This study investigates the use of patient portals for disclosing sexually transmitted infection (STI) test result histories to sexual partners among men who have sex with men (MSM) in the United States.
Methods
Using data from the 2022-2023 American Men’s Internet Survey, this cross-sectional analysis examined demographic, behavioral, and healthcare-related factors associated with MSM’s utilization of patient portals for sharing STI test results. Participants (N = 2601) were surveyed on portal use, STI testing frequency, and partner disclosure practices.
Results
18% of survey participants used portals to disclose a STI test result to parrtners, with higher prevalences among individuals aged 16–37 years old versus 56 years and older, black non-Hispanic (26.4%) versus white non-Hispanic (16.8%), and those reporting nine or more times being tested for STIs (30.1%) versus 1 to 3 times (7.5%). Participants reporting sex work (33.3% vs 17.7%) and HIV pre-exposure prophylaxis (PrEP) use (24.2% vs 13.0%) also had a higher prevalence of portal use for disclosure. Multivariable Poisson regression analysis with robust error variance showed that sexual behavioral stigma from family and friends [adjusted prevalence ratio (aPR) = 1.11; p = .04] also, being tested for STIs four to 8 (aPR = 2.21; p < .001) and nine or more times aPR = 3.42; p < .001) were significantly associated with prevalence of portal-based disclosure.
Conclusion
Findings suggest patient portals may be viable tools for STI prevention in MSM communities, especially among individuals with increased vulnerability to STI acquisition. Addressing disparities in portal access and explaining patient portal capabilities may enhance the role of digital health in reducing STI transmission among MSM communities.
CariniEVillaniLPezzulloAM, et al.The impact of digital patient portals on health outcomes, system efficiency, and patient Attitudes: updated systematic literature Review. J Med Internet Res2021; 23(9): e26189. DOI: 10.2196/26189.
LeeCNSullivanJForakerR, et al.Integrating a patient decision aid into the electronic health record: a case report on the implementation of BREASTChoice at 2 sites. MDM Policy Pract2022; 7(2): 23814683221131317. DOI: 10.1177/23814683221131317.
ClossonKSROlarewajuGCrosbyR. Associations between economic dependence, sexual behaviours, and sexually transmitted infections among young, Black, gay, bisexual and other men who have sex with men living with and without HIV in Jackson, Mississippi, USA. Sex Health2018; 15(5): 473–476. DOI: 10.1071/SH17218.
8.
Hightow-WeidmanLBPhillipsG2ndOutlawAY, et al.Patterns of HIV disclosure and condom use among HIV-infected young racial/ethnic minority men who have sex with men. AIDS Behav2013; 17(1): 360–368. DOI: 10.1007/s10461-012-0331-x.
9.
DaskalopoulouMRodgerAJPhillipsAN, et al.Attitudes to disclosure of HIV-serostatus to new sexual partners and sexual behaviours among HIV-diagnosed gay, bisexual and other men who have sex with men in the UK. AIDS Care2020; 32(10): 1323–1332. DOI: 10.1080/09540121.2020.1728218.
10.
JackmanKPLatkinCAMaksutJL, et al.Patient portals as highly acceptable tools to support HIV preventative behaviors among adolescent and young sexual minority men. J Adolesc Health2020. DOI: 10.1016/j.jadohealth.2020.03.029.
11.
JackmanK-MBaralSDHightow-WeidmanL, et al.Uncovering a role for electronic personal health records in reducing disparities in sexually transmitted infection rates among students at a predominantly african American university: mixed-methods study. JMIR Medical Informatics2018; 6: e41. DOI: 10.2196/medinform.9174.
12.
JackmanKPDangerfieldDTYangC, et al.Behavioral intentions to use patient portals to disclose HIV and other sexually transmitted infection testing histories with sexual partners among U.S. Sexual minority men. AIDS Behav20202020; 25(4): 1199–1209. DOI: 10.1007/s10461-020-03092-w.
13.
SanchezTHSineathRCKahleEM, et al.The annual American men's internet survey (AMIS) of behaviors of men who have sex with men in the United States: protocol and key indicators report 2013. JMIR Public Health Surveill2015; 1(1): e3. DOI: 10.2196/publichealth.4314.
Health Information National Trends Survey. Trends and disparities in patient portal use. Maryland: HINTS Briefs, 2021, vol 45.
17.
TurerRWMcDonaldSALehmannCU, et al.Real-time electronic patient portal use among emergency department patients. JAMA Netw Open2024; 7(5): e249831. DOI: 10.1001/jamanetworkopen.2024.9831.
18.
ZhangHSanchezTZlotorzynskaM, et al.Experiences of stigma and HIV status associated with awareness and usage of safer sex functions in dating apps among MSM, 2019 American men's internet survey (AMIS) study. AIDS Behav2023; 27(11): 3603–3611. DOI: 10.1007/s10461-023-04074-4.
19.
SunHTFanXRGuYZ, et al.WeChat-based HIV e-report, a new approach for HIV serostatus requests and disclosures among men who have sex with men: prospective subgroup analysis of a randomized controlled trial. JMIR Mhealth Uhealth2023; 11: e44513. DOI: 10.2196/44513.
20.
