Individual and Social Network Characteristics Associated with Disclosure of Male-Male Sex Behavior to Healthcare Providers Among African American Men Who Have Sex with Men

Introduction: HIV testing and subsequent learning about serostatus can be an important component of HIV prevention. Despite the emphasis on knowing one’s HIV status, in Baltimore, 77% of black MSM reported that they were unaware of their HIV infection when tested for the national HIV behavioral surveillance study. One possible method to increase HIV/STI testing, among MSM, is to encourage disclosure of same sex behaviors to health care providers (HCPs). However, black MSM are less likely to disclose compared to other racial/ethnic groups. Therefore, the purpose of this study is to investigate individual and social network factors among black MSM associated with disclosure to HCPs.

Methods: Data for the current study were from the baseline survey from Unity iN Diversity, a pilot HIV risk-reduction intervention for African American MSM conducted in Baltimore. Participants were 226 Black MSM recruited through venue-based outreach, print advertisement, referrals from agencies, and websites. Independent variables consisted of sociodemographic characteristics, access to health care, depression, substance use, HIV status, sex risk behaviors, experiences of discrimination, medical distrust, and social network characteristics. Control variables were having a primary HCP and number of medical visits. All variables that were statistically significant in the bivariate analysis (p < .20) were entered into backwards selection (criteria to remove p < .10) logistic regression models with generalized estimating equations.

Results: Men who work part-time, talk to or see social network members more often, identify as bisexual, and engage in heavy drinking were less likely to have disclosed male-male sex behaviors to their HCPs. However, having disclosed to one’s entire social network, having a larger enacted social support network, and being HIV positive were associated with higher odds of disclosure. There was no association with having a primary HCP or the frequency of seeing a HCP.

Conclusions: Interventions that could facilitate disclosure include training all health care providers to be sensitive to the health needs and concerns and various sexual identities of MSM. In particular, providers who are not judgmental of bisexual men and provide supportive counseling to heavy alcohol users may be needed. Additionally, changing the social environment through stigma reduction campaigns such that disclosure of male-male sex behavior would not be met with judgment or negative reactions from social network members could increase the likelihood men disclose same-sex behavior to their HCPs. Achieving this goal would require structural interventions to change the currently stigmatizing environment and remove the multitude of discriminatory practices against MSM.