Experienced Sexual Stigma, Community Tolerance, and Other Factors Associated with Disclosure of MSM's Same-sex Behavior to a Healthcare Provider Open Access

Abstract

Disclosure of same-sex behavior to a healthcare provider in men who have sex with men (MSM) is important because MSM have unique health needs. This analysis sought to investigate the associations between sexual stigma, community tolerance, and disclosure of same-sex behavior to a healthcare provider among MSM in the United States. 3,264 HIV-negative MSM who completed the stigma sub-survey of the cross-sectional American Men's Internet Survey (AMIS) in 2013 were selected for the analysis. The primary outcome of interest was disclosure of same-sex behavior to a healthcare provider and main exposure variables included community tolerance of MSM and experience of sexual stigma. 2,321 (70%) of MSM in the analysis disclosed their same-sex behavior to a healthcare provider. MSM who did disclose were at a lower odds for having been called named or insulted because someone assumed they were MSM (aOR 0.50; 95% CI 0.38, 0.66), a greater odds for strongly agreeing their community was tolerant of MSM (aOR 2.65; 95% CI 1.93, 3.64), and a greater odds for agreeing that their community was tolerant of MSM (aOR 1.35; 95% CI 1.10, 1.69) when adjusting for demographic confounders, versus MSM who did not disclose their sexual behavior. This analysis found that MSM who were stigmatized on an individual and community level were less likely to disclose their same-sex behavior to their healthcare provider. These results demonstrate the need for healthcare providers be open, tolerant, and aware of LGBT health issues in order to increase disclosure and reduce stigma towards MSM.

Table of Contents

I. Background and Literature Review 1

a. HIV and STDs in the United States 1-3

b. Discrimination and Stigma 3-7

c. Community Tolerance and Acceptance of the LGBT Community 7-8

d. Disclosure of Same-sex Behavior to a Healthcare Provider 8-10

e. Risk Factors Associated with Non-Disclosure 10-12

f. Conclusions 12-13

II. Manuscript 14

a. Introduction 14-17

b. Methods 17-21

c. Results 22-24

d. Discussion 24-30

e. References 31-39

f. Tables 40-41

g. Figures 42

About this Master's Thesis

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• Permission granted by the author to include this thesis or dissertation in this repository. All rights reserved by the author. Please contact the author for information regarding the reproduction and use of this thesis or dissertation.

School	Rollins School of Public Health
Department	Epidemiology
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Public Health Health Sciences, Epidemiology
Keyword	Sexual stigma Community tolerance Discrimination MSM Disclosure to healthcare provider
Committee Chair / Thesis Advisor	Sullivan, Patrick S, Emory University
Partnering Agencies	Emory University schools, faculty or affiliated programs

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