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LGBT medical issues are those that relate to lesbian, gay, bisexual and transgender people's health issues and access to health services. According to the United States based Gay and Lesbian Medical Association (GLMA), besides HIV/AIDS, issues related to LGBT health include breast and cervical cancer, hepatitis, mental health, substance abuse, tobacco use, depression, access to care for transgender persons, issues surrounding marriage and family recognition, conversion therapy, and refusal clause legislation, and laws that are intended to "immunize health care professionals from liability for discriminating against persons of whom they disapprove."[1]

Studies show that LGBT people experience health issues and barriers related to their sexual orientation and/or gender identity or expression. Many avoid or delay care or receive inappropriate or inferior care because of perceived or real homophobia or transphobia, and discrimination by health care providers and institutions.[2], in other words reason is negative personal experience, the assumption or expectation of negative experience based on knowing of history of such experience in other LGBT people, or both.[3]

Issues affecting LGBT people generally

Research from the UK indicates that there appears to be limited evidence available from which to draw general conclusions about lesbian, gay, bisexual and transgender health because epidemiological studies have not incorporated sexuality as a factor in data collection.[4] Review of research that has been undertaken suggests that there are no differences in terms of major health problems between LGBT people and the general population, although LGBT people generally appear to enjoy poorer health, with no information on common and major diseases, cancers or long-term health.[4] mental health appears worse amongst LGBT people than the general population, with depression, anxiety and suicide ideation being 2-3 times higher than the general population.[4][5] There appear to be higher rates of eating disorder and self harm, but similar levels of obesity and domestic violence to the general population; lack of exercise and smoking appear more significant and drug use higher, while alcohol consumption is similar to the general population.[4] Polycystic ovaries and infertility were identified as being more common amongst lesbians than heterosexual women.[4] The research indicates noticeable barriers between LGB patients and health professionals, and the reasons suggested are homophobia, assumptions of heterosexuality, lack of knowledge, misunderstanding and over-caution; institutional barriers were identified as well, due to assumed heterosexuality, inappropriate referrals, lack of patient confidentiality, discontinuity of care, absence of LGBT-specific healthcare, lack of relevant psycho-sexual training.[4][5]

Research points to issues encountered from an early age, such as LGBT people being targeted for bullying, assault, and discrimination, as contributing significantly to depression, suicide and other mental health issues in adulthood.[6][7][8] Social research suggests that LGBT experience discriminatory practices in accessing healthcare.[9][10][11]

Sexism or homophobia

Phobia and discrimination towards LGBT patients can manifest in three ways.

  1. homophobic attitudes
  2. heterosexist judgements and behaviour
  3. general sexism - with focusing primarily male health concerns and services; assigning subordinate to that of men health roles for women, as for service providers and service recipients.[12][13]
Heterosexism can be purposeful (decreased funding or support of research projects that focus on sexual orientation) or unconscious (demographic questions on intake forms that ask the respondent to rate herself or himself as married, divorced, or single). These forms of discrimination limit medical research and negatively impact the health care of LGB individuals. This disparity is particularly extreme for lesbian women (compared to homosexual men) because they have a double minority status, and experience oppression for being both female and homosexual.

– S. Trettin, E. L. Moses-Kolko, and K. L. Wisner, Lesbian perinatal depression and the heterosexism that affects knowledge about this minority population

Assisted living issues

As the populations in western countries ages, more LGBT people will be in the assisted living or nursing home environment. Issues can range from transphobia and/or homophobia from care providers, to policies concerning the gender identity or sexuality of the client (such as being denied time with a partner, or being referred to by incorrect pronouns).[14]

Issues affecting transgender people

Access to health care

Transgender individuals are often reluctant to seek medical care or are denied access by providers due to transphobia/homophobia or a lack of knowledge or experience with transgender health.[15] Additionally, in some jurisdictions health care related to transgender issues is not covered by medical insurance making it financially impossible for some to transition.[16]

After reassignment surgery, while most trans people are able to obtain healthcare for complications, there is still an overall lack of training on dealing with the needs of post-op trans patients[17].

