If talking to teens about sex is difficult for parents, imagine the awkwardness their physicians face when broaching the subject. Many doctors simply don’t ask about it, said Celia Fisher, Ph.D., professor of psychology and the Marie Ward Doty University Chair in Ethics. The subject gets touchier when it comes to asking young men about gay sex.
Fisher was the principle investigator on a recently completed quantitative study that resulted in a paper published in the journal AIDS and Behavior titled “Patient-Provider Communication Barriers and Facilitators to HIV and STI Preventive Services for Adolescent MSM.” In the study, Fisher found that young males who have sex with males were reticent to discuss sex with their doctors. But when doctors initiated the conversation, they were more forthcoming with vital information that could affect their health.
The nationwide study was conducted anonymously via a questionnaire linked to from a trusted website frequented by gay teens. It surveyed 198 adolescent gay males. Several participants said they completed the survey because they wanted to help their community.
“This is the first study to ask kids about their attitudes on getting sexual health care,” said Fisher, who directs Fordham’s Center for Ethics Education. “Pediatricians and general practitioners are the gateway of youth experiences with health care, but [these patients]only go once a year, so this is an ideal time to ask [about their sexual activity].”
Fisher said there are several studies that have found that most doctors are not trained to ask questions relevant to sexual minorities, and many doctors assume the youth they treat are straight. Furthermore, the language of sexuality has evolved for young people.
“The other issue is that doctors should not use terms like ‘gay,’ or ‘LGBT,’ because for many young people the terminology is in flux,” said Fisher. “Youth no longer identify with these traditional behaviors; the question should be ‘Who are you attracted to sexually?’”
But most importantly, Fisher said, the conversation needs to be initiated by the doctors, even though doctors often have the “misperception that the kid would be uncomfortable.”
“Physicians need to be well versed in safety advice and should be able to communicate to all,” she said. “The kids don’t bring it up because they think the doctor will be prejudiced.”
Another concern among the young men was that the doctors might tell their parents, but Fisher said most states allow doctors to provide information to teens on sexual health, including HIV prevention, without parental consent. Some states, like New York, even allow doctors to prescribe PrEP, the pill that protects against HIV, to minors without getting parents involved.
“The grey area is if the child is having sex with an adult that might be considered sexual abuse and that needs to be reported,” said Fisher.
But such cases only reinforce the need for doctors need to be proactive in their conversations with youth, she said. Even if the relationship is legal and consensual, some youth lack assertiveness skills to demand a condom from an older or aggressive peer partner, she said.
“They need advice specific to males having sex with males,” said Fisher. “Giving gay males advice on sex with females is useless, but when they’re aware of those specifics they’ll be safer and healthier.”