Gay men and other men who have sex with men
Abebe - an international student from Ethiopia, 24-year-old who identifies as male (he/him/they) and has been sexually active for the last five years. Abebe’s appointment is by telehealth. About three months ago, he started exploring his sexuality and has had sex with a few male partners (if asked for more detail – 4/5 partners, both insertive and receptive anal and oral sex, infrequent condom use). Abebe is feeling confused and uncertain about his sexuality and would never have felt comfortable exploring it further while living with his parents in Ethiopia. He is worried about anyone in his family finding out, particularly his father. Abebe has no significant medical history but has been feeling a little anxious lately. Abebe has never smoked cigarettes but has been experimenting with some recreational drugs since coming to Australia. He drinks alcohol with friends on weekends (4-5 drinks per occasion) and has tried some MDMA. These occasions are also when he started to experiment having sex with men. Harm reduction education is provided regarding drug use and linked into community organisation for ongoing support.
Clinical indicator
- Young person (< 30 years old).
- Culturally and linguistically diverse people
- MSM
- People who use drugs
Key learnings and take away
- English as a second language - Despite Abebe appearing he could understand and speak English quite confidently from the start of the consult the clinician still confirmed the need for an interpreter.
- Role of assumptions – This consult is a very comprehensive and detailed consult in terms of addressing any of Abebe’s assumptions about HIV, STIs and risks associated with condomless sex. This also assisted in the clinician in ascertaining all information required to perform a comprehensive sexual history.
Simon - 42-year-old who identifies as male (he/him) who presents to your service for the first time for an asymptomatic screen. He heard about PrEP and was unsure whether to consider taking it. Simon has a regular male partner of 4 months (Tom he/him - HIV status unknown). He mostly uses condoms for anal sex and is versatile. No drug use, minimal alcohol use. He last had neg STI and BBV screening 6 months ago. He is worried that Tom has other partners.
Clinical indicator
- MSM
- HIV risk from partner
- Multiple sexual partners (partner)
Key learnings and take away
- Role of assumptions – Assuming Simon knew exactly what and how PrEP worked would not have identified the fact he thought it protected him against STIs in general.
- Role of assumptions – Assuming because Simon asked about PrEP, he must have known of PEP would have missed the opportunity to educate him about PEP which he had no knowledge of.
- Role of assumptions – Simon mentioned his last STI screen only involved a urine tests and bloods. This demonstrates either assumptions were made about Simons sexual partners and practices or lack of knowledge what STI tests constitute a comprehensive sexual health check-up for a male having sexual contact with other men.
Angus - 28-year-old who identifies as male (he/him) who has recently tested positive to gonorrhoea and is returning to your clinic to receive his diagnosis and treatment. Angus identifies as heterosexual and is married with two children. Angus and his partner Olivia (32-year-old who identifies as female). Upon being told about his diagnosis Angus says on occasion has sex with male partners and notes Olivia is not aware of this. You discuss contact tracing options with Angus.
Clinical indicator
- Young person (< 30 years old).
- STI diagnosis
- MSM
Key learnings and take away
- Normalising – Normalising the reasons for asking the types and depth of questions to determine what tests need to be performed.
- Role of assumptions – Without the right questioning in this scenario and an assumption being made about Angus being married it may have resulted in him not having the additional tests or not having a full understanding of his risk profile.
- Role of assumptions – If assumed Angus was only having sex with his wife and no further history taking occurred this would have also missed an opportunity to discuss PEP and PrEP with him.
- Patient linkage to community support services – Angus would be a patient you might think about linking with community support services for men who have sex with men that may not identify as homosexual an example of such a service is GAMMA (Gay and Married Men’s Association NSW).
Scenario_9_v2.mp4 from ASHM on Vimeo.
Junior - 37-year-old who identifies as male (he/him) who three years ago immigrated from Africa to the Northern Territory. He attends the sexual health centre for a routine STI screen. Junior regularly attends the clinic given he is a sex worker. Junior has sex with both male and female (including people with a penis and vagina) partners for work and uses condoms most of the time. Recently a rash has appeared on Junior’s penis. Junior has been searching the internet regarding his symptoms and signs. You address the misinformation from online platforms.
Clinical indicator
- Culturally and linguistically diverse people
- Syphilis Outbreak region
- Sex worker
- MSM
Key learnings and take away
- Normalising – Normalising the reasons for asking the types and depth of questions to determine what tests need to be performed. Although Francisco is a regular patient and had previous sexual health check-ups this is still important.
- Normalising – The role of the internet when searching for answers related to health but also the way in which the internet may reinforce anxiety related to health concerns.
- Role of assumptions – Without the right questioning and making assumptions that Junior might not have sexual contact outside work a full understanding regarding his risk profile might not be obtained.