WayalSReidDWeatherburnP, et al.Association between knowledge, risk behaviours, and testing for sexually transmitted infections among men who have sex with men: findings from a large online survey in the United Kingdom. HIV Med2019; 20(8): 523–533. DOI: 10.1111/hiv.12753.
21.
FitzpatrickCLoweMRichardsonD. Sexually transmitted infection testing and rates in men who have sex with men (MSM) using HIV pre-exposure prophylaxis. HIV Med2019; 20(6): e12. DOI: 10.1111/hiv.12736.
22.
LiRWangHPanX, et al.Prevalence of condomless anal intercourse and recent HIV testing and their associated factors among men who have sex with men in Hangzhou, China: a respondent-driven sampling survey. PLoS One2017; 12(3): e0167730. DOI: 10.1371/journal.pone.0167730.
23.
HartTANoorSWBerlinGW, et al.Pre-exposure prophylaxis and bacterial sexually transmitted infections (STIs) among gay and bisexual men. Sex Transm Infect2023; 99(3): 167–172. DOI: 10.1136/sextrans-2021-055381.
24.
TraegerMWCornelisseVJAsselinJ, et al.Association of HIV preexposure prophylaxis with incidence of sexually transmitted infections among individuals at high risk of HIV infection. JAMA2019; 321(14): 1380–1390. DOI: 10.1001/jama.2019.2947.
25.
TaoGPearsonWSSullivanJM, et al.Sexually transmitted infection testing and prevalence before and after preexposure prophylaxis initiation among men aged ≥18 Years in US private settings. Sex Transm Dis2021; 48(7): 515–520. DOI: 10.1097/olq.0000000000001339.
26.
GafosMHorneRNutlandW, et al.The context of sexual risk behaviour among men who have sex with men seeking PrEP, and the impact of PrEP on sexual behaviour. AIDS Behav2019; 23(7): 1708–1720. DOI: 10.1007/s10461-018-2300-5.
27.
BeymerMRDeVostMAWeissRE, et al.Does HIV pre-exposure prophylaxis use lead to a higher incidence of sexually transmitted infections? A case-crossover study of men who have sex with men in Los Angeles, California. Sex Transm Infect2018; 94(6): 457–462. DOI: 10.1136/sextrans-2017-053377.
JackmanKPTilchinCWagnerJ, et al.Desires for individual- and interpersonal-level patient portal use for HIV prevention among urban sexual minority men: cross-sectional study. JMIR Form Res2023; 7: e43550. DOI: 10.2196/43550.
30.
JackmanKPMurraySHightow-WeidmanL, et al.Digital technology to address HIV and other sexually transmitted infection disparities: intentions to disclose online personal health records to sex partners among students at a historically Black college. PLoS One2020; 15(8): e0237648. DOI: 10.1371/journal.pone.0237648.
31.
SoetensLCvan BenthemBHOp de CoulEL. Chlamydia test results were associated with sexual risk behavior change among participants of the Chlamydia screening implementation in The Netherlands. Sex Transm Dis2015; 42(3): 109–114. DOI: 10.1097/olq.0000000000000234.
32.
van WeesDADrissenMden DaasC, et al.The impact of STI test results and face-to-face consultations on subsequent behavior and psychological characteristics. Prev Med2020; 139: 106200. DOI: 10.1016/j.ypmed.2020.106200.
33.
RahmanMMJohnsonCWhyteM, et al.Electronic messaging for gonorrhea and Chlamydia test result notification, improving treatment and patient satisfaction. Sex Transm Dis2022; 49(4): 257–261. DOI: 10.1097/olq.0000000000001584.
34.
AlveyBStoneJSalyukT, et al.Associations between sexual behavior stigma and HIV risk behaviors, testing, treatment, and infection among men who have sex with men in Ukraine. AIDS Behav2024; 28(3): 786–798. DOI: 10.1007/s10461-023-04182-1.
35.
PetersCMMDukers-MuijrersNEversYJ, et al.Barriers and facilitators to utilisation of public sexual healthcare services for male sex workers who have sex with men (MSW-MSM) in The Netherlands: a qualitative study. BMC Publ Health2022; 22(1): 1398. DOI: 10.1186/s12889-022-13799-1.
36.
NealTMLichtensteinBBrodskySL. Clinical implications of stigma in HIV/AIDS and other sexually transmitted infections. Int J STD AIDS2010; 21(3): 158–160. DOI: 10.1258/ijsa.2008.008445.
37.
DesaiPJZottCGauthreauxN, et al., and the CDSiC Trustand Patient-Centeredness Workgroup: An Introductory Handbook for Patient Engagement Throughout the Patient-Centered Clinical Decision Support Lifecycle, Prepared under Contract No. 75Q80120D00018. AHRQ Publication No. 23-0085.Rockville, MD: Agency for Healthcare Research and Quality; September 2023.
38.
DullabhPDunganRRajM, et al.And the trust and patient-centeredness workgroup. Methods for involving end-users in PC CDS Co-design, Prepared underContract No. 75Q80120D00018. AHRQ Publication No. 23-0079. Rockville, MD: Agency for Healthcare Research and Quality; August 2023.
39.
BatterhamPRiceERotheram BorusMJ. Predictors of serostatus disclosure to partners among young people living with HIV in the pre- and post-HAART eras. AIDS Behav2005; 9(3): 281–287. DOI: 10.1007/s10461-005-9002-5.
