Posted: September 12, 2016

HIV Risk Behaviors in Adult Men


Undergraduate medical education fails to adequately address the health of individuals who are lesbian, gay, bisexual, transgender (LGBT), gender nonconforming (GNC), and/or born with differences of sex development (DSD). This lack of content is evident in preclinical years and even more so during clinical years. Inadequate preparation in caring for the aforementioned communities is believed to contribute to the negative experiences – from microaggressions to overt bias – experienced by individuals who are LGBT, gender nonconforming, and/or born with DSD when accessing and receiving health care. Addressing these gaps in medical education can be challenging for myriad reasons, including (1) determining what to teach, particularly when educators likely have received sparse instruction themselves and (2) limited teaching resources, particularly those that permit expansion of learning opportunities beyond didactic instruction.

Until recently, the determination of what to teach (i.e., deliverable curricular content aimed at supporting the acquisition of competence) was challenged by a lack of definition regarding the key components that define competence in caring for individuals who are LGBT, GNC, and/or born with DSD. In November 2014, the American Association of Medical Colleges (AAMC) Advisory Committee on Sexual Orientation, Gender Identity, and Sex Development (AXIS) published a landmark document titled Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD: A Resource for Medical Educators. This publication identified 30 specifiers of competence, based on the Physician Competency Reference Set, that are necessary for the provision of care to these populations and presented recommendations to guide curricular integration, institutional climate change, and learner and program assessment in medical education settings. Eight Case Scenarios were included in the publication to illustrate clinical experiences encountered frequently when caring for members of the aforementioned populations, highlight key questions when applying cases in competency-based curricula, and present experiential learning activities to support the acquisition of physician competence when caring for individuals who are LGBT, gender nonconforming, and/or born with DSD. The case in the current resource, Case Scenario 6: HIV Risk Behaviors in Adult Men, was written by Dr. Andrés F. Sciolla, an expert in LGBT, DSD, and GNC health care, and edited by Dr. Alice Dreger.

CONTENT EDITOR: Jonathan S. Appelbaum, MD, FACP Laurie L. Dozier Jr., MD, Education Director, Professor of Internal Medicine, Florida State University College of Medicine.

STRUCTURAL EDITOR: Michelle Forcier, MD, MPH Associate Professor, Clinical, Pediatrics Brown University Alpert School of Medicine.


Depression, PTSD, LGBT, HIV, Lesbian, Gay, Bisexual, Transgender, AXIS, Differences of Sex Development, Motivational Interviewing, Gender Nonconforming, Microaggressions, Curricular Content, Trauma History, ART


Anne Daul, MD, MPH, Emory University

Carl G. Streed Jr., MD, Harvard Brigham & Women’s Hospital

Robert C. Kelly, MD, NH Dartmouth Family Medicine Residency