Cancer

Cancers related to hormone use include breast cancer and liver cancer. In addition, transmen who have not had removal of the uterus, ovaries, or breasts remain at risk to develop cancer of these organs, while trans women remain at risk for prostate cancer.[16]

Depression and anxiety

According to Rebecca A. Allison, trans people are "particularly prone" to depression and anxiety: "In addition to loss of family and friends, they face job stress and the risk of unemployment. Trans people who have not transitioned and remain in their birth gender are very prone to depression and anxiety. Suicide is a risk, with up to 41 percent of trans people having reported attempting suicide (compared to 1.6 percent of the general population)[15]. One of the most important aspects of the transgender therapy relationship is management of depression and/or anxiety."[16]

Hormones

Transgender individuals frequently take hormones to achieve feminizing or masculinizing effects. Side effects of hormone use include increased risk of blood clotting, high or low blood pressure, elevated blood sugar, water retention, dehydration, electrolyte disturbances, liver damage, increased risk for heart attack and stroke.[16]

In addition, due to lack of either affordable or accessible healthcare needed for monitored hormone therapy, many trans people seek gray or black market sources of HRT medications, resulting in increased risk of adverse health effects.

Injectable silicone

Some trans people use injectable silicone in a process known as "pumping", to achieve their desired physique. Such silicone may migrate, causing disfigurement years later. Non-medical grade silicone may contain contaminants, and may be injected using a shared needle.[16]

Sexually transmitted infections

Trans people are frequently forced into sex work to make a living, and are subsequently at increased risk for STIs including HIV at a rate of four times the national average[15].

Substance abuse

Like gay and bisexual men and women, trans people are more likely than the general population to use substances. For example, studies have shown that transmen are 50% more likely, and trans women 200% more likely to smoke cigarettes than other populations.[2]

Issues affecting intersex people

Main article: Intersex

Including intersex under LGBT can be controversial, with some intersex people identifying with LGBT and some not; some argue "I" (for intersex) should be included as "LGBTI". Intersex people may identify as heterosexual, lesbian, gay, bisexual, trans or no such labels, and so experience some of the issues related to these groups; however, intersex people can also have a variety of health issues from birth onwards that are unique to intersex people. There are a range of ways people can be intersex, so between different types of intersex people there can be different health issues that relate to their situation. For more information, see the article on intersex.

Issues affecting lesbians

Breast cancer

According to Katherine A. O’Hanlan, lesbians "have the richest concentration of risk factors for breast cancer [of any] subset of women in the world." Additionally, many lesbians do not get routine mammograms, do breast self-exams, or have clinical breast exams.[18]

Depression and anxiety

As with gay men, depression and anxiety are thought to affect lesbians at a higher rate than in the general population, for similar reasons.[18]

Domestic violence

Domestic violence is reported to occur in about 11 percent of lesbian homes. While this rate is about half the rate of 20 percent reported by heterosexual women, lesbians often have fewer resources available for shelter and counseling.[18]

Physical fitness

Research shows that on average lesbians have a higher body mass index than heterosexual women.[18]

Substance abuse

As with gay men, lesbians often have high rates of substance use, including recreational drugs, alcohol and tobacco. Studies have shown that lesbian and bisexual women are 200% more likely to smoke tobacco than other women.[2]

Issues affecting gay men

Anal papilloma

Human papilloma virus, which causes anal and genital warts, plays a role in the increased rates of anal cancers in gay men, and some health professionals now recommend routine screening with anal pap smears to detect early cancers.[19]

Depression and anxiety

Studies by Cochran et al. (2003) and Mills et al. (2004), among others, suggest that depression and anxiety appear to affect gay men at a higher rate than in the general population.[19][20]

