Ten Things Gay Men Should Discuss with Their Health Care Providers
Ten Things Gay Men Should Discuss with Their Health Care Providers
Press release
By: Vincent M. Silenzio
Date: July 17, 2002
Source: Silenzio, Vincent M. "Ten Things Gay Men Should Discuss With Their Health Care Providers." Gay and Lesbian Medical Association, July 17, 2002.
About the Author: Dr. Vincent M. Silenzio graduated from the University of Pennsylvania, then completed his medical and public health studies at Rutgers University. After founding the Program in Sexuality and Health at Columbia University, he became the Director of Social and Community Medicine at the University of Rochester School of Medicine and Dentistry. He has served on the Board of the Gay and Lesbian Medical Association and as Co-Editor-in-Chief of the Association's journal.
INTRODUCTION
While straight men can turn to parents, a family physician, or the mass media for health care information, it is far more difficult for gay men to obtain health guidance. Gay clinics and openly gay therapists are rare with homophobia widespread among health care providers. There are few comprehensive resources available to give a gay man general information tailored specifically to his sexuality, his body, and his mental and emotional health.
Gay men are disproportionally affected by certain ills. In addition to all of the physical diseases that affect men more than women, there are diseases that spread differently among gay men than straight men. Transmission variables, quality of health care, discriminatory health care practices, misdiagnosis of illness based on presumptions about sexual identity, and higher levels of stress combine to increase health risks for gay men. Additionally, some of the health care issues that affect gay men are political, including lack of insurance coverage for services related to same-sex activity, lack of coverage for same-sex partners, bias, and violence as well as homophobia among health care providers.
In response to the problems specific to gay men's health care, activists in the gay male community began in the 1980s to provide health care information for gays. They believe that gay male wellness includes the development of individual skills and techniques for coping with health care issues.
PRIMARY SOURCE
TEN THINGS GAY MEN SHOULD DISCUSS WITH THEIR HEALTH CARE PROVIDERS
SAN FRANCISCO—A survey of members of the Gay and Lesbian Medical Association (GLMA) released today listed 10 health care concerns men who have sex with men (MSM) should include in discussions with their physicians or other health care providers.
"Clinicians providing health care to gay and bisexual men may not be aware of all of the things that should be discussed during the visit," said GLMA President Christopher E. Harris, MD. "We are concerned that physicians and other health care providers who do not understand the health risks in the gay community cannot provide competent care. This is why we asked our members to help us define the health care concerns most relevant to MSM. Our purpose is to inform health providers and allow patients to be proactive in their relationship by knowing what questions to ask."
"Naturally, not everyone has the same set of risks," said educator and medical journal editor Vincent M. B. Silenzio, MD, MPH. "But after we look at gender (men in general are increased risk of heart disease, for example) age, family history, and other basic factors, we need to consider issues that relate to the culture or subculture. We know that gay men face greater discrimination than their heterosexual counterparts, for example. Family pressures, combined with social pressure, cause significant stress. It might be important to discuss depression or anxiety, and possibly substance use. If you know that someone is sexually active, it is important to talk about safe sex, the need for hepatitis immunization, or periodic tests for anal papiloma."
Both Harris and Silenzio stress that this list broadens previously held views about appropriate treatment for gay men. They indicated this doesn't represent special treatment for gay or bisexual men, but appropriate treatment. Patients often don't know what they should ask their health care provider. And worse, many providers don't know what to look for. To effectively provide the best in health care, knowledge and honesty are essential.
"Both the provider and the patient should be aware of these concerns and they should be addressed non-judgmentally as part of a patient's regular health care program," Harris said.
Gay Men and MSM Health Concerns
- HIV/AIDS, Safe Sex
- Substance Use
- Depression/Anxiety
- Hepatitis Immunization
- STDs
- Prostate/Testicular/Colon Cancer
- Alcohol
- Tobacco
- Fitness (Diet & Exercise)
- Anal Papiloma
"Certainly, there are other health concerns that gay men and MSM face," Harris added. "And there are other cultural competence issues—gender identity, race, ethnicity, economic status, for example. But the 'Ten Things' list is a way to get the discussions started. Every physician and every health care professional—gay or straight—should know these things. And they should provide an open, comfortable environment in which these issues can be discussed."
- HIV/AIDS, Safe Sex—That men who have sex with men are at an increased risk of HIV infection is well known, but the effectiveness of safe sex in reducing the rate of HIV infection is one of the gay community's great success stories. However, the last few years have seen the return of many unsafe sex practices. While effective HIV treatments may be on the horizon, there is no substitute for preventing infection. Safe sex is proven to reduce the risk of receiving or transmitting HIV. All health care professionals should be aware of how to counsel and support maintenance of safe sex practices.
- Substance Use—Gay men use substances at a higher rate than the general population, and not just in larger communities such as New York, San Francisco, and Los Angeles. These include a number of substances ranging from amyl nitrate ("poppers"), to marijuana, Ecstasy, and amphetamines. The long-term effects of many of these substances are unknown; however current wisdom suggests potentially serious consequences as we age.
- Depression/Anxiety—Depression and anxiety appear to affect gay men at a higher rate than in the general population. The likelihood of depression or anxiety may be greater, and 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.
