Health Concerns of the LGBT Community

Assembled by David G. Chu and Gina Clemens, University of Penn 2002
Provided to GLAAM by Dr. J. Rosenfeld

Why do lesbian, gay, bisexual and transgender people have unique health concerns?

A 1994 Gay & Lesbian Medical Association Membership Survey found that 50% of respondents witnessed substandard care based on patient's perceived sexual orientation. 64% of respondents believe revealing sexual orientation places patients at risk for substandard care. This and other factors unique to the lifestyles of LGBT patients can place LGBT patients at greater risk for certain health issues.

Most importantly, remember that nearly all of the following increased health risks of LGBT patients are a direct result of the societal marginalization and stigmatization of sexual minorities and are NOT due to their identification as being lesbian, gay, bisexual, or transgender.

_____________________________
LESBIAN HEALTH

Breast Cancer – more prevalent because:
- Fewer Pregnancies
- Higher prevalence of Obesity
- Increased Alcohol use
- Increased risk of advanced Breast Cancer due to Delayed Diagnosis

Cervical Cancer – increased because:
- Lesbians often avoid visits to the Gynecologist, due to past negative experiences.
- Interval between Pap Smears up to three times longer than for Heterosexuals.
- Pap Tests are typically performed with gynecological exams annually, usually for contraception renewal.
- Physicians ask female patients "how many men have you been with," but do not assess for women who
have sex with women (WSW).
- Lesbians and Physicians often wrongly assume lesbians are at lower or no risk.
- Many lesbian identified women have had sexual intercourse with a male at some point during life and
some continue to do so at irregular intervals.
- HPV (virus associated with Cervical Cancer) can be transmitted by sharing sex toys with an infected
partner if not properly cleaned between uses.

Ovarian and Endometrial Cancer – increased because:
- Decreased number of pregnancies
- Decreased use of oral contraceptives
- Often diagnosed at Advanced Stages due to less frequent visits to physician.

Sexually Transmitted Diseases (STD's)
- Lesbian sex can transmit most STD's – it is important to offer screening to lesbian and bisexual women on
the same basis as heterosexual women.
- Common vaginal infections can also be spread during woman-to-woman sexual contact – including yeast,
trichomonas, and non-specific bacterial vaginosis.

Reproductive Health
- Reproductive needs can be discussed outside implied heterosexual activity.
- Fertility Assistance – it is possible for both women to be biological parents if one woman donates eggs and
resulting embryos are implanted in her partner's uterus.
- Seeking a court's validation of both women as legal parents is advisable.

_____________________________
GAY MEN'S HEALTH

Anal Cancer – caused by HPV, but HIV+ men at higher risk because:
-Immunocompromised Patients have higher incidence of Anal Cancer.
- Decreased CD4+ count associated with increased progression to Anal Cancer.
- AIDS also increases risk of Non-Hodgkin's Lymphoma and Kaposi's Sarcoma.

HIV – while no longer the primary population effected by HIV, HIV/AIDS continues to have a profound
effect both physically and psychologically on this community.
- HIV transmission up to 3-5 times higher when other STDs are present.
- CDC identified Youth (ages 13-24) as the most likely group to contract an STD, with 30% of new HIV
infections reported as MSM.

Sexually Transmitted Diseases (STD's)
- Hepatitis A Virus (HAV) and Hepatitis B Virus (HBV) are Vaccine-Preventable diseases, but physicians
and patients often do not discuss due to embarrassment.
- Men who have sex with Men (MSM) are at higher risk of both HAV (oral -fecal) and HBV (sexual contact)
and the CDC recommends vaccination.
- LGBT Youth (especially MSM) are particularly vulnerable because the lack of supportive environments
and accurate health prevention information leads Youth to engage in anonymous sexual encounters and
other high risk behaviors.

Eating Disorders
- Eating disorders are not uncommon in the gay male culture, where in many parts of the community social
pressure to conform to physical ideals is pervasive.
- Harvard University study of 122 men (2001) found that 14% of gay men appeared to suffer from Bulimia,
while another 20% showed signs of Anorexia.

_____________________________
LGBT ADOLESCENTS

Suicide and Depression
- Suicide is a leading cause of death, especially of questioning/gay male adolescents - physicians are urged
to consider sexual orientation as a risk factor.
- Nearly one third of all adolescent male suicide attempts are linked to a crisis over sexual orientation.