According to GLMA, "the problem may be more severe for those men who remain in the closet or who do not have adequate social supports. Adolescents and young adults may be at particularly high risk of suicide because of these concerns. Culturally sensitive mental health services targeted specifically at gay men may be more effective in the prevention, early detection, and treatment of these conditions."[19] Researchers at the University of California at San Francisco found that major risk factors for depression in gay and bisexual men included a recent experience of anti-gay violence or threats, not identifying as gay, or feeling alienated from the gay community.[20]

Diet and fitness

Gay men are more likely than straight men to suffer from eating disorders such as bulimia or anorexia nervosa, while obesity affects other gay men.[19]

Hepatitis

Men who have sex with men are at an increased risk of sexually transmitted infection with hepatitis, and immunization for Hepatitis A and Hepatitis B is recommended for all men who have sex with men. Safer sex is currently the only means of prevention for the Hepatitis C.[19]

Sexually transmitted infections

The first name proposed for what is now known as AIDS was Gay-related immune deficiency, or GRID.[21] This name was proposed in 1982, after public health scientists noticed clusters of Kaposi's sarcoma and Pneumocystis pneumonia among gay males in California and New York City.[22]

Men who have sex with men are more likely to acquire HIV in the modern West, Japan,[23] India,[24] and Taiwan,[25] as well as other developed countries than among the general population[26], in the United States, 60 times more likely than the general population.[27] An estimated 62% of adult and adolescent American males living with HIV/AIDS got it through sexual contact with other men.[28]

The US Center for Disease Control recommends annual screening for syphilis, gonorrhea, HIV and chlamydia for men who have sex with men.[2]

Substance abuse

Studies have shown that gay men often have higher rates of substance abuse, including recreational drugs, alcohol and tobacco when compared to the general population. Dr. David McDowell of Columbia University, who has studied substance abuse in gay men, wrote that club drugs are particularly popular at gay bars and circuit parties.[29] Studies have shown that gay and bisexual men are 50% more likely to smoke tobacco than other men.[2]

Issues affecting bisexual people

Research specifically addressing the health issues of bisexual people tends to be lacking, in part because a focus on bisexuality as a separate identity-group is relatively recent and less cohesive than has been seen with lesbian, gay and transgender activisms. Bisexual health issues tend to be assumed as being covered by the health issues gay men and/or lesbians deal with, rather than as a unique set of health issues in their own right.


