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Abstract
Objectives Gay, bisexual and other men who have sex with men (GBMSM) in Singapore may fear disclosing their sexual orientation to others due to negative societal attitudes, and the law that criminalises sexual relations between men, which may, in turn, impede access to HIV/sexually transmitted infection (STI)-related health services. This study attempts to determine how selective disclosure to varying social groups, and the extent of disclosure, may serve to impact HIV/STI testing patterns among GBMSM.
Methods In this observational study, we recruited GBMSM in Singapore through an online cross-sectional survey disseminated via the smartphone app Grindr from 14 January to 11 February 2018. Respondents provided information on their sociodemographic characteristics, disclosure of sexual orientation towards other lesbian, gay, bisexual, transgender and questioning (LGBTQ) individuals, non-LGBTQ family members, non-LGBTQ friends and non-LGBTQ colleagues, along with their HIV/STI testing patterns. Extent of disclosure was defined as the number of social groups that a participant had disclosed his sexual orientation to. Statistical analyses were conducted through descriptive statistics, multivariable binary, ordinal, and multinomial logistic regression models.
Results We recruited 1339 respondents, of which 1098 who had provided their response to questions on HIV/STI testing were included in the analytic sample. Multivariable analyses indicated that disclosure towards non-LGBTQ family members (adjusted OR [aOR] 1.85, 95% CI 1.12 to 3.07) and other LGBTQ individuals (aOR 1.63, 95% CI 1.12 to 2.37) were positively associated with recent HIV testing, whereas disclosure towards non-LGBTQ colleagues (aOR 1.56, 95% CI 1.09 to 2.22) was positively associated with regular HIV testing. Extent of disclosure exhibited a positive, dose–response relationship with all testing outcomes.
Conclusions Results indicate how the fear of being identified as an LGBTQ individual may deter GBMSM from getting tested for HIV and other STIs. Health services should bridge the gaps to accessing healthcare among individuals who fear being stigmatised for attending sexual health-specific clinics or being identified as GBMSM.
- HIV testing
- sexual health
- homosexuality
- testing
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Footnotes
Handling editor Adam Huw Bourne
Contributors RKJT, AKJT, NK, JH-Q, MI-CC and CSW contributed to the survey design, oversight of recruitment, and data collection. RKJT, AKJT and MI-CC cleaned and analysed the data. RKJT and AKJT wrote the paper. RKJT, AKJT, NK, JH-Q, MI-CC and CSW reviewed the paper.
Funding This publication is funded by the National Centre for Infectious Diseases, Singapore
Competing interests None declared.
Patient consent for publication Not required.
Ethics approval Ethics approval was obtained from the institutional review board at the National University of Singapore (NUS-IRB Reference Code S-17–335) prior to data collection.
Provenance and peer review Not commissioned; externally peer reviewed.