As a gay man in his mid-twenties, I knew HIV testing was a normal part of my health care regimen, but I knew little else about lesbian, gay, bisexual and transgender (LGBT) health care. Each minority group has its own special health care concerns and issues, but did LGBT health mean more than HIV and AIDS? When I looked deeper, what I found are complex issues that impact one of the smallest and most diverse populations.
What’s somewhat unique about the LGBT community is that it spans all other populations, like those based on race or social and economic status. Despite the acronym, lesbian, gay, bisexual and transgender people also all face different health care barriers and needs. As the United States increases legal protections for LGBT individuals, it’s crucial that reporting on emerging health care issues and medical evidence is sound.
Distinctive health issues
One concern is the quality of data in medical studies on LGBT populations. The data have been limited by an inherit aversion of declaring on surveys a person’s sexual orientation, gender identity and the existence of same-sex partners. While significant progress was made over the past few years, factors discouraging participation in data collection remain. Those factors include lack of questions specific to the LGBT community, stigma that varies in intensity by geographic location and the threat to personal security when discrimination based on sexual orientation and gender identity is allowed. Reporters and editors must pay special attention to data and its limitations used in research on LGBT health.
LGBT people also share the strains of societal stigma, discrimination and denial of civil and human rights, according to the U.S. government’s Healthy People 2020 initiative. In many cases, the health care disparities and issues faced by LGBT populations are linked to that stigmatization and discrimination. This often is known as minority stress.
The negative impact of stigma and discrimination makes LGBT mental health a popular area of research. A large portion of that focus centers on LGBT youth, who are at increased risk of attempting suicide.
Like any other group, terminology is also important to the entire LGBT community. For example, the word homosexual grew out of favor over the years – the AP Stylebook dropped it in 2006, saying gay was the preferred term. Meanwhile, the term queer is coming back into acceptance for some people who self-identify as queer. The best approach to finding the right terminology and pronouns is to ask subjects and researchers. Your news organization may have its own style determination. The National Lesbian and Gay Journalists Association provides a comprehensive stylebook for newsrooms.
HIV/AIDS
ILO HIV/AIDS human ribbon, 2010 via photopin (license)
HIV and AIDS continue to disproportionately impact gay and bisexual men and transgender women. For example, less than 2 percent of the U.S. population identifies as gay and bisexual, but about two-thirds of the country’s new infections are diagnosed among that group. Infections are also on the rise among gay and bisexual men, who make up more than half of the infections among Americans. Research suggests that transgender women may be at an equally or even greater risk of HIV infection, but data are lacking.
In the coming years, attention on the HIV/AIDS epidemic will likely focus on three areas: prevention, testing and treatment. People in the United States now can take a daily pill – Gilead’s Truvada – to reduce their risk of HIV infection by more than 90 percent. The form of prevention is known as pre-exposure prophylaxis (PrEP). Research will focus on how PrEP/Truvada is changing the face of the HIV/AIDS epidemic. As for testing, there is concern that younger gay and bisexual men are not being regularly tested. Also, there will be focus on getting people newly diagnosed with HIV into treatment as soon as possible, which is a slight departure from the previous approach that limited treatment based on a patient’s immune response. For those on treatment, research will likely focus on a new population of older people living with HIV as a chronic disease.
Preventive services
Other than prevention and testing for HIV, there is an evolving body of research looking at special focuses and services needed among the LGBT community, such as preventing substance abuse.
In addition, previous research found a higher prevalence of some reproductive cancers, such as ovarian cancer, among lesbians and bisexual women compared with their heterosexual counterparts. New research suggests the disparity may be driven by a difference in health behaviors, such as lesbians and bisexual women being more likely to avoid cancer screenings.
Similarly, gay and bisexual men are at an increased risk of certain cancers, compared with their heterosexual counterparts. For example, a growing body of research is suggesting gay and bisexual men are more likely than straight men to use indoor tanning facilities, which increase the risk of skin cancer. Men who have sex with men also are at an increased risk of HPV infections, which increases their risk of anal cancer. The U.S. Centers for Disease Control and Prevention advise men who have sex with men get the HPV vaccine up to age 26 if they did not receive it when they were younger.
There is also a growing awareness that sexual education throughout the United States is inadequate and exclusive of the LGBT community. Some suggest a higher rate of teen pregnancy among LGBT youth is linked to gaps in sexual education.
Transgender health
While often lumped together with lesbian, gay and bisexual people, transgender individuals face unique challenges within the LGBT community. They are the least likely to be included in research, and often face discrimination throughout the health care community.
Journalists should expect to see more research on transgender populations emerging over the next decade. Already, journals dedicated to transgender health research are being published. Studies on transgender children, who are being allowed to explore their gender identities at young ages, also are underway.
In the meantime, the transgender community has been its own best advocate in educating people about their community’s healthcare needs. For example, Trans Bodies, Trans Selves, recently was published as comprehensive resource for transgender individuals. The book includes valuable information on transgender health care needs.
What to do when online or other resources fail?
Since data on LGBT health is often lacking, it’s not uncommon to find gaps in research and other information. When reporters and editors run into those barriers, coworkers, community groups, friends and families can be great resources. Build your sources to include gay, lesbian, bisexual and transgender people. They often can provide answers or suggestions when reporters are working on stories involving their community’s health. In addition, reaching out to community, university or hospital-system based clinics that help treat LGBT patients can provide resources.
Andrew M. Seaman (@andrewmseaman) is an AHCJ member and a senior medical writer for Reuters Health in New York covering medical studies on a wide range of issues, including LGBT health. His work was recognized by the National Lesbian and Gay Journalists Association in 2015.
