The Relationship between Outness to Healthcare Providers and HIV testing Open Access

Wang, David (Spring 2023)

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Rates of HIV and STI testing in the US have remained suboptimal for the past several decades. Research conducted thus far on the correlation between outness and HIV and STI testing has shown that among US men who have sex with men (MSM), those who have disclosed their sexuality (outness) to any healthcare provider are more likely to have received HIV and STI testing. Those studies haven’t investigated the relationship between outness to a healthcare provider and the recommendation of HIV testing from that specific healthcare provider. Our study examined this correlation and whether it may differ among MSM with different backgrounds. Using data from the nationwide cross-sectional 2021 American Men’s Internet Survey, Poisson multivariable regression modeling was used to assess the association between outness to a healthcare provider in the last 12 months and a recommendation of HIV testing by that same provider in the last 12 months while controlling for important covariates. Analyses also examined potential interactions between covariates and outness on recommendation of HIV testing. Overall, 77.2% (4834/6265) of men who were seen by a healthcare provider in the past 12 months were out to that provider. Among those who were out to their provider, 75.8% (3665/4834) were offered an HIV test compared to 24.6% (352/1431) of those not out to their provider. Multivariable modeling identified a significant interaction between outness and race/ethnicity. In the adjusted model, outness resulted in a greater likelihood of an HIV testing recommendation across all racial and ethnic groups. However, the effect of outness on the offering of an HIV test was strongest for white MSM (PR=3.19, CI=2.69-3.77) and weakest for black MSM (PR=1.66, CI=1.25-2.19). Based on our findings, it is imperative that healthcare providers 1) educate patients on the importance of being transparent with healthcare providers about their sexual activity and 2) be aware of the interaction between outness and race/ethnicity, as White MSM in particular have shockingly low rates of HIV testing recommendation before coming out.

Table of Contents

Introduction................. 1

Methods....................... 3

Results......................... 5

Discussion................... 12

References................... 17

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