Gay and Lesbian Health
Gay and lesbian health
Lesbian, gay, bisexual, and transgender (LGBT) individuals are as diverse as the general population in terms of race, ethnicity, age, religion, education, income, and family history. A number of health concerns are unique to or shared by the LGBT community, however, including an increased risk of certain cancers, infectious and sexually transmitted diseases (STDs), and mental health disorders, issues relating to nutrition and weight, tobacco use, and substance abuse, and discrimination by health care and insurance providers.
The definitions of different sexual identities have shifted over the years, as have the perceptions and stereotypes of the general population. Because of the wide range of behaviors and identities that exist in the LGBT community, it is difficult to develop an inclusive definition. It is generally accepted, however, that gay men and lesbians are sexually attracted to or participate in sexual behaviors with individuals of the same gender, while bisexual men and women are sexually attracted to or participate in sexual behaviors with individuals of both genders. Transgender individuals live part- or full-time in a gender role opposite to their genetic sex.
Estimated suggest that approximately 2.8% of men and 1.4% of women identify as being gay, lesbian, or bisexual while 9.1% of men and 4.3% of women have participated in sexual behavior with someone of the same gender at least once. The true extent of the transgender community has not been well researched in the United States. Note that estimates or the LGBT community are based self-reported information and actual rates may be higher.
Certain issues arise when trying to define sexual orientation. Many gay men and lesbians have participated in or continue to participate in sexual activities with members of the opposite sex but choose not to identify as heterosexuals or bisexuals. Others have never participated in sexual activities at all yet still identify as gay, lesbian, or bisexual. Some men and women identifying as bisexuals are in long-term, monogamous relationships with individuals of the same or opposite sex. Male-to-female (MTF) or female-to-male (FTM) transgender individuals may or may not identify themselves as gay or lesbian.
The implications of these identity issues are far-reaching. Misdiagnoses or improper medical recommendations might be made by health care providers who have mistakenly assumed sexual behaviors or risks from the patient's stated identity. For example, a provider might incorrectly assume that a lesbian patient has never had sexual intercourse with a male and therefore would not have contracted STDs. It has been difficult to closely estimate the numbers of LGBT individuals in the United States because of varying definitions. Likewise, the statistics in medical or social studies and surveys on LGBT issues might vary widely depending on what definitions were provided for the respondents. Because of this, many researchers have opted for the more inclusive terms of "men who have sex with men" (MSM) and "women who have sex with women" (WSW) to categorize gay, lesbian, and bisexual respondents.
Important health care issues
Many LGBT individuals have difficulty revealing their sexual identity ("coming out") to their health care providers. They may fear discrimination from providers or believe that their confidentiality might be breached. In some cases health care workers have been poorly trained to address the needs of LGBT individuals, have difficulty communicating with their LGBT patient, or feel uncomfortable providing care for LGBT patients. In addition, many questions posed in questionnaires or examinations are heterosexually biased (e.g., asking a lesbian which birth control methods she uses).
Other reasons why LGBT individuals are often hesitant to share their sexual identity are more logistical. Many insurance companies deny benefits to long-term partners on the basis that they are not married. LGBT patients may have inadequate access to health care, either because they live in a remote rural area or in the crowded inner city. Some same-sex partners encounter discrimination in hospitals and clinics when they are denied the rights usually given to spouses of a patient such as visiting, making medical decisions, and participating in consultations with physicians.
Some of the health concerns and risk factors that are relevant to LGBT individuals may be shared by the general population, while others are more specific to the LGBT community, and still others are specific to different subgroups of LGBT individuals. These health concerns may be grouped into the following areas of concern:
- Sexual behavior issues: STDs such as human immunodeficiency virus (HIV) and acquired immune deficiency syndrome (AIDS), hepatitis A virus (HAV), hepatitis B virus (HBV), bacterial vaginosis, gonorrhea, chlamydia, and genital warts (human papillomavirus or HPV); anal, ovarian, and cervical cancer.
- Cultural issues: body image, nutrition, weight, and eating disorders; drug and alcohol abuse; tobacco use; parenting and family planning.
- Discrimination issues: inadequate medical care; harassment at work, school, or home; difficulty in obtaining housing, insurance coverage, or child custody; violence.
- Sexual identity issues: conflicts with family, friends, and work mates; psychological issues such as anxiety, depression, and suicide; economic hardship.
Cancer is the second leading cause of death (after heart disease) in the United States. In 2008, it was estimated that about 1.4 million individuals were diagnosed with cancer and about 565,600 lost their lives as a result. LGBT individuals are at an increased risk for certain types of cancers.
Several studies indicated that lesbians appear to have a higher risk for developing uterine, breast, cervical, endometrial, and ovarian cancers This is partially related to higher rates of risk factors such as obesity, alcohol use, tobacco use, and nulliparity (not bearing children). Lesbians are less likely than heterosexual women to visit a doctor for routine Pap screening that can detect cervical cancer. Lesbians also have additional risk of developing ovarian cancer, due to inadequate access to health care, nulliparity, and not using oral contraceptives (use of oral contraceptives has been shown to decrease the risk of getting ovarian cancer).
