Men Who Have Sex With Men (MSM) Sexual Risk Screening

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Perform with Each New Patient and on a Regular Basis

Remember:

  • Assure confidentiality and explain importance
  • Ask DIRECT questions about specific behaviors
  • Exploratory and open-ended questions may help
  • Normalizing the behavior may elicit more honest responses

Sexual Behavior Risk Factors

  • Use specific terms: Consider using "men who have sex with men" instead of gay.
  • Do NOT assume anything: Marriage does not guarantee monogamy or that the individual is heterosexual.
  • Ask for an explanation of sexual practices: "I don't know what you mean, could you explain...?"
  • Direct and non-judgmental questions are best:

Broaching the Topic:

  • Tell me about your sex life.
  • When you say you've had sex, what exactly do you mean?
  • Do you have sex with men, women, or both?

Asking About Partners:

  • Tell me about the number of partners in the last month...the last six months?
  • Where do you meet your partners? (on-line, bars, bathhouses/sex clubs, public venues)
  • How well do you know your sexual partners?
  • What do you know about the HIV status of your partners?
  • How does your partner's status affect your sexual behaviors?
  • Have you noticed STD-type symptoms in your partner?
  • Do you ever combine sex with drugs and/or alcohol? How often? With what types of drugs? (Methamphetamine, GHB, Special K, Ecstasy, etc...)
  • When are you more likely to combine sex and drugs?

Asking About Sexual Activity:

  • What sexual activities do your sexual partners engage in?
  • Do you have oral sex? Vaginal sex? Anal sex?
  • What types, if any, of strategic positioning ("top," "bottom") do you use to decrease HIV transmission risk?
  • Do you select partners based on HIV status ("serosort")?

Asking About Prevention Methods:

  • What do you do to protect yourself during sex?
  • Do you use condoms when having sex? How often? With what types of sex?
  • What has been your experience with using condoms?
  • What factors/situations get in the way of using condoms?

Injection Drug-Related Risk Factors

It is important to be non-judgmental and non-moralistic.

If there is a history of drug use, get more information:

  • Do you share needles? Cottons? Cookers?
  • With how many partners?
  • What do you know about the HIV status of your needle-sharing partners? Sex partners?
  • Is your equipment clean? How do you know?
  • What drugs do you inject?
  • What types of situations or environments make you more likely to use drugs?

Clinical Risk Factors

A basic medical history is essential to the early diagnosis of sexually transmitted diseases:

  • Screen all patients for signs and symptoms consistent with an STD
  • Genital, oral, and/or anal lesions
  • Pain or burning with urination
  • New or unusual skin rash
  • Rectal symptoms: discharge, burning, or itching
  • Urethral discharge, groin pain

Laboratory Screening for STDs

  • Initial visit: All: Test for Syphilis (serologic), Gonorrhea and Chlamydia (urogenital, anal, oral)
  • Screen for STDs regularly (at least annually)
  • Screen more frequently (3 to 6 month intervals) if:
    1. Multiple or anonymous sex partners
    2. History of STDs
    3. Other risky behaviors associated with transmission
    4. Sex or needle-sharing partner(s) with above risks
    5. Life changes that may lead to higher risk behaviors
    6. High prevalence of STDs in your area
  • Adapted from: "STD/HIV Risk Assessment," compiled by the Mountain Plains Regional AETC and Seattle STD/HIV Prevention Training Center; and "Incorporating HIV Prevention into the Medical Care of Persons Living with HIV" (CDC/HRSA/NIH/HIVMA)

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