The New York Times - July 23, 2008
Sewell Chan

Health officials said the survey results had troubling implications for H.I.V. prevention. The survey found, for example, that men who disclosed their sexual activity with other men were twice as likely as men who did not to have been tested for H.I.V. (63 percent versus 36 percent).

The survey found a striking distinction: While 78 percent of the men who had sex with men and identified themselves as homosexual said they had discussed their sexuality with their doctors, none of the men who had sex with men but identified themselves as bisexual had told their doctors.

The survey also found wide racial and ethnic variation in disclosure rates. Sixty percent of black men who had sex with other men said they had not discussed their sex lives with their doctors, compared with 48 percent of Hispanic men, 47 percent of Asian men and 19 percent of white men.

Other differences in disclosure were also observed. Men who were 28 or older were more like than younger men (69 percent vs. 52 percent) to be out to their providers. Those born in the United States were more likely than immigrant men to disclose their practices, and those who were better educated disclosed at higher rates than the less educated.

Dr. Monica Sweeney, the assistant health commissioner for H.I.V. prevention and control, said the findings reflected a strong stigma against homosexuality in minority communities. (About three-quarters of the men in the survey who described themselves as bisexual were black and Hispanic.)

"There is a frequent phenomenon in the black community in which a man who is gay, by the conventional ways that we all know to identify somebody as gay, identifies himself as bisexual," Dr. Sweeney said, referring to the phenomenon known as the "down low."

The survey results, published this month in The Archives of Internal Medicine, examined data from the National H.I.V. Behavioral Survey conducted in 2004-5 by the Centers for Disease Control and Prevention. The New York segment of the study involved data from 452 men who were interviewed anonymously at gay bars and clubs, tested for H.I.V., and offered medical and social services as needed.

Officials not only urged patients to be forthcoming about their sexual behavior, but also urged doctors to ask about sexual history.

"Health care providers should screen patients routinely for H.I.V.," said Dr. Elizabeth Begier, director of H.I.V. epidemiology at the health department. "They should also ask their patients about behavior that may put them at risk. And New Yorkers shouldn't hesitate to talk openly with their health care providers."

In a phone interview, Dr. Sweeney said that doctors are often squeamish about asking personal questions.

"When the doctor initiates the subject, no matter how sensitive, most people talk about these things," said Dr. Sweeney, who is trained in internal medicine and geriatrics. She added that she was not surprised by the survey findings; if anything, she said, she was surprised that the overall disclosure rate - 61 percent - was as high as it was.

Marjorie J. Hill, chief executive of Gay Men's Health Crisis, a nonprofit advocacy group, offered a similar assessment in a phone interview. "While distressed, I am not at all surprised," she said of the findings. "Medical providers are not sufficiently trained in outreach and engagement with gay, lesbian, bisexual and transgendered people."

Outside of obstetrician-gynecologists, she said, "doctors are not encouraged to have conversations about sex."

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