LGBT Youth are denied many “Rites of Passage” unique to Adolescence
- “Rites of Passage” unique to adolescence include:
- Classroom romances, first date, first kiss, Senior Prom

- No role models or relationship models to identify with
- Lack of healthy outlets for sexual exploration/experimentation
- Failure to experience these activities stifles the normal Social Development of LGBT Youth.

Violence against Youth is frequent and has significant impact
- Average High School student hears 25.5 Anti-Gay Slurs each day.
1 in 3 LGBT Youth in a Chicago had an object thrown at them and 1 in 5 had been kicked, punched, or

beaten because of their Sexual Orientation.
- Seattle study found LGBT Youth were 6 times more likely to be targets of offensive comments or attacks

and 3 times more likely to be injured in a fight.
- Significant number of victims of Anti-Gay Violence are actually Straight.

_______________________________

TRANSGENDERED HEALTH

Male to Female (MTF) Transsexuals – do not have their prostate removed after sex reassignment surgery and still are at risk of Prostate Cancer.

Female to Male (FTM) Transsexuals – still at risk of Breast Cancer in spite of breast reduction surgery, as well as risk of Ovarian Cancer if ovaries are not removed.
- No studies have been done addressing STD risks of the Transgender Community.

____________________________

GENERAL HEALTH

Hate Crimes

- LGBT individuals are at higher risk for physical assault and violence
- LGBT persons are victims of more violent homicides than the general population
- Settings at particular risk: schools, colleges, armed services, and public places

Substance Abuse - Gay Men and Lesbians 2-3 times more likely to engage in Substance Abuse because:

- Vehicle to escape social stressors of being LGBT identified
- Most safe spaces in the Gay Community are centered around Bars and Clubs
- Peer pressure on LGBT adolescents to find community acceptance
- Physicians do not frequently discuss SA risks and screen for dependence

Domestic Violence

- Physicians often do not screen same sex couples for DV, despite similar rates

Access to Health Care
- Denial of Domestic Partner Benefits creates a barrier to access of Health Care.
- Both partners must ensure employment with health insurance coverage
- Prevents stay-at-home parenting by one partner
- Institutionalized bias in health insurance and public entitlements, which routinely fail to cover gay and

lesbian partners. (ie. Medicaid, Social Security)
- Difficulty experienced with validation of relationship by healthcare system.
- Lack of Partner visitation rights in ICUs and EDs.
- Lack of Partner medical decision-making rights. (Partner vs. Family)

____________________________

Points to Remember

- Homophobia is a Health Hazard.
- Quality of care is affected.
- Education and training regarding LGBT health needs is inadequate.
- Communication and disclosure of sexual orientation are significant issues.
- Never assume Sexual Behavior based on Sexual Orientation.
- Never assume Sexual Orientation based on Sexual Behavior.
- Physician discomfort around issues of sexuality is evidenced by the fact that studies indicate that only

11% to 37% of primary care physicians routinely take a sexual history from new adult patients.
- Stigma is compounded for the LGBT Community as studies indicate only 18% to 49% of LGBT patients

disclose their Sexual Orientation to their physician.
- Be aware of these issues so that you can provide the best care possible to your patients regardless of

Sexual Orientation!


REFERENCES

1. Bockting WO, Robinson BE, Rosser BRS. Transgender HIV prevention: a qualitative needs assessment. AIDS Care. 1998;10(4):505-526.

2. Bradford J, Ryan C. The National Lesbian Health Care Survey. National Lesbian and Gay Health Foundation, Washington, DC, 1988:76-85.

3. Centers for Disease Control. HIV/AIDS Among Racial/Ethnic Minority Men Who Have Sex with Men – United States, 1989-1998. MMWR. Jan 2000;49(1).

4. Centers for Disease Control. Cigarette smoking among adults – United States, 1997. Morbidity and Mortality Weekly Report 18(43):993-996, 1999.

5. Centers for Disease Control and Prevention. Kaposi’s Sarcoma and Pneumocystis pneumonia among homosexual men – New York City and California. MMWR. 1981;30:305-308.

6. Schatz B, O’Hanlan K. Anti-Gay Discrimination in Medicine: Results of a National Survey of Lesbian, Gay and Bisexual Physicians. American Association of Physicians for Human Rights/Gay Lesbian Medical Association, San Francisco, May 1994.

7. GLMA. Healthy People 2010 - Companion Document for LGBT Health. April 2001
http://www.glma.org/policy/hp2010/index.html