Only half of gay and bisexual men surveyed in New Zealand believed their general practitioner knew about their sexual orientation, according to new research led by the University of Auckland.
A further 17 percent said they were unsure if their GP knew that they were gay or had sex with men and about a third said their GP did not know.
The research was led by Adrian Ludlam and Dr Peter Saxton from the University of Auckland’s Gay Men’s Sexual Health research group, with Associate Professor Nigel Dickson from the University of Otago and Tony Hughes from the New Zealand AIDS Foundation (NZAF).
“This low level of awareness means that many gay and bisexual men are likely not being offered relevant care, such as HIV and STI tests, vaccination and advice about safe sex by their GP,” says lead author Adrian Ludlam. “These findings are timely as new HIV diagnoses among gay and bisexual men in New Zealand are at an all-time high and there are also rises in sexually transmitted infections,” he says.
The findings were recently published in the Journal of Primary Health Care and presented at the World STI and HIV Congress in Brisbane in September. The data is from a community and internet study of 3168 gay and bisexual men conducted in 2014.
“Gay and bisexual men have greater needs around HIV, sexual health and vaccination against human papillomavirus (HPV) than other men” says Ludlam. He adds “GPs play a critical role in addressing these needs but because sexuality is an invisible trait, a GP must ask their patient or the patient has to feel comfortable disclosing this information.”
While half the respondents believed that their GP did know about their sexuality, this was lower among respondents who were younger, who identified as bisexual, who were of an Asian or other non-European/Maori/Pacific ethnicity, or who reported fewer recent same-sex partnerships.
“When we examined sexual health screening, respondents whose GP was unaware of their sexual orientation were much less likely to have been offered HIV and STI tests, or had much less comprehensive testing,” Ludlam says. “This is a huge missed opportunity to address health inequalities.”
“We were interested in the quality of care in general practice for gay and bisexual men,” says Dr Peter Saxton, Director of the Gay Men’s Sexual Health research group. “For example, anti-discrimination and marriage equality in New Zealand has been achieved in law, but as yet there’s been no reduction in sexual health inequalities. Inclusivity needs to flow right through society especially in health care, not merely written in ink.”
“The implication of such low levels of awareness is that many gay and bisexual men aren’t being asked or don’t feel comfortable disclosing their sexuality,” says Saxton. “Some possibly anticipate negative reactions or awkwardness..”
“There are multiple ways to improve care for patients with minority sexual orientations. Sexual orientation can be a standard question asked at first consultation.,”says Saxton. “Clinics can display inclusive material and professional training around sexual orientation and gender identity issues can be improved, so that GPs feel confident and able to provide sensitive and relevant services.”.
“No-one wants a long-time patient suddenly presenting with advanced HIV disease when this could have been diagnosed earlier with a simple question and annual screening.”
According to the AIDS Epidemiology Group data, gay and bisexual men account for approximately 80 percent of HIV infections transmitted in New Zealand, and general practice is the most common site where the diagnosis is made.
In addition, in the past five years, 42 percent of HIV infections among gay men have been diagnosed late, that is after the point at which HIV treatments would normally have been initiated, half of which probably occurred more than four years prior to their diagnosis.
For copy of this paper; Ludlam A, Saxton P, Dickson N, Hughes A. General practitioner awareness of sexual orientation among a community and internet sample of gay and bisexual men in New Zealand. Journal of Primary Health Care. 2015;7(3):204–212. Go to this link https://www.rnzcgp.org.nz/jphc-september-2015/?stage=Live