HIV, MSM, and minorities: Epidemiological evidence for missed opportunities in primary care

Background: African-American men who have sex with men are disproportionately impacted by HIV and other STDs. Data suggest missed opportunities for HIV/ STD prevention and screening among African-American men who have visited healthcare providers in the year prior to a new HIV diagnosis. National Medical Association (NMA) providers recently described discomfort with discussing sexual health with male patients as a barrier to offering routine HIV testing. Methods: From 2006-2009, fourteen training sessions were held at regional and national NMA conferences with over 2,000 NMA physicians regarding the implementation of routine HIV screening in their practices. Concerns expressed by NMA physicians about facilitators and barriers surrounding implementation of routine HIV screening were reviewed for common themes and summarized in a final report. Results/Conclusions: The majority of participating NMA physicians expressed hesitancy with initiating sexual health discussions, particularly with male patients, as a barrier to offering routine HIV screenings. They suggested that a dialogue could be facilitated by having a routine, basic sexual health discussion that could occur quickly during a clinical encounter. Implications for Program, Policy and/or Research: NMA physicians are willing to explore methods to increase routine sexual histories and HIV/STD screenings during clinical encounters with men. Implementing tools that support routine sexual history discussions for providers and patients represents an important step in combating the HIV and STD epidemics among men in the United States. A standard sexual history instrument will be introduced to NMA physicians who are serving African-American men in their practices in 10-12 high HIV and STD prevalence areas in the United States. Pre- and post-intervention evaluation tools will be used to measure the documented number of sexual histories and HIV/STD screenings at baseline and 3-months post-intervention.