Can Doctors Use Self-Reported Sexual Identity as a Reliable Indicator of Sexual Behavior?

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The summary below is from the full report titled "Discordance between Sexual Behavior and Self-Reported Sexual Identity: A Population-Based Survey of New York City Men." It is in the 19 September 2006 issue of Annals of Internal Medicine (volume 145, pages 416-425). The authors are P. Pathela, A. Hajat, J. Schillinger, S. Blank, R. Sell, and F. Mostashari.

What is the problem and what is known about it so far?

About 45% of all cases of HIV infection in the United States occur in men who have sex with men. Although men who identify themselves as being gay may be likely to use condoms and to undergo HIV testing, not all men who have sex with men identify themselves as being gay and may not take the same precautions. In fact, researchers have shown that it is not uncommon for men who have sex with men to identify themselves as being straight. Small studies of these men have suggested that they are less likely to use condoms during anal sex with other men and that they are less likely than self-identified gay men to have been recently tested for AIDS. The problem is that researchers have performed most of these studies on small groups of men who congregate at locations where they go for purposes of having sex. These groups may not be representative of all men who identify themselves as straight but actually have sex with other men.

Why did the researchers do this particular study?

To find out how common it is among men in the general population to identify themselves as being straight but have behavior that includes having sex with other men.

Who was studied?

4193 men living in New York City.

How was the study done?

The researchers conducted telephone interviews with a representative sample of male residents of New York City. Among 130 survey items, participants were asked several questions about whether they considered themselves straight or bisexual. A section of the interview separated from the questions on self-identification of sexual orientation contained other questions about the participants' actual sexual practices and whether they had sex only with women, only with men, or with both men and women. In addition, participants were asked questions about whether they had undergone HIV testing, their use of condoms, and whether they had a history of sexually transmitted disease.

What did the researchers find?

Of all the male participants who self-identified as straight, 9.4% reported having sex with at least 1 man during the previous year. The self-identified straight men who had sex with men only (as opposed to those who self-identified as gay) were more likely to belong to a minority racial or ethnic group, be foreign-born, have a lower educational level, and live outside Manhattan. Seventy percent reported being married. They were also less likely to have been tested for HIV infection and less likely to have used a condom during their last sexual encounter.

What are the limitations of the study?

Researchers have not specifically tested whether participants answer sexual identity questions honestly.

What are the implications of the study?

Doctors need to ask patients about specific sexual practices instead of relying on self-reported sexual orientation to assess risk for unsafe sexual practices and risk for sexually transmitted diseases.