Trust in officialdom as it relates to confidentiality: HIV/AIDS and men who have sex with men in Taiwan

Newly diagnosed cases of AIDS in Taiwan among men who have sex with men are increasing despite the island’s free access to HIV medications and treatment which slow and often prevent HIV from becoming AIDS. These increases are not matched by increases in newly diagnosed HIV cases. This suggests that MSM in Taiwan are not seeking testing and/or treatment until the disease has significantly progressed. The author theorizes that Taiwan’s MSM’s need for confidentiality and their lack of trust in health officials to maintain confidentiality is the source of this delay in taking action. A questionnaire given to 152 MSM living in Taiwan suggested that there was lack of trust, but that trust was largely centered around the system itself and the capability of higher level health officials they never come in contact with, rather than doctors, nurses and related social workers. The questionnaire suggested a positive correlation between trust and anonymous testing, as opposed to non-anonymous testing. The questionnaire also suggested older MSM are more likely to get tested regularly and younger MSM are more likely to get tested because of unsafe sex. The results of the questionnaire were supported by interviews. Eleven MSM who had undergone HIV tests were interviewed, including 3 HIV positive interviewees, 2 of whom having AIDS. The interviews affirmed a strong need for confidentiality and illustrated misconceptions, doubts, lack of knowledge and hearsay were inhibitors to trust in health officials. The need for confidentiality was especially strong in relation to family and work. The interviews also suggested that the environment they were tested and treated in raised concerns about ability to remain confidential