References

  1. ↑ "About GLMA". Gay and Lesbian Medical Association. Retrieved on 2008-12-28.
  2. ↑ 2.0 2.1 2.2 2.3 2.4 "GUIDELINES FOR CARE OF LESBIAN, GAY, BISEXUAL, AND TRANSGENDER PATIENTS. Gay and Lesbian Medical Association. Retrieved on 2008-12-28.
  3. ↑ Handbook of health behavior research, David S. Gochman, p.145
  4. ↑ 4.0 4.1 4.2 4.3 4.4 4.5 Meads, C; Pennant, M & McManus, J et al. (2009), A systematic review of lesbian, gay, bisexual and transgender health in the West Midlands region of the UK compared to published UK research, Unit of Public Health, Epidemiology & Biostatistics, West Midlands Health Technology Assessment Group
  5. ↑ 5.0 5.1 King, M; Semlyen, J & See Tai, S et al. (2009), Mental disorders, suicide, and deliberate self harm in lesbian, gay and bisexual people: a systematic review of the literature, Department of Mental Health Sciences, Royal Free and University College Medical School, University College London
  6. ↑ Rates and predictors of mental illness in gay men, lesbians and bisexual men and women, British Journal of Psychiatry, (2004) 185: 479-485
  7. ↑ Rivers, I (2001), "The bullying of sexual minorities at school: Its nature and long-term correlates.", Educational and Child Psychology (no. 18(1)): 32–46
  8. ↑ Rivers, I (2004), "Recollections of Bullying at School and Their Long-Term Implications for Lesbians, Gay Men, and Bisexuals", Crisis (no. 25(4)): 169–175
  9. ↑ Wilton, Tamsin (2000), Sexualities in health and social care: a textbook, Open University Press, ISBN 0335200265
  10. ↑ Wilton, Tamsin (1999), "Towards an understanding of the cultural roots of homophobia in order to provide a better midwifery service for lesbian clients", Midwifery (Harcourt Publishers) (no. 15(3))
  11. ↑ Wilton, T. & Kaufmann, T. (2001), "Lesbian mothers' experiences of maternity care in the UK", Midwifery (Harcourt Publishers) (no. 17(3))
  12. ↑ Handbook of health behavior research, David S. Gochman, chapter 7, Health behaviour in lesbians, (Homophobia and heterosexism in healthcare system), pp. 145-147
  13. ↑ [Heterosexism in Health and Social Care, Julie Fish, 2006]
  14. ↑ The aging gender dysphoria (transsexual) patient by L. M. Lothstein (Archives of Sexual Behavior, Volume 8 Number 5, September 1979)
  15. ↑ 15.0 15.1 15.2 Report reveals discrimination against transgender people by health providers, high HIV rates, lack of access to necessary care
  16. ↑ 16.0 16.1 16.2 16.3 16.4 "TEN THINGS Transgender persons SHOULD DISCUSS WITH THEIR HEALTH CARE PROVIDERS". Gay and Lesbian Medical Association. Retrieved on 2008-12-28.
  17. ↑ Primary care needs of patients who have undergone gender reassignment by Mary Sobralske (Journal of the American Academy of Nurse Practitioners, Volume 17 Issue 4, Oct 2005)
  18. ↑ 18.0 18.1 18.2 18.3 "TEN THINGS LESBIANS SHOULD DISCUSS WITH THEIR HEALTH CARE PROVIDERS". Gay and Lesbian Medical Association. Retrieved on 2008-12-28.
  19. ↑ 19.0 19.1 19.2 19.3 19.4 "TEN THINGS GAY MEN SHOULD DISCUSS WITH THEIR HEALTH CARE PROVIDERS". Gay and Lesbian Medical Association. Retrieved on 2008-12-28.
  20. ↑ 20.0 20.1 "Depression in the Gay Community". Gay.com News. Retrieved on 2008-12-28.
  21. ↑ "The History of AIDS and ARC" at the LSU Law Center
  22. ↑ A Cluster of Kaposi's Sarcoma and Pneumocystis carinii Pneumonia among Homosexual Male Residents of Los Angeles and Orange Counties, California. MMWR, 31(23);305-7 (June 18, 1982). Retrieved on 2007-01-24.
  23. ↑ Statistics from the Ministry of Health, Labor and Welfare
  24. ↑ Go VF, Srikrishnan AK, Sivaram S, et al. (March 2004). "High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India". J. Acquir. Immune Defic. Syndr. 35 (3): 314–9. PMID 15076248. 
  25. ↑ Lee HC, Ko NY, Lee NY, Chang CM, Ko WC (May 2008). "Seroprevalence of viral hepatitis and sexually transmitted disease among adults with recently diagnosed HIV infection in Southern Taiwan, 2000-2005: upsurge in hepatitis C virus infections among injection drug users". J. Formos. Med. Assoc. 107 (5): 404–11. PMID 18492625.  Increased Risk for Entamoeba histolytica Infection and Invasive Amebiasis in HIV Seropositive Men Who Have Sex with Men in Taiwan
  26. ↑ UNAIDS 2006 report on the global AIDS epidemic, Chapter 05, June 2006
  27. ↑ FDA Policy on Blood Donations from Men Who Have Sex with Other Men
  28. ↑ Estimated numbers of persons living with HIV/AIDS at the end of 2006, by race/ethnicity, sex, and transmission category—33 states with confidential name-based HIV infection reporting, Center for Disease and Control Prevention
  29. ↑ Addictions in the Gay and Lesbian Community, Jeffrey R. Guss, Jack Drescher, Published by Haworth Press, 2000, ISBN 0789010372, 9780789010377

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