TELLING THE TRUTH AT THE CLINIC —WHY IS IT SO HARD?

“So who do you have sex with—men, women or both?”
That was the question posed to a friend the moment he sat down in the consultation room at the “men’s corner” of the local clinic, after asking about PrEP for HIV prevention. No small talk, no gradual building of trust and rapport, no explanation of why that question was even being asked.

He was so stunned that he answered “both”, even though he says he has never been with a woman. Caught completely off guard, his instincts told him that “both” was a more acceptable answer.

He’s not alone. Many of us have found ourselves in an awkward interaction with a nurse or doctor— feeling uncomfortable talking about our sexual health, perhaps because we’re unsure whether it’s a safe space and perhaps also because we’re carrying our own baggage around sex.

Some of us are unambiguously “out and proud”. We don’t care who knows it or how they feel about it. But a lot of us, for a variety of reasons, are in a different place. While it’s hard to get an accurate read, surveys have found that 58-71% of men who have sex with men identify publicly (and often even privately) as straight.

Even those of us who identify as gay often disclose selectively depending on the context. We may be out to a close circle of friends but not to family, co-workers, or the wider community. We may be out in the city where we live but not in our hometown. When it comes to healthcare, we may not be out to the doctor or nurse doing the consultation or examination.

That’s a problem. Because if the nurse or doctor doesn’t know what kind of sex we’re having, they might not check for the things they should be checking for. That can lead to untreated STIs, some of which can increase our vulnerability to HIV, cancer, organ damage and infertility.

Part of the solution lies with us. We need to get more comfortable talking about sex. We need to get to the point where we can do it without mumbling or looking away or blurting out “both”.

The other part lies in improving healthcare. We need clinic spaces that feel safe and private. We need nurses and doctors who respect our dignity and our desire for sensitivity and discretion. We need to root out the biases and bigotry that often find their way into the consultation room.

How do we do that? I don’t know. It’s obviously complicated. I’m part of a project that will be working on it over the next three years, and I’d love to hear your thoughts (and stories!) in the comments. What makes it so hard to tell the truth at the clinic? And what would make it easier?

Shawn Malone works for PSI on a project to reach gay men and other men who have sex with men with HIV testing, prevention and treatment. He can be contacted at smalone@psi.org.

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