007/s13178-019-00398-w

Cited by 5 publications

(4 citation statements)

References 76 publications

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“…This study validates a search term-based method to identify patients from SGM groups in the EMR, but it contrasts with prior studies 19,31 in also using behavioral search terms, which resulted in a substantially higher yield than ICD-10 codes and SGM identity categories. 32 Health-associated behaviors in patients from SGM groups were consistent with those described in the medical literature. The SGM patients had higher rates of substance use, but apart from having fewer children than cisgender heterosexual patients, they had similar hormonal risk factors (ages at menarche and menopause; oral contraceptive and hormone replacement therapy use).…”

Section: Discussionsupporting

confidence: 82%

“…Historically, identification of patients from SGM groups has hampered health care disparities research aimed at improving the outcomes of this patient population. This study validates a search term–based method to identify patients from SGM groups in the EMR, but it contrasts with prior studies in also using behavioral search terms, which resulted in a substantially higher yield than ICD-10 codes and SGM identity categories …”

Section: Discussionsupporting

confidence: 60%

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Breast Cancer Diagnosis, Treatment, and Outcomes of Patients From Sex and Gender Minority Groups

et al. 2023

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ImportanceSexual orientation and gender identity data are not collected by most hospitals or cancer registries; thus, little is known about the quality of breast cancer treatment for patients from sex and gender minority (SGM) groups.ObjectiveTo evaluate the quality of breast cancer treatment and recurrence outcomes for patients from SGM groups compared with cisgender heterosexual patients.Design, Setting, and ParticipantsExposure-matched retrospective case-control study of 92 patients from SGM groups treated at an academic medical center from January 1, 2008, to January 1, 2022, matched to cisgender heterosexual patients with breast cancer by year of diagnosis, age, tumor stage, estrogen receptor status, and ERBB2 (HER2) status.Main Outcomes and MeasuresPatient demographic and clinical characteristics, as well as treatment quality, as measured by missed guideline-based breast cancer screening, appropriate referral for genetic counseling and testing, mastectomy vs lumpectomy, receipt of chest reconstruction, adjuvant radiation therapy after lumpectomy, neoadjuvant chemotherapy for stage III disease, antiestrogen therapy for at least 5 years for estrogen receptor–positive disease, ERBB2-directed therapy for ERBB2-positive disease, patient refusal of an oncologist-recommended treatment, time from symptom onset to tissue diagnosis, time from diagnosis to first treatment, and time from breast cancer diagnosis to first recurrence. Results were adjusted for multiple hypothesis testing. Compared with cisgender heterosexual patients, those from SGM groups were hypothesized to have disparities in 1 or more of these quality metrics.ResultsNinety-two patients from SGM groups were matched to 92 cisgender heterosexual patients (n = 184). The median age at diagnosis for all patients was 49 years (IQR, 43-56 years); 74 were lesbian (80%), 12 were bisexual (13%), and 6 were transgender (6%). Compared with cisgender heterosexual patients, those from SGM groups experienced a delay in time from symptom onset to diagnosis (median time to diagnosis, 34 vs 64 days; multivariable adjusted hazard ratio, 0.65; 95% CI, 0.42-0.99; P = .04), were more likely to decline an oncologist-recommended treatment modality (35 [38%] vs 18 [20%]; multivariable adjusted odds ratio, 2.27; 95% CI, 1.09-4.74; P = .03), and were more likely to experience a breast cancer recurrence (multivariable adjusted hazard ratio, 3.07; 95% CI, 1.56-6.03; P = .001).Conclusions and RelevanceThis study found that among patients with breast cancer, those from SGM groups experienced delayed diagnosis, with faster recurrence at a 3-fold higher rate compared with cisgender heterosexual patients. These results suggest disparities in the care of patients from SGM groups and warrant further study to inform interventions.

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Section: Discussionsupporting

confidence: 82%

Section: Discussionsupporting

confidence: 60%

Breast Cancer Diagnosis, Treatment, and Outcomes of Patients From Sex and Gender Minority Groups

et al. 2023

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“…Identity or attraction are not risk factors for sexually transmitted infections but may be proxies for current or future risks and for needs for prevention services. However, as our data show, identity and attraction are not necessarily specific or sensitive [24]: a person who identifies as straight may still engage in anal or oral sex with another man, a man identifying as gay or bisexual may have anal or vaginal sex with a female. Providing additional prevalence estimates for orientation and attraction gives users more choices to fit their needs when trying to estimate these proportion of men who identify as gay/bisexual or are attracted to men, based on their programmatic goal or research question.…”

Section: Discussionmentioning

confidence: 72%

Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys (Preprint)

