Tuesday, Jan. 17, 2012

The state of our health

Chris Rudisill.

 

I’m usually talking about issues of health this time of year. My sinuses always flare up with the ever-changing temps and my mental health is usually a little awry after the holidays as well.

Earlier this month, the U.S. Department of Health and Human Services issued a summary update entitled “Better Health and Well-Being: Making Improvements for Lesbian, Gay, Bisexual and Transgender (LGBT) Americans” as a follow-up to LGBT listening sessions that the HHS held across the country. The listening sessions were held in various cities including Atlanta, Austin, Texas, Houston, Washington, D.C., Milwaukee, Wis., Phoenix, Philadelphia, Seattle, Denver, and Hartford, Conn. Secretary Kathleen Sebelius was tasked by the Obama administration to provide annual recommendations to the president from feedback from these sessions.

One of the big changes in the HHS is that under President Obama’s commitment to provide equal treatment to LGBT citizens, the HHC established senior representatives from each division to coordinate LGBT-related policies and improve the health and well-being of the community. The increased effort stemmed from the administration’s memorandum last year on hospital visitation, which addressed the rights of hospital patients to designate visitors despite sexual orientation or gender identity.

The report also identified additional steps the organization has taken to ensure equality for LGBT Americans, including increased enforcement of hospital visitation rights, clarifying that same-sex couples have the same rights as other couples in naming a representative who can make medical decisions on a patient’s behalf, issued guidance to states making it clear that same-sex partners are afforded comparable treatment to other spouses such as long-term care and nursing home care under Medicaid.

Finally, HHS has started to enhance the collection of health data on the LGBT population, which will hopefully help researchers, policy makers, health care providers and advocates identify and address health disparities affecting LGBT people in the future.

There are some serious health issues that are significant to the LGBT community. Research shows that only between 18 and 49 percent of LGBT people disclose their sexual orientation to their physician. In addition, many insurance companies and employers do not honor domestic partner benefits in health care coverage, making insurance more expensive and coverage less likely. Even when you’re out of the closet to your physician and have good coverage, many in the medical field are unaware of gay-related health issues and often harbor seeds of discrimination. Lack of training and education for healthcare workers combining with LGBT people’s fear to be open with their healthcare providers leads to poor health planning and provision. In addition, LGBT patients often have a high risk for depression and anxiety, alcohol and drug abuse and there’s an elevated risk for sexually transmitted diseases in gay men.

Lesbians seemed to be at a higher risk of obesity (58 percent greater). Transgender persons have the daunting risks of being susceptible to both male and female diseases following transition and often deal with even more fear and untrained medical staffs, which increases the amount of transgender people who merely avoid medical care all together.

The Gay and Lesbian Medical Association lists the top ten things that gay men, lesbians and transgender people should discuss with their healthcare providers. Here are those items.

For gay men:

HIV/AIDS, Safe Sex – the last few years have seen the return of many unsafe sex practices and men who have sex with men are still at an increased risk of HIV infection.

Substance Abuse – Research shows that gay men use substances at a higher rate than the general population.

Depression/Anxiety – Depression and anxiety appear to affect gay men at a higher rate and may be more severe for men who remain in the closet or who do not have social support.

Hepatitis Immunization – Potentially fatal, men who have sex with men are at an increased risk of contracting the viruses that cause the serious condition of the liver known as hepatitis.

STDs (sexually transmitted diseases) – Including STD infections which are curable and those that are not, they occur in sexually active gay men at a high rate.

Prostate, Testicular and Colon Cancer – Gay men may be at risk for potentially fatal prostate, testicular and/or colon cancer.

Alcohol – Although more recent studies have improved understanding of alcohol use in the gay community, it is still thought that gay men have higher rates of alcohol dependence and abuse.

Tobacco – Studies seem to support the notion that gay men use tobacco at much higher rates, nearly 50 percent in some reports.

