|
Volume CXXXIII, Number 15 |
 |
Homosexuals should heed health tips
JEFF BENSON, M.D.
DUDLEY COE HEALTH CENTER
Dear Dr. Jeff: Do gay and lesbian students have special health care needs? And can they be met at the Health Center?-J.Z.
Dear J.Z.: Your first question is in fact a very interesting one. There are a number of special preventive health care needs which have been identified for gays and lesbians.
According to the Gay and Lesbian Medical Association, those include the following for gay men: HIV/AIDS; safe sex and STD prevention; hepatitis immunization; prostate, testicular, and anal cancer prevention; and mental health promotion and substance use prevention. For lesbians, GLMA highlights preventive measures for breast, cervical, endometrial, and ovarian cancers; osteoporosis; mental health promotion; and substance use prevention.
Let's take a look at these needs. Some, like prostate and testicular cancer, involve the same risks and prevention strategies as for heterosexuals. That's assuming gay men have equal access to health care services (and are comfortable seeking them out).
Some, like cervical cancer among lesbians, involve lower risk. Cervical cancer is almost always associated with Human Papilloma Virus, one of the most common heterosexual STDs.
Others, like breast and gynecologic cancers, may involve greater risks. Breast cancer risks are higher among women who have never had (and breastfed) a baby. And long term use of oral contraceptives are protective against ovarian cancer.
The rate of anal cancer among gay men, on the other hand, is more than 35 times higher than the population as a whole. Like cervical cancer in women, anal cancer in men is associated with HPV infection. And just as cervical cancer is best prevented by condoms and regular Pap tests for women, anal cancer is best prevented by condoms and regular anal pap tests for men.
Here's the obvious (or maybe not-so-obvious) point. There's nothing about anal cancer that makes it a particularly "gay" disease, and there's nothing, biologically speaking, about gay men or their rectal mucosae, that makes them more likely to develop anal cancer. It is all about HPV transmission through unprotected intercourse and lack of preventive screening.
The same pretty much goes for the other "special" health care risks and needs of gays and lesbians. They are not biologically based, but behaviorally, socially and culturally based-and therefore behaviorally, socially, and culturally preventable and treatable.
Public health advocates no longer describe risk groups as "gay" or "lesbian," but instead describe behaviors practised by some "MSM" (Men who have Sex with Men) or "WSW" (Women who have Sex with Women), which might put individuals at risk for particular health outcomes. Take the example of HIV risk among lesbian women. Women who have had sex only with other women and have not injected drugs have a very low risk of HIV. Women who have had sex with men, which includes the majority of women who identify as lesbian, have a higher risk of HIV. Women who have had unprotected sex with men who have had unsafe sex with men or with men who have injected drugs and shared needles are at especially high risk.
Public health advocates also stress the cultural factors that have a psychological impact on the LGBT community and lead to inadequate physical and mental health care. These factors include heterosexist prejudice, societal discrimination, and violence against LGBT individuals.
So, J.Z., a somewhat long and drawn out answer to your first question.
Your second question is easier. At the Health Center, we are very happy to do our best to meet your health care needs, whatever they may be. We can screen for STD's, discuss safe sex techniques, perform cervical paps and anal paps, and immunize against Hepatitis A and B. If we can't help you ourselves, we'll refer you to someone who can. And whatever we'll do, we'll do it with an open heart and with respect.
Be well!
Jeff Benson, M.D.
Dudley Coe Health Center
For information on sending a letter to the editor, please click here.
|
FastCounter by bCentral |