1. SAMPLE DESCRIPTION
Patient-Provider Prevention Discussions and Sexual
Healthcare Utilization among Young Men Who Have Sex with Men
Chelsea Harmell, Steven Meanley, MPH, Alyssa Gale, MPH, Emily Pingel, MPH, & José A. Bauermeister, MPH, PhD
University of Michigan Center for Sexuality & Health Disparities, Health Behavior & Health Education Department at the School of Public Health
OBJECTIVE
Using data from our United for HIV Integration and Policy (UHIP) project, we
examined how patient-provider conversations about sexual health influenced
testing rates for HIV or other STIs among young men who have sex with men
(YMSM). Because of the synergistic relationship between HIV and other STIs, we
wanted to explore the ways in which HIV testing behaviors related to other STI
testing behaviors for YMSM in the Detroit Metro Area (DMA).
BACKGROUND
The United for HIV Integration and Policy (UHIP) Project is a collaboration
between the Center for Sexuality and Health Disparities and four community-
based organizations working with young men who have sex with men (YMSM) in
the DMA. UHIP sought to understand YMSM’s structural vulnerabilities to
HIV/AIDS.
DISCUSSION
Recommendations
Cultural competence trainings for medical providers
Provide trainings about comprehensive sexual healthcare and
LGBTQ patients’ needs
Increase patient-provider discussions regarding the role that STIs
play in increasing infectiousness and susceptibility to HIV
Increased access to health insurance for YMSM and older MSM
New opportunities for insurance coverage under the ACA for men
under 26 and/or below 133% FPL
End of public health’s historic separation of HIV, STIs, and sexual health
Expanded STI testing recommendations, referrals, and service
provision at healthcare centers, clinics, and AIDS service
organizations
Additional research to understand testing motivations for YMSM
Do provider recommendations influence intention to get tested?
How effective are provider recommendations in moving HIV only
testers into HIV and Other STI Testing group?
Limitations
Cross-Sectional Study Design
Data only reflect participants’ testing and medical provider
experiences in the past year
Data are about YMSM and may not be generalizable to older MSM
Results may not be generalizable outside of the DMA
CONCLUSIONS
Patient-provider conversations about sexual health may play an
important role in promoting HIV/STI testing for YMSM.
Comfort discussing sexual behaviors with providers is a key factor
of HIV/STI testing
Access to healthcare may be determined in part by age and
insurance coverage
YMSM who have never been tested for HIV or other STIs may also
have lower access to healthcare coverage in general
Never
Testers
16.7%
HIV Only
17.8%
HIV & Other
STI Test
65.5%
HIV & STI Testing
History What are your main reasons for
not getting tested?
14.8% reported “I don’t know where
to get tested.”
21.3% reported “Fear of finding out
the results.”
13.1% reported “I’m not at risk of
becoming HIV-infected.
8.2% reported not being sexually
active.
Variable OR 95% CI Sig.
Age .85 .77, .93 ***
Insurance Coverage 4.13 2.44, 7.00 ***
Provider Comfort (Discussing Sexual Behaviors) 1.49 1.11, 2.00 *
Test Group
HIV Test Only
HIV & Other Test
1.50
3.67
.59, 3.85
1.58, 8.51 **
RESULTS
Table 2. Logistic Regression – Medical Provider Visit/Routine Check-Up Prior Year, N = 325
Chelsea Harmell, MPH Candidate
Center for Sexuality and Health Disparities
300 North Ingalls
Ann Arbor, MI 48104
Office (734) 764-6653
harmell@umich.edu
CONTACT INFORMATION
METHODS
DATA ANALYTIC STRATEGIES
χ2 and ANOVA test were conducted to determine differences in testing group
categories by demographic or psychosocial variables.
Logistic regression explored predictors of accessing a medical provider for a
routine physical or check-up in the prior year
Multinomial logistic regressions tested whether there was a relationship
between patient-provider discussions about HIV/STI prevention and the
testing groups.
Online surveys (N=429) completed by YMSM in the DMA ages 18 to 29.
Participants were recruited through bar outreach, peers, social media
advertisements, and referrals from agencies serving YMSM.
Variable
Never
Testers
(N = 57)
HIV Only
(N = 57)
HIV & Other
STI Tests
(N = 211)
Sig.
Race/Ethnicity
Black/African American
White/Caucasian
Latino
Other Race/Ethnicity
20 (12.7%)
21 (23.6%)
13 (26.5%)
3 (10.3%)
30 (19.0%)
15 (16.9%)
11 (22.4%)
1 (3.4%)
108 (68.4%)
53 (59.6%)
25 (51.0%)
25 (86.2%)
*
Sexual Identity
Gay/Homosexual
Bisexual
Other Sexual Identity
51 (19.2%)
4 (15.4%)
2 (6.1%)
52 (19.5%)
3 (11.5%)
2 (6.1%)
163 (61.3%)
19 (73.1%)
29 (87.9%)
*
Testing Location Knowledge
No
Yes
23 (62.2%)
34 (11.8%)
3 (8.1%)
54 (18.8%)
11 (29.7%)
200 (69.4%)
***
Routine Medical Visit
Not in Prior Year
In Prior Year
41 (26.1%)
16 (9.5%)
35 (22.3%)
22 (13.1%)
81 (51.6%)
130 (77.4%)
***
Provider Comfort, M (SD)
(Discussing Sexual Behaviors)
2.65 (1.03) 3.02 (.86) 3.01 (.83) *
Prov. Prevention Discussions
No
Yes
48 (39.7%)
9 (4.4%)
26 (21.5%)
31 (15.2%)
47 (38.8%)
164 (80.4%)
***
Non-Significant Variables: Education Level, Housing Instability, Insurance
Coverage, & Perceived Susceptibility to HIV
Non-Significant Variables: Housing Instability, Perceived Susceptibility, HIV Testing Location
Knowledge, & Prior Provider Prevention Discussions
Never Testers Vs. HIV & Other STI Test
Participants who reported having received an HIV
and Other STI Test were 10 times more likely (OR =
.10; 95% CI: .03, .32; p < .001) to have reported prior
discussions with a medical provider regarding HIV
and STI Prevention compared to individuals who
have never been tested for HIV or STIs.
Participants who reported having received an HIV
and Other STI Test were 4.76 times more likely (OR
= .21; 95% CI: .08, .57; p < .01) to have reported prior
discussions with a medical provider regarding HIV
and STI Prevention compared to individuals who
have only received an HIV test.
HIV Only Vs. HIV & Other STI Test