Factors Associated with Healthcare Provider Recommendations for Screening: Results from the 2017-2019 National Survey of Family Growth

Early detection by screening for Human Immunodeficiency Virus (HIV) and sexually transmitted infections (STIs), such as chlamydia, gonorrhea, and syphilis, can prevent negative health outcomes such as delay and disruption of the HIV care continuum and infertility among men. STI screening recommendations typically focus on women and often overlook men, therefore healthcare provider recommendation and discussion have a strong influence on rates of HIV and STI screening. Research has also suggested provider-initiated conversations about HIV and STI screening may differ by patient's sociodemographic factors such as race and ethnicity and patient sexual behaviors. However, little is known on the specific interactions providers have with patients, including the risk factors and content discussed during sexual health visits and how that affects screening rates. The purpose of this study was to assess interactions with a healthcare provider regarding STIs and related risk factors and HIV/STI screening, adjusting (and testing interaction effects) for sexual orientation, race/ethnicity, and number of sexual partners. Using the 2017-2019 National Survey of Family Growth data, seven survey-weighted multivariable multinomial/binary logistic regression were analyzed in a complex, multistage probability-based sample designed to be representative of U.S. household members aged 15-49 years old. There were 5,206 men in the NSFG dataset; however, based on the inclusion and exclusion criteria, the final analysis sample consisted of 4,263 men. This study was approved by the North Texas Regional Institutional Review Board. Compared to White men, being Hispanic, Black, and Other race was associated with higher odds of a healthcare provider discussing: number of partners, condom usage, and type of sexual intercourse. Being a Black man was associated with higher odds of a healthcare provider discussing sexual orientation (aOR: 2.522 (95%CI: 1.711-3.592) and HIV/AIDS (aOR: 2.235), compared to White men. Identity as a Hispanic man was associated with higher odds of a healthcare provider discussing HIV/AIDS (aOR: 1.313) compared to White men. Identity as a sexual minority were associated with higher odds of a healthcare provider discussing all risk factors and HIV/AIDS compared to heterosexual men. A general trend was observed for number of sexual partners: every additional opposite/same-sex partner was associated with higher odds of HIV/AIDS screening (aOR: 1.080; 1.393), STI screening (aOR: 1.028; 1.201), respectively. Lastly, every additional same-sex partner was associated with higher odds of a healthcare provider discussing HIV/AIDS with the patient (aOR: 1.241). Results may provide insight on how healthcare providers facilitate HIV/AIDS and STI screening among men and which patient groups are more likely to receive a discussion of risks factors with from their healthcare provider. Additionally, these results may further support the need for more healthcare providers to utilize standardized guidelines for interactions with patients regarding sexual health (i.e., Sexual Health and Your Patients: A Provider's Guide by the National Coalition for Sexual Health). Future studies can use results from this study to design targeted interventions to promote equity in provider behavior and ultimately reduce the negative health outcomes associated with HIV and STIs.