Healthcare Provider Barriers to Screening HIV-Infected MSM for STDs

Background: Guidelines recommend at least annual screening of HIV-infected MSM for syphilis, and chlamydia and gonorrhea at all exposed anatomic sites to protect their health and the health of their sexual partner(s).  STDs increase the risk of HIV transmission, and HIV-infected MSM are at increased risk of acquiring STDs because of continuing high risk sexual behaviors.

Objectives: Our objective was to understand barriers encountered by HIV care providers in adhering to STD screening guidelines for HIV-infected MSM.

Methods: In 2007, we conducted 40 individual interviews with healthcare providers (physicians, midlevel providers, nurses, and health educators) of HIV-infected MSM at eight large HIV clinics in six U.S. cities.  Providers were asked about the barriers to conducting sexual risk assessment of their patients, their STD screening practices, and barriers to screening.  Data was analyzed using NVivo 8 qualitative software.

Results: Providers reported few barriers to syphilis screening, but indicated that they encountered several obstacles that prevent routine chlamydia and gonorrhea screening:  language barriers, provider discomfort with taking a sexual history, confidentiality concerns, and time-constraints.  Specifically, providers cited discomfort discussing sexuality, especially with men of a different race or ethnicity.  Providers indicated that chlamydia and gonorrhea screening were not among their highest priorities.  In addition, providers perceived their patients would be concerned about confidentiality and having an STD documented in their medical record, and that patients might be embarrassed if their provider knew they were engaging in risky behavior.  Providers did not report health insurance or laboratory issues as barriers to screening.

Conclusions: Key barriers to chlamydia and gonorrhea screening were provider discomfort and lack of cultural competency in conducting a sexual history, and provider’s perceived patient concerns about confidentiality.

Implications for Programs, Policy, and/or Research: Provider-focused interventions to increase sexual history taking skills and ensure patient confidentiality might help to mitigate barriers to chlamydia and gonorrhea screening.