How Are U.S. Primary Care Providers Assessing Whether Their Male Patient Has Male Sex Partners?

Background: Identifying patients at-risk for HIV infection, such as men who have sex with men (MSM), is the first step toward providing HIV prevention interventions. It is unknown how primary care physicians (PCPs) evaluate MSM status and related HIV-risk factors.

Methods: We analyzed data from DocStyles 2014, a panel-derived web-based survey for healthcare providers to describe how PCPs, who actively saw patients in the US for ≥3 years, determined MSM status among their patients. We calculated adjusted prevalence ratios (aPR) and 95% confidence intervals (CI) to describe PCP characteristics associated with systematically determining MSM status  (i.e., PCP used “a patient-completed questionnaire ” or “routine verbal review of sex history”).  

Results: Among 1008 PCPs, 73% were male, 57% white, 72% did not routinely screen all patients aged 13-64 for HIV. Among 918 PCPs (91%) assessing MSM status: 56% used “routine verbal review of sexual history”; 47%, “patient disclosure”; 39%, “questions driven by symptoms/history”; and 23%, “a patient-completed questionnaire.”  Of PCPs assessing HIV risk factors: 62% assessed “patient’s self-reported HIV status”; 58%, “any recent history or current symptom of STI”; 57%, “condomless sex”; 57%, “frequency of HIV testing”; and 54%, “number of male sex partners.”  PCPs who systematically determined MSM status (n=665; 66%) were more likely to be female (aPR=1.15, CI=1.05-1.27), be non-Hispanic black (aPR=1.25, CI=1.02-1.53), and routinely screen all patients aged 13-64 for HIV (aPR=1.35, CI=1.24-1.48), compared to males, non-Hispanic whites and PCPs who do not routinely screen for HIV, respectively.

Conclusions: Most PCPs discuss MSM status and HIV risk factors but report using verbal reviews of sexual history. Implementing a systematic approach such as a patient questionnaire to review sexual history and HIV risk factors, which was used by less than a quarter of PCPs, could reduce the impact of cultural factors (PCP race and gender) that hinder the assessment of MSM status.