title: Relationship between disclosure of same-sex sexual activity to providers, HIV diagnosis and sexual health services for men who have sex with men in Vancouver, Canada.
abstract: OBJECTIVE
  Men who have sex with men (MSM) report challenges to accessing appropriate health care. We sought to understand the relationship between disclosure of same-sex sexual activity to a health care practitioner (HCP), sexual behaviour and measures of sexual health care.
  
  
  METHODS
  Participants recruited through community venues and events completed a questionnaire and provided a blood sample. This analysis includes only individuals with self-reported HIV negative or unknown serostatus. We compared participants who had disclosed having same-sex partners with those who had not using chi-square, Wilcoxon Rank Sum and Fisher's exact tests and used logistic regression to examine those variables associated with receiving an HIV test.
  
  
  RESULTS
  Participants who had disclosed were more likely to have a higher level of education (p&lt;0.001) and higher income (p&lt;0.001), and to define themselves as "gay" or "queer" (p&lt;0.001). Those who had not disclosed were less likely to report having risky sex (p=0.023) and to have been tested for HIV in the previous two years (adjusted odds ratio 0.23, 95% confidence interval: 0.16-0.34). There was no difference in undiagnosed HIV infection (3.9% versus 2.6%, p=0.34). Individuals who had disclosed were also more likely to have been tested for gonorrhea and syphilis, and more likely to have ever been vaccinated against hepatitis A and hepatitis B (p&lt;0.001 for all).
  
  
  CONCLUSIONS
  While generally reporting lower risk behaviour, MSM who did not disclose same-sex sexual activity to their HCP did have undiagnosed HIV infections and were less likely to have been tested or vaccinated. Strategies to improve access to appropriate sexual health care for MSM are needed.
authors.affiliation: University of British Columbia. cantor2537@gmail.com.
authors.forename: Brian E
authors.initials: BE
authors.lastname: Ng
authors.forename: David
authors.initials: D
authors.lastname: Moore
authors.forename: Warren
authors.initials: W
authors.lastname: Michelow
authors.forename: Robert
authors.initials: R
authors.lastname: Hogg
authors.forename: Réka
authors.initials: R
authors.lastname: Gustafson
authors.forename: Wayne
authors.initials: W
authors.lastname: Robert
authors.forename: Steve
authors.initials: S
authors.lastname: Kanters
authors.forename: Meaghan
authors.initials: M
authors.lastname: Thumath
authors.forename: Marissa
authors.initials: M
authors.lastname: McGuire
authors.forename: Mark
authors.initials: M
authors.lastname: Gilbert
mesh_terms: D000328:Adult; D002170:Canada; D003430:Cross-Sectional Studies; D030881:Disclosure / Q000706:statistics & numerical data*; D015658:HIV Infections / Q000175:diagnosis*; D006297:Health Services Accessibility; D018451:Homosexuality, Male / Q000523:psychology* / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D010817:Physician-Patient Relations; D034121:Reproductive Health Services / Q000706:statistics & numerical data*; D012309:Risk-Taking; D012725:Sexual Behavior / Q000523:psychology / Q000706:statistics & numerical data; D012959:Socioeconomic Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
keywords: HIV; disclosure; homosexuality; male; reproductive health