Ending LGBT invisibility in health care: The first step in ensuring equitable care
ABSTRACTLesbian, gay, bisexual, and transgender (LGBT) individuals experience health care disparities that will be eliminated only if clinicians elicit information about sexual orientation and gender identity from their patients through thoughtful, nonjudgmental discussion and history-taking.
KEY POINTS
- LGBT people are represented in most medical practices, and their health issues, including sexually transmitted diseases such as human immunodeficiency virus, can generally be managed in traditional health care settings rather than in special clinics.
- Physicians need to become more comfortable asking patients about sexual health, identity, and behavior, and make such queries more routine.
- Sexual behavior is not always congruent with routine understanding of sexual identity. For example, many men who do not identify themselves as gay occasionally have sex with men, as do many self-identified lesbians. It is important to know this to provide appropriate preventive screening and care.
MENTAL HEALTH CONCERNS
Given the marginalization and stigma that LGBT people face throughout their lives, it is not surprising that mental health problems are more prevalent in this population than in the general population. Gay and bisexual men have more depression, panic attacks, suicidal ideation, psychological distress, and body image and eating disorders than do heterosexual men. Lesbian and bisexual women are at greater risk of generalized anxiety disorder, depression, antidepressant use, and psychological distress.10 Care providers should screen for mental health disorders, assess comfort with sexual identity, and ask about social support.
FAMILY LIFE
Gays and lesbians increasingly want to discuss commitment, marriage, having children, parenting, and legal issues. A lot of research is being conducted on the sexual orientation of children raised by gay parents, and evidence shows that they are not more likely to be gay or lesbian than children raised by straight parents.
Elderly same-sex couples face special difficulties. They are less likely to feel comfortable “out of the closet” than are younger people. Fewer family and community supports are available to them, and they are often unable to live together in an assisted living facility. They particularly need to have advanced directives because they do not have the legal protections of other couples.
JUST A BEGINNING
While the points made above are relatively straightforward, they will open the door for many patients to have more meaningful conversations about their lives with their health care providers. It may only be a first step, but it can make a world of difference helping LGBT people feel comfortable accessing health care and receiving appropriate preventive care and treatment. Beyond the interaction with clinicians, health care providers should consider their overall environment and ensure that it is welcoming to LGBT individuals who come there for care.11
RESOURCES
Family Acceptance Project. familyproject.sfsu.edu
Gay & Lesbian Medical Association. www.glma.org
Human Rights Campaign. HRC.org
Parents, Families and Friends of Lesbians and Gays. PFLAG.org
World Professional Association for Transgender Health. www.wpath.org
Youth Resource (website by and for LGBT youth). Youthresource.com
