title: Disclosure of sexual orientation to health professionals in China: results from an online cross-sectional study.
abstract: Many men who have sex with men (MSM) in China are "in the closet." The low rate of disclosure may impact sexual behaviours, testing for HIV and other sexually transmitted infections (STIs), and diseases transmission. This study examines factors associated with overall sexual orientation disclosure and disclosure to healthcare professionals.
  
  
  
  A nationwide cross-sectional online survey was conducted from September 2014 to October 2014 in China. Participants completed questions covering socio-demographic information, sexual behaviours, HIV/STI testing history, and self-reported HIV status. We defined healthcare professional disclosure as disclosing to a doctor or other medical provider.
  
  
  
  A total of 1819 men started the survey and 1424 (78.3%) completed it. Among the 1424 participants, 62.2% (886/1424) reported overall disclosure, and 16.3% (232/1424) disclosed to healthcare professionals. In multivariate analyses, the odds of sexual orientation disclosure were 56% higher among MSM who used smartphone-based, sex-seeking applications [adjusted odds ratio (aOR) = 1.56, 95% CI: 1.25-2.95], but were lower among MSM reporting sex while drunk or recreational drug use. The odds of disclosure to a healthcare professional were greater among MSM who had ever tested for HIV or STIs (aOR = 3.36, 95% CI: 2.50-4.51 for HIV, and aOR = 4.92, 95% CI: 3.47-6.96 for STIs, respectively) or self-reported as living with HIV (aOR = 1.59, 95% CI: 0.93-2.72).
  
  
  
  Over 80% of MSM had not disclosed their sexual orientation to health professionals. This low level of disclosure likely represents a major obstacle to serving the unique needs of MSM in clinical settings. Further research and interventions to facilitate MSM sexual orientation disclosure, especially to health professionals, are urgently needed.
authors.affiliation: University of North Carolina at Chapel Hill Project-China, Guangzhou, China.|SESH Study Group of University of North Carolina at Chapel Hill, Guangzhou, China.|Department of STI Control, Guangdong Center for Skin Diseases and STI Control, Guangzhou, China.|Department of Infectious Diseases, School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Weiming
authors.initials: W
authors.lastname: Tang
authors.affiliation: SESH Study Group of University of North Carolina at Chapel Hill, Guangzhou, China.
authors.forename: Jessica
authors.initials: J
authors.lastname: Mao
authors.affiliation: University of North Carolina at Chapel Hill Project-China, Guangzhou, China.|SESH Study Group of University of North Carolina at Chapel Hill, Guangzhou, China.
authors.forename: Songyuan
authors.initials: S
authors.lastname: Tang
authors.affiliation: University of North Carolina at Chapel Hill Project-China, Guangzhou, China.|SESH Study Group of University of North Carolina at Chapel Hill, Guangzhou, China.
authors.forename: Chuncheng
authors.initials: C
authors.lastname: Liu
authors.affiliation: Department of Infectious Diseases, School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Katie
authors.initials: K
authors.lastname: Mollan
authors.affiliation: University of North Carolina at Chapel Hill Project-China, Guangzhou, China.
authors.forename: Bolin
authors.initials: B
authors.lastname: Cao
authors.affiliation: Department of Infectious Diseases, School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Terrence
authors.initials: T
authors.lastname: Wong
authors.affiliation: University of North Carolina at Chapel Hill Project-China, Guangzhou, China.|SESH Study Group of University of North Carolina at Chapel Hill, Guangzhou, China.|Department of STI Control, Guangdong Center for Skin Diseases and STI Control, Guangzhou, China.
authors.forename: Ye
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Department of Biostatistics of University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Hudgens
authors.affiliation: SESH Study Group of University of North Carolina at Chapel Hill, Guangzhou, China.
authors.forename: Yilu
authors.initials: Y
authors.lastname: Qin
authors.affiliation: University of North Carolina at Chapel Hill Project-China, Guangzhou, China.|SESH Study Group of University of North Carolina at Chapel Hill, Guangzhou, China.|Department of Biostatistics of University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Larry
authors.initials: L
authors.lastname: Han
authors.affiliation: Danlan Gongyi, Beijing, China.
authors.forename: Baoli
authors.initials: B
authors.lastname: Ma
authors.affiliation: Department of STI Control, Guangdong Center for Skin Diseases and STI Control, Guangzhou, China.
authors.forename: Bin
authors.initials: B
authors.lastname: Yang
authors.affiliation: School of Public Health, Shandong University, Jinan, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Ma
authors.affiliation: School of Medicine, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Chongyi
authors.initials: C
authors.lastname: Wei
authors.affiliation: University of North Carolina at Chapel Hill Project-China, Guangzhou, China.|SESH Study Group of University of North Carolina at Chapel Hill, Guangzhou, China.|Department of Infectious Diseases, School of Medicine of University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
authors.forename: Joseph D
authors.initials: JD
authors.lastname: Tucker
mesh_terms: D000328:Adult; D002681:China; D003430:Cross-Sectional Studies; D015658:HIV Infections / Q000635:transmission; D006282:Health Personnel; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D011369:Professional-Patient Relations; D012650:Self Disclosure; D012725:Sexual Behavior; D012749:Sexually Transmitted Diseases; D019966:Substance-Related Disorders; D011795:Surveys and Questionnaires
keywords: China; disclosure; healthcare professional; men who have sex with men (MSM); sexual behaviours; sexual orientation