Fitness (Diet and Exercise) – Body image is a major concern for gay men and there are higher risks for eating disorders such as bulimia and anorexia nervosa.

Anal Papilloma – In gay men, this sexually transmitted infection can play a role in increased rates of anal cancer.

For lesbians:

Breast Cancer – Lesbians have the richest concentration of risk factors for breast cancer than any subset of women, plus many do not get routine mammograms or self-exams.

Depression/Anxiety – A problem that exists with many in the LGBT community, lesbians have been shown to experience chronic stress from homophobic discrimination.

Heart Health – Smoking and obesity add to the risk that already exists among women.

Gynecological Cancer – Lesbians have higher risks for many of these cancers.

Fitness – Research shows that lesbians have higher body mass, which is associated with heart disease, cancers and premature death.

Tobacco – Just like gay men, rates of lesbian smokers are sometimes as high as double that of straight counterparts.

Alcohol – Another issue, along with substance abuse, that seems to have higher percentages among the LGBT community.

Substance Abuse

Domestic Violence – Domestic violence is reported to occur in about 11 percent of lesbian homes, but the problem exists when these cases go unreported and battered lesbians are less likely to seek assistance.

Osteoporosis – The rates here have not been documented well, but calcium and weight-bearing exercise as well as avoidance of tobacco and alcohol are mainstays of prevention.

For transgender:

Access to Health Care – Transgender people are often reluctant to seek medical care through traditional providers and some are even turned away.

Health History – Some trans persons will omit part of their history, especially after transition.

Hormones – Hormone therapy carries distinctive risks, including the increase in the risk of blood clotting, high blood pressure, elevated blood sugar and water retention caused by estrogen and liver damage caused by testosterone, especially if not monitored appropriately.

Cardiovascular Health – Higher risk is caused here from hormone use and the tobacco use, obesity, hypertension and failure to monitor mentioned earlier.

Cancer – Hormone-related cancer (breast in trans women, liver in women or men) is rare but should be monitored. A bigger concern here is cancer of the reproductive organs.

STDs and Safe Sex – Due to the high number of young transgender homeless, sex work is prevalent among this community.

Alcohol and Tobacco – Again, alcohol and tobacco use is higher among the entire LGBT population, along with depression/anxiety and substance abuse.

Depression/Anxiety

Injectable Silicone – Often done when some transgender women do not want to wait for the effects of estrogen and instead use non-medical silicone which can cause disfigurement years later and can often contain contaminants. Hepatitis is also a problem here with the use of needles.

Fitness (Diet & Exercise) – Many transgender people are sedentary and overweight or they may be working long hours to support their expensive transitions. Healthy diet and exercise prior to sex reassignment surgery will reduce operative risk and promote faster recovery.

The best thing to remember when dealing with your health is to be honest with your physician(s). If they have a problem with you or your questions – then find another physician. If you don’t have a doctor, I’ve always found that the easiest way to find a gay or gay-friendly doctor is to simply ask around through your circle of friends. In some cities you can also search the database of providers at the Gay and Lesbian Medical Association Web site (www.glma.org). A quick search found a few results in Charleston, but none in the Myrtle Beach area and no primary care physicians earmarked as gay-friendly within 100 miles of Myrtle Beach. This doesn’t mean they don’t exist – it just means they don’t choose to be listed. Remember, ask your friends and be open with your physicians until you are satisfied with their answers and responses.

OUT & ABOUT

Friday, Feb. 3 – The First Friday Happy Hour group will meet from 5:30 – 7:30 p.m. on Friday, Feb. 3 at Gordon Biersch Brewery Restaurant, at 3060 Howard Avenue at The Market Common in Myrtle Beach. First Friday is a gay professionals after work happy hour where everyone is welcome. For more information email FirstFriday@GambleLivingston.com.

Have a thought, comment or Out & About event? Send Chris Rudisill an e-mail to SouthernGayWriter@gmail.com. You can also follow along on Facebook.com @SouthernGayWriter for more news and events.