- Hepatitis Immunization—Men who have sex with men are at an increased risk of sexually transmitted infection with the viruses that cause the serious condition of the liver known as hepatitis. These infections can be potentially fatal, and can lead to very serious long-term issues such as cirrhosis and liver cancer. Fortunately, immunizations are available to prevent two of the three most serious viruses. Universal immunization for Hepatitis A Virus and Hepatitis B Virus is recommended for all men who have sex with men. Safe sex is effective at reducing the risk of viral hepatitis, and is currently the only means of prevention for the very serious Hepatitis C Virus.
- STDs—Sexually transmitted diseases (STDs) occur in sexually active gay men at a high rate. This includes STD infections for which effective treatment is available (syphilis, gonorrhea, chlamydia, pubic lice, and others), and for which no cure is available (HIV, Hepatitis A, B, or C virus, Human Papilloma Virus, etc.). There is absolutely no doubt that safe sex reduces the risk of sexually transmitted diseases, and prevention of these infections through safe sex is key.
- Prostate, Testicular, and Colon Cancer—Gay men may be at risk for death by prostate, testicular, or colon cancer. Screening for these cancers occurs at different times across the life cycle, and access to screening services may be negatively impacted because of issues and challenges in receiving culturally sensitive care for gay men. All gay men should undergo these screenings routinely as recommended for the general population.
- Alcohol—Although more recent studies have improved our understanding of alcohol use in the gay community, it is still thought that gay men have higher rates of alcohol dependence and abuse than straight men. One drink daily may not adversely affect health, however alcohol-related illnesses can occur with low levels of consumption. Culturally sensitive services targeted to gay men are important in successful prevention and treatment programs.
- Tobacco—Recent studies seem to support the notion that gay men use tobacco at much higher rates than straight men, reaching nearly 50 percent in several studies. Tobacco-related health problems include lung disease and lung cancer, heart disease, high blood pressure, and a whole host of other serious problems. All gay men should be screened for and offered cultur-ally sensitive prevention and cessation programs for tobacco use.
- Fitness (Diet and Exercise)—Problems with body image are more common among gay men than their straight counterparts, and gay men are much more likely to experience an eating disorder such as bulimia or anorexia nervosa. While regular exercise is very good for cardiovascular health and in other areas, too much of a good thing can be harmful. The use of substances such as anabolic steroids and certain supplements can adversely affect health. At the opposite end of the spectrum, overweight and obesity are problems that also affect a large subset of the gay community. This can cause a number of health problems, including diabetes, high blood pressure, and heart disease.
- Anal Papilloma—Of all the sexually transmitted infections gay men are at risk for, human papilloma virus—which cause anal and genital warts—is often thought to be little more than an unsightly inconvenience. However, these infections may play a role in the increased rates of anal cancers in gay men. Some health professionals now recommend routine screening with anal Pap Smears, similar to the test done for women to detect early cancers. Safe sex should be emphasized. Treatments for HPV do exist, but recurrences of the warts are very common, and the rate at which the infection can be spread between partners is very high.
SIGNIFICANCE
The education of gay men about health issues specific to the gay community has bettered the lives of gay men. However, many factors restrict the ability of gays to get adequate health care, including negative attitudes toward homosexuality held by health care providers.
Health care providers are not immune to homophobia and are typically not educated about gay and lesbian health issues in their medical training, with the exception of HIV. In a 1994 survey of the membership of the Gay and Lesbian Medical Association (GLMA), over half of the respondents reported observing heterosexual colleagues deny care or provide reduced or substandard care to gay or lesbian patients because of their sexual orientation, with eighty-eight percent reporting that their physician colleagues made disparaging remarks in public about gay patients. While the overwhelming majority of GLMA members believed that it was medically important for patients to inform their physicians of their orientation, sixty-four percent believed that in doing so, patients risked receiving substandard care. Surveys of nurses and medical students have also discovered that many of these health care providers hold hostile attitudes toward gays.
The attitudes of nurses, medical students, and physicians are perceived by patients and can negatively affect their health care. Many gay patients report experiencing ostracism, rough treatment, and derogatory comments, as well as disrespect for their partners from their medical practitioners. Many gay men withhold information about their sexual behavior from their health care providers, fearing repercussions if they reveal their sexual orientation. As a result, some gays are hesitant to return to their physician's offices for new complaints and are less likely to receive medical screening tests.
Lastly, although substance use is listed as one of the major items that gay men should discuss with health care providers, little support is available for gay men with substance abuse issues. Detoxification and rehabilitation programs often show little sensitivity to issues of sexual orientation and generally do not encourage disclosure. It has been shown that failure to acknowledge gay identity issues in alcoholism treatment makes recovery more difficult and increases the likelihood of relapse.
FURTHER RESOURCES
Books
Eliason, Michele J. Who Cares?: Institutional Barriers to Health Care for Lesbians, Gays, and Bisexual Persons. New York: NLN Press, 1996.
Penn, Robert E. The Gay Men's Wellness Guide: The National Lesbian and Gay Health Association's Complete Book of Physical, Emotional, and Mental Health and Well-Being for Every Gay Male. New York: Henry Holt, 1997.
Peterkin, Allan D., and Cathy Risdon. Caring for Lesbian and Gay People: A Clinical Guide. Toronto: University of Toronto Press, 2003.