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The importance of both sexual behavior and identity.
American Journal of Public Health 2006;96(5):765.
Pathela P, Blank S, Seil RL, Schillinger JA.
Abstract
BACKGROUND: Persons reporting sexual identity that is discordant with their
sexual behavior may engage in riskier sexual behaviors than those with concordant
identity and behavior. The former group could play an important role in the
spread of sexually transmitted diseases. OBJECTIVE: To describe discordance
between self-described sexual identity and behavior among men who have sex
with men and associations between identity-behavior and risk behaviors. DESIGN:
Cross-sectional, random digit-dialed telephone survey of health status and
risk behaviors. SETTING: New York City. PARTICIPANTS: Population-based sample
of 4193 men. MEASUREMENTS: Concurrent measures of sexual identity and sexual
behaviors, including number and sex of sex partners, condom use during last
sexual encounter, and recent testing for HIV infection. Sex partner information
was ascertained in a separate section from sexual identity; all participants
were asked about the number of male sex partners and then were asked about
the number of female sex partners in the past year. RESULTS: Of New York
City men reporting a sexual identity, 12% reported sex with other men. Men
who had sex with men exclusively but self-identified as heterosexual were
more likely than their gay-identified counterparts to belong to minority
racial or ethnic groups, be foreign-born, have lower education and income
levels, and be married. These men were more likely than gay-identified men
who have sex with men to report having only 1 sexual partner in the previous
year. However, they were less likely to have been tested for HIV infection
during that time (adjusted prevalence ratio, 0.6 [95% CI, 0.4 to 0.9]) and
less likely to have used condoms during their last sexual encounter (adjusted
prevalence ratio, 0.5 [CI, 0.3 to 1.0]). LIMITATIONS: The survey did not
sample groups that cannot be reached by using residential telephone services.
CONCLUSIONS: Many New York City men who have sex with men do not identify
as gay. Medical providers cannot rely on patients' self-reported identities
to appropriately assess risk for HIV infection and sexually transmitted diseases;
they must inquire about behavior. Public health prevention messages should
target risky sexual activities rather than a person's sexual identity.