Health Care Access and Sexually Transmitted Disease Screening Frequency Among at Risk Massachusetts Men Who Have Sex with Men (MSM)

Background:
Despite the Centers for Disease Control and Preventions (CDC) recommendations that all sexually active MSM receive routine screening for HIV and other STDs, many MSM remain unaware of their HIV/ STD status.

Objective:
The current study assessed behavioral risk factors, health care access, and rates of screening for HIV and other STDs among at risk MSM in Massachusetts.

Method:
Using a modified respondent-driven sampling method, this study recruited a diverse sample of MSM (n=126). All participants completed a quantitative survey assessment between March 2006 and May 2007.

Result:
Fifty percent of MSM had a history of one or more STDs. HIV-infected MSM (54%) were more likely to report prior STD diagnoses (OR=4.04; P<0.001). Most participants (97%) had health insurance and had visited a health care provider (HCP) in the past year, but 39% had not been screened for STDs in 2 years. White MSM were more likely to have been tested for STDs (OR=3.82; P<0.01). Non-white MSM were more likely to be bisexual (OR=5.83; P<0.001) and less likely to have disclosed MSM activity to HCPs (OR=2.94; P<0.01). Bisexual men were less likely to have told HCPs about male-to-male sexual behavior (OR=4.66; P<0.001) and to have been tested for STDs in the past 2 years (OR=6.91; P<0.001); they were 5 times more likely to engage in insertive anal sex without a condom with an HIV-infected partner (OR=5.04; P<0.005).

Conclusion:
The current study demonstrates high rates of sexual risk taking and low rates of HIV/STD screening among a diverse sample of Massachusetts MSM, particularly among non-white bisexual men who have not disclosed MSM sexual activity to HCPs.

Implications:
Clinicians need to encourage discussion about sexual risk taking behaviors and more routinely screen for STDs in sexually active men irrespective of disclosure of MSM history.