by Vadim Shteyler
Amid this week’s disheartening studies highlighting discrimination of LGBT populations, the American College of Physicians (ACP) affirms its support and offers new recommendations for furthering LGBT health.
The bad “news”: is not really news. It is further evidence of how much more effort needs to be placed on ending LGBT discrimination and inequalities. A national survey published in the Ann of Intern Med found that lesbians were significantly less likely to get vaccinated for HPV than their heterosexual counterparts (adjusted prevalence of 8.5% v 28.4%). HPV is easily transmissible through contact and believed to be equally transmissible in gay and heterosexual women. The vaccine can prevent most cases of cervical cancer, which has terrible outcomes if discovered late, indicating that many deaths could have been prevented. An editorial in the same issue describes neglected health concerns affecting LGBT populations and calls for better professional education on LGBT health. The CDC’s and American Congress of Obstetrics and Gynecology’s (ACOG) efforts to inform patients about pap smear rates not been slow and inconsistent in changing medical practice. Combined with markedly lower HPV vaccination rates, cervical cancer remains a big concern.
Just after the NFL drafted Michael Sam, its first openly gay player, an international survey published extremely high rates of homophobia in sports. Very few (1%) believed LGB people were completely accepted in sports and a majority (both gay and straight) thought they were targeted on the field, in the bleachers, and in schools (e.g., PE class). Many LGB athletes worried about rejection by teammates and many LGB kids and young adults did not participate in sports from fear of homophobia. Of the 6 countries surveyed (US, UK, Ireland, Canada, Australia, and New Zealand), Americans most perceived sports as unsafe or unwelcoming and witnessed/experienced homophobic slurs more.
The good news: The ACP published a position statement this week, listing 9 policy recommendations promoting LGBT health:
- Include gender identity in all non-discrimination and anti-harassment policies in all medical institutions as independent of sexual orientation.
- Expand private and public insurance coverage to include comprehensive coverage to trans people for transition and non-transition related interventions.
- Expand the definition of “family” to include all people with an emotional, and not just legal or biological, relationship.
- Allow all patients to choose who may visit or make decisions for them, regardless of their sexual orientation, gender identity, or marital status.
- Expand civil marriage rights to all same-sex couples.
- Increase research on LGBT issues.
- Incorporate LGBT health training and encourage more LGBT people to practice medicine.
- Ban conversion therapy for LGBT people.
- Continue to review blood donation policies for MSM.
Though another step in the right direction, the extent to which these recommendations will translate into policy and practice is unclear. Implementation is always slow, especially for injustices that permeate so many aspects of society. Admittedly, the ACPs call for increased protection of LGBT health joins the wave of many other medical organizations such as the AMA, ACOG, APA, and many others; it’s relatively extensive and concrete policy recommendations, however, may be more impactful.
Of course, the health issues the ACP addresses is far from comprehensive. Decreased funding for HIV prevention correlates with a recent increase in infections in MSM. Structural issues in healthcare make documenting gender identity, interpreting reference ranges for certain gender-specific lab values, and ordering gender-specific interventions (e.g., pap smears) difficult for trans people. LGBT populations, as some of the most stigmatized and underserved groups in medicine, deserve increasing attention.