Acceptability Of Sexual Health: Sex Men With Men
Introduction
“HIV incidence among men who have sex with men (MSM) has steadily increased since the early 1990’s.” This could suggest the need for HIV interventions and sexual health information to help combat the prevalence of HIV amongst the MSM community. As stated in the Yogyakarta Principles, MSM are entitled to their human rights, which include the highest attainable standard of ‘health, non-discrimination and privacy.’ However, it has been known that stigma, ‘punitive laws’ and inequalities of sexual minorities undermine the effectiveness of HIV and sexual health programmes. In my literature review, I aim to investigate the different mediums from which sexual health information is available and accessible to MSM, with further discussion on the advantages and disadvantages of using the internet as a source of imparting this information. Additionally, I aim to explore the barriers which prevent MSM from accessing sexual health information. If interventions are made more available and more accepted by MSM, they could help reduce risky behaviours and increase acceptance of HIV testing, which could have an impact on decreasing HIV prevalence world-wide. Methodology The main sources I received data from were Ovid database and BMJ journal. Ovid database included papers from Medline Ovid, PsycINFO, Embase, AMED and others. The number of papers returned from the search was extensive, however, this meant there were risks of choosing papers which were not relevant to my literature review. By ‘exploding’ terms and using ‘OR’ and ‘AND’ in the right context when combining keywords in my search, I was able to make my search specific to my title of accessibility and availability of sexual health information for MSM. I only included studies which were targeted to the audience of MSM and contained my keywords. Results and discussion School Curriculum and sexual health education Sexual health is typically first taught in school. These adolescent years are a time for discovery, of the mind, body and sexual orientation. However, social inequalities are present in sexual health education today. Upon researching MSM and the availability of sexual health information, two papers uncovered that young people commonly found Sexual Education in school was heterosexist and gendered. This is emphasised by a study which completed a survey on schools in America, where “69% of LGBQ youth report the sexual health curricula provided by their school doesn’t include information relevant to their sexual orientation.”
Additionally, the survey expressed some teachers had a negative attitude to same-sex relationships, meaning MSM and other sexual minority groups could face a barrier in accessing information from a young age, due to society not accepting their sexual orientation. By disregarding homosexuality in school settings, it could prevent sexual minority groups from seeking health care, as they are made to feel alienated, isolated and fearful of speaking out against the norm of heterosexual couples. To combat this, sexual health information must have nonjudgemental discussions including same-sex relationships. Mediums for providing sexual health information for MSM Sexual health information is provided by various health settings worldwide. This range from general practitioners; genitourinary medicine (GUM) clinics; and enhanced sexual health services (EHSH). From a survey report conducted in 2000, GUM clinics are the most commonly used source of sexual health information for MSM, providing confidential, free health care services which offer ‘specialist STI (sexually transmitted infections) testing’. Statistics produced by Public Health England, showed ‘HIV testing coverage in GUM clinics improved amongst MSM from 78% in 2009 to 86% in 2013’.Contrary to the acceptance and utilisation of GUM clinics and GP practices, there are still barriers in the way for some MSM to access sexual health information from these platforms. Entrenched homophobia and the inability of ESHS to provide the full range of health services needed by MSM suggests there are inequalities in the availability and accessibility of sexual health information for MSM. These disparities faced by MSM and other sexual minority groups have been recognised by the NHS, UK. New guidelines implemented from April 2019 will advise Health Professionals to ask patients 16 and over their sexual orientation, “allowing public sector bodies to better understand, respond to and improve lesbian, gay and bisexual (LGB) patient’s service access.” However, not all countries recognise or consult these inequalities. There is criminalisation of same-gender relationships in more than 75 countries, making it dangerous for those seeking sexual health information, if unable to be done anonymously. Furthermore, stigma and discrimination related to MSM and associated HIV can result in active denial of MSM’s sexual orientation, preventing them from accessing social support needed to improve their health. Online as an intervention for sexual health information As discussed above, there are many platforms providing sexual health information for MSM, however, the utilisation of the Web as a source of health information has increased significantly in the last ten years. One study showed searching sexual health information online greatly varied depending on sexual orientation: ‘with 78% being LGBT youth compared to only 19% of heterosexual youth.’ This could be because information online allows MSM access in private whenever they like, whilst reducing their fear of being exposed. R. Knight’s systematic review looked at seventeen studies assessing research involving online interventions that address HIV among MSM. One such study by K.M. Carpenter, showed different ways of delivering ‘safe sex interventions’ to increase knowledge and reduce HIV risk: via chatrooms, videos and one-on-one help.
