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Implications for HIV Testing Approaches

Kyle T. Bernstein, PhD, ScM; Kai-Lih Liu, PhD; Elizabeth M. Begier, MD, MPH; Beryl Koblin, PhD; Adam Karpati, MD, MPH; Christopher Murrill, PhD, MPH

Arch Intern Med. 2008;168(13):1458-1464.

Background  While the Centers for Disease Control and Prevention recommends at least annual human immunodeficiency virus (HIV) screening for men who have sex with men (MSM), a large number of HIV infections among this population go unrecognized. We examined the association between disclosing to their medical providers (eg, physicians, nurses, physician assistants) same-sex attraction and self-reported HIV testing among MSM in New York City, New York.

Methods  All men recruited from the New York City National HIV Behavioral Surveillance (NHBS) project who reported at least 1 male sex partner in the past year and self-reported as HIV seronegative were included in the analysis. The primary outcome of interest was a participant having told his health care provider that he is attracted to or has sex with other men. Sociodemographic and behavioral factors were examined in relation to disclosure of same-sex attraction.

Results  Among the 452 MSM respondents, 175 (39%) did not disclose to their health care providers. Black and Hispanic MSM (adjusted odds ratios, 0.28 [95% confidence interval, 0.14-0.53] and 0.46 [95% confidence interval, 0.24-0.85], respectively) were less likely than white MSM to have disclosed to their health care providers. No MSM who identified themselves as bisexual had disclosed to their health care providers. Those who had ever been tested for HIV were more likely to have disclosed to their health care providers (adjusted odds ratio, 2.10; 95% confidence interval, 1.01-4.38).

Conclusions  These data suggest that risk-based HIV testing, which is contingent on health care providers being aware of their patients' risks, could miss these high-risk persons.

Author Affiliations: New York City Department of Health and Mental Hygiene, Bureau of HIV/AIDS Prevention and Control (Drs Bernstein, Liu, and Begier and Messrs Karpati and Murrill), Department of Emergency Medicine, New York University School of Medicine (Dr Bernstein), and New York Blood Center (Dr Koblin), New York.

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