The Problem With Patient Histories

Patient information is a sensitive topic, and even more so, it would seem, when it involves sexual history. For a long time, doctors have struggled with patients who do not reveal elements of their history until they are face-to-face with a condition that makes their situation evident. One such example is HIV patients.

A new study published by Morbidity and Mortality Weekly Reports in September showed that 23% of men who tested positive for HIV at three North Carolina STD clinics initially hid the fact that they engaged in sexual intercourse with other men. As part of a prospective study assessing HIV diagnosis at 12 STD clinics in New York City, San Francisco, and North Carolina, 113 men being tested at the North Carolina sites were first asked about their sexual partners during pretest counseling and were then asked again during a partner services interview after their HIV-positive diagnosis. Most of these men were quite young, with a median age of 24 years.

This brings to light the fact that we need better ways to gain private information from patients in general. Personally, I feel some may be more comfortable answering a computerized questionnaire given in a medical facility, rather than having to verbalize it out loud. I have definitely had instances when we drew HIV tests on a patient who did not tell us they were HIV positive. We called the person back into the office to give them their results, only to have them tell us they knew they were indeed positive.

While I can’t pinpoint an exact reason as to why patients won’t be upfront with their sexual history, it seems evident that there is an uncomfortable stigma attached to HIV patients and it’s not uncommon for some to deny being homosexual to begin with. I may not have the answers to the best solution, but I hope that we do find a better way to work together and help each other - that’s what clinicians like myself are here for.

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