The intervention group who were given ‘safe sex interventions’ had a greater decrease in number of unprotected acts with risky partners than the control group. Another study from the systematic review, had an intervention designed to ‘increase condom use during anal sex and decrease frequency of anal sex.’ Men with one sex partner from the intervention group, ‘reduced the reported percentage of partners with whom they had anal sex from 80% to 69%, and increased the percentage of anal sex partners with whom they used condoms from 41% to 60%’. The results from the studies above demonstrate that online sex educational sources can have beneficial effects for the MSM community. By utilising the internet well, it makes it possible to provide preventative education to difficult-to-reach populations at a low cost. Moreover, by providing ‘24/7 access in an anonymous forum’ it gives the individual security that their information will be kept confidential. However, the limitations of both studies need consideration as they could have impacted on the results. Carpenter’s study suffered from low rates of participation by those of lower socioeconomic status, whereas Bowen’s study only focused on ‘rural MSM’, meaning both studies were not generalisable. The lack of a control group and long term follow up from Bowen’s study also meant it was impossible to distinguish whether the positive results from the intervention group were due to the intervention or other confounding variables.These limitations suggest further research is needed on a grander scale, with a more diverse audience of MSM targeted. Future research also needs to ‘assess the effects of “real-world” and “live” interventions’, as this would give a better idea of the long-term effects of online interventions. MSM attitudes and perceptions to online interventions Although there are several advantages to using online interventions to reach MSM, it is important to understand whether MSM are willing to use these online interventions to access available sexual health information. One study aimed to assess the acceptability and engagement of MSM using an Internet based partner notification system. In the study, men were asked how likely they would use a link on a website, which provided information of where they can get tested for HIV and STI’s, to which ’82.6%’ agreed they would. The likeliness to go to a link about STI information on transmission and symptoms further increased to ‘86.2%’. This implies MSM are likely to seek sexual health information online if it is made available to them through websites they regularly use. Another study aimed to promote HIV and STI testing to MSM population using an app. Due to the increasing use of portable technology and ease of downloading apps for free, online technology gives MSM available sexual health information anywhere, and from this study ’63.8% of participants reported the want to receive sexual health information via an app.’ The above studies show the willingness of MSM to use online interventions and links on websites to access sexual health information. The study by Mimiaja, suggested men were also willing to go to sexual health clinics where they could be treated, but they needed the information to find where these clinics were. Therefore, the internet could be used as an intermediate source between MSM and accessing sexual health care tests and screening. Nevertheless, the turnover with new technology is rapid, meaning once popular sites and information are replaced. For this reason, public health professionals and creators of sexual health online interventions must stay well-informed and responsive when creating new internet platforms. This will make the information more accessible by a greater cohort of MSM. Advantages and disadvantages of using the Internet as a sexual health intervention for MSM Some MSM use the internet to meet new people and engage in relationships. One study showed ‘68% of young MSM reported using the internet to meet a romantic or sexual partner.’
However, the same study stated, compared with peers MSM utilising the internet to meet sexual relations reported statistically higher rates of risky sexual behaviour, and greater use of ‘Viagra and methamphetamine’, whilst another study reported MSM using the internet to find sexual partners are more likely to ‘report unprotected anal intercourse’. These risky behaviours could be a result of having never had sex education, meaning MSM may not realise the risks they are exposing themselves to. However, the fact these risks are being imposed via internet sources would suggest that using the internet as a medium to intervene and teach sexual health information is even more crucial as they are more likely to target MSM inclined to partake in risky behaviours. Social networking sites, such as ‘Grindr, Scruff and Tinder’ have active MSM users worldwide, which provide opportunities to meet people “where they are at”. These sites also provide intervention platforms for sexual health. As one study showed, the more engaging social networking platforms are, the more interactions they had with the public and the more successful the health promotion would be. This evidences that sexual health information online can provide innovative, promising opportunities to deliver the ‘right intervention to the right group of MSM at the right time.’ However, we shouldn’t forget that online interventions, although able to give sexual health information, cannot be a platform to give treatment. Therefore, as a first line medium to help educate MSM about possible risks of sexual behaviours and STI’s/HIV, online interventions may have an exponential positive effect, but for a reduction in HIV and STI transmission, MSM must be treated and that can only be done through health care settings. Conclusion In conclusion, my literature review shows I was able to fulfill my overarching aim of discovering the accessibility and availability of sexual health information for MSM and the barriers they face in society today. The papers included showed the promising benefits of using online interventions as an effective source to relay sexual health information to MSM who are unable to receive health care elsewhere. I have discovered that the cost-effectiveness, easy access worldwide and anonymity of using online interventions makes the web an ideal medium to reach MSM.
Although promising, my research shows further, rigorous, wide spread studies are needed to further prove the benefits of online interventions for educating MSM in sexual health. Reflection From this project, I have learned how to access databases and narrow my search to find the most relevant papers for my title. Initially, I wasted time as my search drifted off course because I found it difficult to make sure all my references were specific to my title. To combat this, I received help from librarians, who taught me how to use Ovid database effectively. In future research, this skill will help me structure my search efficiently by using relevant keywords and terms. This assignment has been valuable to me, as it has increased my knowledge and understanding of MSM and sexual health; a topic I previously knew little about. Additionally, it has shown me the significance of using trials, as they give evidence to help prove certain hypothesis. In this review, the trials and studies showed how online interventions work to aid sexual health information, giving men accessibility and availability, which is vital to help reduce HIV transmission and risky behaviours amongst MSM. I believe as a future doctor, I will take forth greater awareness of the difficulties still faced by MSM in society. Moreover, it has shown me how doctors and other health care professionals can help fight the barriers faced, by being non-judgemental, gaining trust and making the patients aware of the different mediums from which they can access sexual health information worldwide.