Gay and bisexual men (or more generally, men who have sex with men [MSM]) are at higher risk of developing non-Hodgkin's lymphoma, Hodgkin's disease, and anal cancer. Kaposi's sarcoma, an AIDS-associated cancer, are also found in the gay community at rates higher than the general population. Anal cancer is associated with transmission of human papillomavirus (HPV), and the risk factors associated with MSM are also associated with increased rates of anal cancer (i.e. smoking, having many sexual partners, and receiving anal intercourse).
The United States Centers for Disease Control and Prevention (CDC) estimated that in 2006, 944,000 people in the United States had been diagnosed with AIDS since the disease was identified in 1981. In 2006, an additional 1-1.2 million Americans were diagnosed as infected with HIV but not yet showing symptoms (HIV positive). However, in early 2009, the CDC issued a statement that they now thought that earlier the HIV-positive estimates were too low, as many more people than were originally estimated are living with unreported or undiagnosed HIV infection. More than 70% of HIV infections are transmitted through sexual contact. Traditionally in the United States, the majority of cases were found in homosexual or bisexual men. In 2007, about half of new HIV cases were acquired by men having sex with other men.
In 1973, the American Psychiatric Association removed homosexuality from their list of mental disorders, Nevertheless, American society has been slow to fully accept of members of the LGBT community. As a result, members of this community often find themselves rejected by their families, socially stigmatized for their sexual orientation, treated unequally by laws and the justice system, and subject to physical and emotional abuse for their lifestyles. These pressures, plus the continuing stress caused by the need some LGBT individuals feel to conceal their sexual orientation from family, LGBT employers, and larger society lead to an increased occurrence of depressive illness, anxiety disorders, and drug and alcohol abuse.
Nutrition and body image
Diet and nutritional factors are associated with a number of diseases including cancer, stroke, diabetes, heart disease, and osteoporosis. It has been shown that lesbians are more likely than heterosexual women to be obese, have a higher body mass index (BMI), have a nutritionally poorer diet, and have higher rates of smoking and alcohol use, but they are also more likely to have a healthier body image than heterosexual women. Gay men and adolescents, on the other hand, have been shown to have increased rates of eating disorder behaviors than heterosexual men (e.g. anorexia nervosa, bulimia, and binge eating) and a poorer body image.
Drug, alcohol, and tobacco use
Marijuana and cocaine use has been shown to be higher among lesbians than heterosexual women. The incidence of the use of some drugs is higher in gay men than heterosexual men; these include marijuana, psychedelic drugs, ecstasy, barbiturates, and stimulants such as amyl or butyl nitrate ("poppers"). Although alcohol use has declined in the LGBT community since the 1990s, the rate is still higher among young LGBT individuals.
Cigarette smoking is responsible for 430,000 deaths a year in the United States, with an estimated 3,000 nonsmokers dying as a result of exposure to secondhand smoke. In 2004 the rate of smoking among all adults was 28%. In contrast, 50% of gay men, lesbians and bisexuals were noted to be smokers. Lesbians are more than two times as likely to become heavy smokers than heterosexual women.
There are numerous ways that health care providers can improve the access to and experience of health care services for LGBT individuals. These include:
- rewording questionnaires and examinations to be inclusive of LGBT patients
- providing referrals to social service agencies and counseling services that are LGBT-friendly
- taking educational courses that are sensitive to the needs of LGBT patients
- treating the families of LGBT patients as one would the families of heterosexual patients
- maintaining the strictest code of confidentiality
- developing and maintaining health care centers or clinics that address LGBT-specific needs
- asking non-threatening questions to determine if a person is at risk of an STD
- educating patients of risk factors associated with STDs, possible vaccines, and treatments available
- providing services to individuals in the process of disclosing their sexual identity and, if applicable, their families
- The condition of being nulliparous, or not bearing offspring.
For Your Information
- Spinelli, Frank. he Advocate Guide to Gay Men&s Health and Wellness. New York: Alyson Books, 2008.
- Makadon, Harvey J., et al. eds. The Fenway Guide to Lesbian, Gay, Bisexual, and Transgender Health. Philadelphia: American College of Physicians, 2008.
- "Gay, Lesbian and Bisexual Issues." American Psychiatric Association. [cited February 25, 2009]. http://healthyminds.org/glbissues.cfm.
- "Gay, Lesbian and Transgender Health." MedlinePlus. January 12, 2009 [cited February 25, 2009]. http://www.nlm.nih.gov/medlineplus/gaylesbianandtransgenderhealth.html.
- "Lesbian Health." WomensHealth.gov. January 1, 2005 [cited February 25, 2009]. http://womenshealth.gov/faq/lesbian-health.cfm.
- Gay and Lesbian Medical Association. 459 Fulton Street, Suite 107, San Francisco, CA 94102. Telephone: (415) 225-4547. Fax: 9(415) 225-4784. Email: firstname.lastname@example.org http://www.glma.org.
- 1726 M Street NW, Suite 400, Washington, DC 20036. Telephone: (202) 467-8180. Fax: (202) (202) 467-8194. Email: email@example.com http://community.pflag.org.