31 The guidelines provide another reasonable clinical approach to surveillance in men who have sex with men. 5 These guidelines are not universally accepted, but screening and treatment of curable STDs can be cost-effective by decreasing the period during which infected persons can transmit diseases to others. The California STD Controllers Association and the Public Health–Seattle and King County Agency have developed guidelines that are derived, in part, from systematic surveys of STD prevalence and sexual behaviors and practices among men who have sex with men. “What kind of sexual acts do you engage in?”Īssess the patient’s history of sexually transmitted infections. “Do you have sex with men, women, or both?” Negotiate with the patient about the information that will be included in the medical record dispel the patient’s concerns about the accessibility of the information to insurers, employers, and others.Īvoid terms such as “gay,” ”queer,” and “straight” when asking or talking about sexual practices or sexual identity.Īvoid making assumptions about sexual behavior based on the patient’s age, marital status, disability, or other characteristics.Īsk specific questions about sexual behavior in a direct, nonjudgmental manner: Remind the patient that the discussion is confidential. Underscore the importance of needing to know the patient’s sexual practices in order to determine appropriate screening and counseling interventions for optimal care.
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Qualify the discussion of sexual health by emphasizing that the discussion is routine with every patient. Possible release of sensitive information by the insurance company to the patient’s employerĪssess risk during every patient’s first visit, during all comprehensive health assessments, and when evidence suggests changing behavior. Lack of evidence-based guidelines or conflicting guidelines for preventive health care services for men who have sex with menīelief that the patient’s employer may learn of the patient’s sexual practices and terminate employment Limited time preventive health care services not routinely offered Lack of interest in preventive health care services Possible cancellation of the policy if the patient is determined to be “high risk” Screening services not covered by most insurance plansīelief that the health insurance company may learn about the patient’s sexual practices and cancel insurance coverage Inability to provide complete screening because of constraints imposed by the patient’s insurance plan Lack of awareness of the benefits of/need for screening services, and the benefits of discussing risks with the physician Lack of knowledge about the patient’s current sexual practices and related risks Possible open hostility toward the patient who reveals that he has sex with menīelief that sexual practices (e.g., oral sex) are not risky
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Personal discomfort or perceived professional constraints lack of training in how to discuss sexual risks and practicesĬoncern about the physician’s reaction to learning that the patient has sex with men Screening guidelines, while inconsistent and subject to change, offer some useful suggestions for the care of men who have sex with men.Įmbarrassment or fear about discussing the subject of sexual practices Targeted screening for sexually transmitted diseases, depression, substance abuse, and other disorders should be performed routinely. Office practices and staff should be similarly non-judgmental, with confidentiality maintained. The physician should ask questions about sexual orientation in a nonjudgmental manner furthermore, confidentiality should be addressed and maintained.
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Periodic screening should include a yearly health risk and physical assessment, as well as a thorough sexual and psychologic history. Recent trends indicate an increasing rate of sexual risk-taking among these men, particularly if they are young.
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Because of greater societal stresses, lack of emotional support, and practice of unsafe sex, men who have sex with men are at increased risk for sexually transmitted diseases (including human immunodeficiency virus infection), anal cancer, psychologic and behavioral disorders, drug abuse, and eating disorders. Lack of disclosure from the patient, discomfort or inadequate training of the physician, perceived or real hostility from medical staff, and insufficient screening guidelines limit preventive care. Men who have sex with men often do not reveal their sexual practices or sexual orientation to their physician.