Discordance between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City Men

19 September 2006 | Volume 145 Issue 6 | Pages 416-425

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.

Editors' Notes Context Self-identification of sexual orientation may not accurately reflect actual sexual practices. Contribution These investigators performed a population-based health survey of men living in New York City and found that almost 10% who self-identified as straight had at least 1 sexual encounter with another man during the previous year. These men were less likely than self-identified gay men to have been tested for HIV infection or to have used a condom during their most recent sexual encounter. Implications Physicians cannot rely on self-identification of sexual orientation to assess the likelihood of risky behavior. They must ask specific questions about sexual practices. —The Editors

 

Author and Article Information

From New York City Department of Health and Mental Hygiene and Mailman School of Public Health, Columbia University, New York, New York; University of North Carolina School of Public Health, Chapel Hill, North Carolina; and Centers for Disease Control and Prevention, Division of Sexually Transmitted Disease Prevention, Atlanta, Georgia.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the Centers for Disease Control and Prevention.

Acknowledgments: The authors thank Bonnie Kerker, PhD, Director, Community Epidemiology, Division of Epidemiology, New York City Department of Health and Mental Hygiene, for providing the background and detailed review of survey procedures, and Lorna Thorpe, PhD, Deputy Director, Division of Epidemiology, New York City Department of Health and Mental Hygiene, and Stuart Berman, MD, Chief, Epidemiology and Surveillance Branch, Division of STD Prevention, Centers for Disease Control and Prevention, for their insightful reviews of the manuscript.

Grant Support: None.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Preeti Pathela, DrPH, New York City Department of Health and Mental Hygiene, 125 Worth Street, Room 207, CN73, New York, NY 10013.

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