Bennett,

DuBose,

Huang

et al. 2024

Preprint

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BACKGROUND Male-to-male sexual transmission continues to account for the greatest proportion of new HIV diagnoses in the United States. However, calculating population-specific surveillance metrics for HIV and other sexually transmitted infections requires regularly updated estimates of the number and proportion of men who have sex with men (MSM) in the United States, which are not collected by census surveys. OBJECTIVE The purpose of this analysis was to estimate the number and percentage of MSM in the United States from population-based surveys. METHODS We used data from 5 population-based surveys to calculate weighted estimates of the proportion of MSM in the United States and pooled these estimates using meta-analytic procedures. We estimated the proportion of MSM using sexual behavior–based questions (encompassing anal or oral sex) for 3 recall periods—past 12 months, past 5 years, and lifetime. In addition, we estimated the proportion of MSM using self-reported identity and attraction survey responses. The total number of MSM and non-MSM in the United States were calculated from estimates of the percentage of MSM who reported sex with another man in the past 12 months. RESULTS The percentage of MSM varied by recall period: 3.3% (95% CI 1.7%-4.9%) indicated sex with another male in the past 12 months, 4.7% (95% CI 0.0%-33.8%) in the past 5 years, and 6.2% (95% CI 2.9%-9.5%) in their lifetime. There were comparable percentages of men who identified as gay or bisexual (3.4%, 95% CI 2.2%-4.6%) or who indicated that they are attracted to other men (4.9%, 95% CI 3.1%-6.7%) based on pooled estimates. Our estimate of the total number of MSM in the United States is 4,230,000 (95% CI 2,179,000-6,281,000) based on the history of recent sexual behavior (sex with another man in the past 12 months). CONCLUSIONS We calculated the pooled percentage and number of MSM in the United States from a meta-analysis of population-based surveys collected from 2017 to 2021. These estimates update and expand upon those derived from the Centers for Disease Control and Prevention in 2012 by including estimates of the percentage of MSM based on sexual identity and sexual attraction. The percentage and number of MSM in the United States is an important indicator for calculating population-specific disease rates and eligibility for preventive interventions such as pre-exposure prophylaxis.

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“…Identity and attraction are not risk factors for sexually transmitted infections but may be proxies for current or future risks and for prevention service needs. However, as our data show, identity and attraction are not necessarily specific or sensitive [ 26 ]: a person who identifies as straight may still engage in anal or oral sex with another man, a man identifying as gay or bisexual may have anal or vaginal sex with a female. Providing additional prevalence estimates for orientation and attraction gives users more choices to fit their needs when trying to estimate these proportion of men who identify as gay or bisexual or are attracted to men, based on their programmatic goal or research question.…”

Section: Discussionmentioning

confidence: 99%

Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys

Bennett,

DuBose,

Huang

et al. 2024

JMIR Public Health Surveill

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Background: Male-to-male sexual transmission continues to account for the greatest proportion of new human immunodeficiency virus (HIV) diagnoses in the United States (US). However, calculating the prevalence and incidence of HIV and other STIs attributed to male-to-male sexual transmission requires regularly updated estimates of the number and proportion of men who have sex with men (MSM) in the U.S., which are not collected by census surveys.Objective: The purpose of this analysis was to estimate the number and percent of men who have sex with men in the United States from population-based surveys. Methods:We used data from 5 population-based surveys to calculate weighted estimates of the proportion of MSM in the US and pooled these estimates using meta-analytic procedures. We estimated the proportion of MSM utilizing sexual behavior-based questions for 3 recall periods and utilizing self-reported identity and attraction. The total number of MSM and Other men in the United States were calculated from estimates of the percentage of MSM who reported sex with another man in the past 12 months. Results:The percentage of MSM varied by recall period: 3.3% indicated sex with another male in the past 12 months, 4.7% in the past 5 years, and 6.2% ever. There were comparable percentages of men who identified as Gay or Bisexual (3.4%) or who indicated that they are attracted to other men (4.9%) based on pooled estimates. Our estimate of the total number or MSM in the United States is 4,477,012 based upon recent sexual history (sex with another man in the past 12 months).Conclusions: Population estimates of the number and percentage of MSM in the United States and the number of gay/bisexual men or men attracted to other men are important for calculating population-specific disease rates.

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The MSM (Non)Identity: Toward Understanding Sexual Behavior and Identity in Health Research and Practice with Straight Men Under the Umbrella

Cited by 5 publications

References 76 publications

Breast Cancer Diagnosis, Treatment, and Outcomes of Patients From Sex and Gender Minority Groups

Breast Cancer Diagnosis, Treatment, and Outcomes of Patients From Sex and Gender Minority Groups

Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys (Preprint)

Population Percentage and Population Size of Men Who Have Sex With Men in the United States, 2017-2021: Meta-Analysis of 5 Population-Based Surveys

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