title: Provider barriers prevent recommended sexually transmitted disease screening of HIV-infected men who have sex with men.
abstract: BACKGROUND
  HIV-infected men who have sex with men (MSM) are at increased risk for transmitting and acquiring sexually transmitted diseases (STDs). Guidelines recommend at least annual screening of HIV-infected MSM for syphilis and for chlamydia and gonorrhea at exposed anatomical sites, to protect their health and their sexual partners' health. Despite these guidelines, STD screening has been suboptimal, with very low nongenital chlamydia and gonorrhea testing rates. Our objective was to better understand barriers encountered by HIV care providers in adhering to STD screening guidelines for HIV-infected MSM.
  
  
  METHODS
  We conducted 40 individual semistructured interviews with health care providers (physicians, midlevel providers, nurses, and health educators) of HIV-infected MSM at 8 large HIV clinics in 6 US cities. Providers were asked about their STD screening practices and barriers to conducting sexual risk assessments of their patients. Emerging themes were identified by qualitative data analysis.
  
  
  RESULTS
  Although most health care providers reported routine syphilis screening, screening for chlamydia and gonorrhea at exposed anatomical sites was less frequent. Obstacles that prevented routine chlamydia and gonorrhea screening included time constraints, difficulty obtaining a sexual history, language and cultural barriers, and patient confidentiality concerns.
  
  
  CONCLUSIONS
  Providers reported many obstacles to routine chlamydia and gonorrhea screening. Interventions are needed to help to mitigate barriers to STD screening, such as structural and patient-directed health services models that might facilitate increased testing coverage of these important preventive services.
authors.affiliation: From the *Division of STD Prevention, Centers for Disease Control and Prevention, Atlanta, GA; †Department of Anthropology, University of Maryland, College Park, MD; and ‡Emory University School of Medicine, Atlanta, GA.
authors.forename: Jarvis W
authors.initials: JW
authors.lastname: Carter
authors.forename: Geoffrey D
authors.initials: GD
authors.lastname: Hart-Cooper
authors.forename: Mary O
authors.initials: MO
authors.lastname: Butler
authors.forename: Kimberly A
authors.initials: KA
authors.lastname: Workowski
authors.forename: Karen W
authors.initials: KW
authors.lastname: Hoover
mesh_terms: D000293:Adolescent; D000328:Adult; D002690:Chlamydia Infections / Q000517:prevention & control*; D006069:Gonorrhea / Q000517:prevention & control*; D006679:HIV Seropositivity / Q000453:epidemiology*; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D008403:Mass Screening; D010342:Patient Acceptance of Health Care; D012725:Sexual Behavior; D012747:Sexual Partners; D011795:Surveys and Questionnaires; D013587:Syphilis / Q000517:prevention & control*; D014481:United States