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DoMD 1 ; Philip J. PetersMD 1. Human immunodeficiency virus HIV prevention interventions, such as preexposure prophylaxis PrEPare often targeted to men who have sex with men MSM who self-report high-risk behaviors 1. In the study, participants were asked about risk behaviors during pretest counseling at the time of testing and then during a partner services 3 interview at HIV diagnosis. Participants whose disclosure of sexual risk behaviors during pretest counseling was different from their disclosure of sexual risk behaviors during their partner services interview were identified, and factors associated with these discordant responses were examined.
Among HIV-infected men, 26 When compared with men who disclosed having male partners at pretest counseling, these 26 MSM who did not disclose male partners during pretest counseling were found to have a similar of male partners during contact tracing, but were more likely to have a female partner In addition, the proportions of MSM found to have at least one HIV-infected partner were similar for both groups MSM who disclosed having male partners during pretest counseling and those who did not.
Participants were asked about sex partners during pretest counseling, and those diagnosed with HIV infection were asked again during a partner services interview following diagnosis. During pretest counseling a counselor recorded demographics and risk behaviors within the past 12 months. Contact information was elicited for sex partners from the 3 months for participants receiving a diagnosis of acute HIV infection and from the 12 months for participants receiving a diagnosis of established HIV infection 3.
Disease intervention specialists contacted sex partners by telephone or internet-based communication e.
HIV testing was offered to notified partners. This analysis included participants from three sexually transmitted disease STD clinics in North Carolina. MSM were defined as male participants with newly diagnosed HIV infection either acute or established who reported a male sex partner during the partner services interview.
Factors associated with not reporting male sex partners during pretest counseling were determined among MSM who did not report a male sex partner during pretest counseling but subsequently did during the partner services interview. Sexual networks for MSM who named at least one sex partner during partner services interviews were also reviewed to evaluate their connections to other MSM.
Among 16, male participants tested during September —October in North Carolina, 1. Among 14 MSM who reported male and female sex partners during partner services interviews, three had also accurately reported male and female sex partners during pretest counseling. Among 17 HIV-infected MSM who did not report male sex partners during pretest counseling and provided contact information for at least one sex partner, nine Nondisclosure of same-sex sexual contact was not associated with of male partners but was associated with reporting at least one female sex partner during partner services; these men also often shared sexual networks with other MSM with newly diagnosed HIV infection.
Nondisclosure of risk for HIV infection including same-sex sexual contacts to health care providers has been ly reported 56. Participants in this analysis were recruited from STD clinics, where staff members were experienced in taking a sexual history; participants in this study, who were seeking STD evaluation, might also have been more prepared to discuss their sexual history with their providers, compared with those recruited from the community or in an emergency department.
Health care providers often assess the need for HIV and STD prevention services on the basis of clients' self-reported risk behaviors, which might be underreported. MSM might misreport risk behaviors for several reasons. First, clients might not be aware of the importance and potential benefits of reporting risk behaviors accurately e. Second, concerns about privacy, confidentiality, fear of being judged, and perceived or experienced homophobia might interfere with accurate reporting of sexual risk behavior 7.
Third, although risk for HIV acquisition is more closely correlated with sexual behavior than with sexual orientation, mistaking sexual orientation or identity 8 as sexual behavior can contribute to misreporting. Reporting at least one female sex partner during partner services interviews was associated with nondisclosure of male sex partners during pretest counseling in this study. Other studies have also noted that MSM who self-identified as bisexual or heterosexual were less likely than those who self-identified as gay to report same-sex behaviors 57.
Bisexual-identifying MSM might have additional barriers to accurately reporting risk behavior.
A qualitative study conducted in New York City reported that society often views bisexuality as non-monogamous and indicative of infidelity 9. This additional stigma might play a role in misreporting sex behaviors. More than half of HIV-infected MSM who did not report male sex partners during pretest counseling shared sexual networks with those who reported male sex partners.
Taken together, these observations suggest similar levels of risk for HIV acquisition across the two groups This potential for missed opportunities to deliver effective prevention services to MSM highlights the importance of accurately identifying risks among this population, which remains the population most affected by HIV infection.
The findings in this report are subject to at least three limitations. First, only HIV-infected participants who accepted partner services were included. Second, barriers to accurately reporting risk behaviors were not assessed. Third, the were observed among clients most of whom were African American at three STD clinics in North Carolina and might not be generalizable. To customize HIV prevention interventions effectively in disproportionately affected persons such as young African American MSM, HIV prevention programs might consider implementing novel strategies to accurately assess risk.
Examples of potential strategies include increased access to testing venues that are customized for young African American MSM, increased use of technology to administer risk screening privately e. Corresponding author: Philip J. Peters, pjpeters cdc. Patients do not always report sexual risk behaviors to their health care providers. Unreported risk behaviors lead to missed opportunities to provide appropriate human imunodeficiency virus HIV prevention services. Among the primarily young and African American study population, a ificant proportion of HIV-infected men who have sex with men MSM did not disclose their sexual risk behaviors at the time of HIV testing.
To effectively customize HIV prevention interventions in disproportionately affected persons such as young African American MSM, novel strategies are needed to accurately assess risk. Bisexual men might also have additional barriers to accurately reporting HIV risk behaviors. Reported risk behaviors at the time of testing and during partner services among participants who received human immunodeficiency virus HIV testing — North Carolina, September —October Alternate Text: The figure above is a flow chart showing reported risk behaviors at the time of testing and during partner services among participants who received HIV testing in North Carolina during September October Characteristics of men who have sex with men with newly diagnosed HIV infection, by whether they did or did not report male sex partners at the time of HIV testing — North Carolina, September —October Reporting sex with an HIV-infected partner at the time of testing.
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HIV pre-exposure prophylaxis in men who have sex with men and transgender women: a secondary analysis of a phase 3 randomised controlled efficacy trial. Lancet Infect Dis ;— J Clin Virol ;58 Suppl 1 :e92—6. Recommendations for partner services programs for HIV infection, syphilis, gonorrhea, and chlamydial infection. Same-sex attraction disclosure to health care providers among New York City men who have sex with men: implications for HIV testing approaches.
Arch Intern Med ;— J Acquir Immune Defic Syndr ;— Patterns and predictors of disclosure of sexual orientation to healthcare providers among lesbians, gay men, and bisexuals. Sex Res Social Policy ;— Ann Epidemiol ;— Beyond the Down Low: sexual risk, protection, and disclosure among at-risk black men who have sex with both men and women MSMW.
Arch Sex Behav ;— Glen or Glenda: reported gender of sex partners in two statewide HIV databases. Am J Public Health ;— Summary What is already known on this topic?
What is added by this report? What are the implications for public health practice? Reported risk behaviors at the time of testing and during partner services among participants who received human immunodeficiency virus HIV testing — North Carolina, September —October Alternate Text: The figure above is a flow chart showing reported risk behaviors at the time of testing and during partner services among participants who received HIV testing in North Carolina during September October Print Updates Subscribe Listen Download.
HIV final status. Median of reported male sex partners in past 12 mos.Sex partner in North carolina
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Unreported Male Sex Partners Among Men with Newly Diagnosed HIV Infection — North Carolina, –