Promoting the Health of Gender and Sexual Minorities _ ____________________________________________
increase in the number of chemotherapy-induced side effects, possibly resulting from aspects of internalized homophobia, fear of compromised care, or other causes [105]. Screening for male cancers, such as prostate and testicular can- cer, as well as colon and anal cancer may be negatively impacted because of the challenges for gay men in receiving care. Many gay men are reluctant to tell their healthcare providers about their sexual orientation due to fears of discrimination affecting the quality of care they will receive [106]. Lack of insurance coverage for unmarried partners is another barrier [106; 107]. Research has suggested that gay and bisexual men with health histories of STIs and/or anal intercourse are at increased risk for anal cancer [8]. Human papillomavirus (HPV) has been associated with the development of anal cancer, but much research must be done related to subtypes of HPV and anal cancer incidence, including the use of anal Pap smears for early detection [8]. Healthcare professionals working with men who have sex with men are in an excellent position to initiate this research. Family Concerns Family concerns affect a growing number in the LGBTQIA community. Because gay and lesbian parents may face loss of custody of children or loss of hospital visitation rights as a result of their sexual orientation, researchers have had difficulty determining the prevalence of gay and lesbian parents raising children. According to the data from the 2019 American Community Survey, 14.3% of same-sex couple households reported at least one child 18 years of age and younger residing in the home [39]. Children of Lesbians and Gays Everywhere (COLAGE) is a valuable resource for a obtaining a wide range of information about children of gay parents (see Resources ). The “lesbian baby boom” is a phrase that has been used to describe the increasing numbers of lesbians who have come out and are choosing to have children [8]. While donor insemi- nation constitutes the majority of the pregnancies among lesbians, other routes to parenthood have been explored by lesbians and gay men. Research has shown no negative outcomes for children raised by gay or lesbian parents nor has it demonstrated that those children are more likely to become gay or lesbian [108]. Several national organizations have adopted policy statements in support of gay and lesbian parents [109; 110]. Because healthcare facilities do not always recognize same- gender couples as a family, visitation eligibility has often been denied to partners or nonbiologic parents [111]. The Joint Commission has defined “family” as “the person(s) who plays a significant role in the individual’s (patient’s) life. This may include a person(s) not legally related to the individual” [111; 112]. The AMA also supports equality in health care for partners and legal recognition of domestic partners for hospital visitation rights [113]. While many biologic families of LGBTQIA individuals are supportive and do not interfere
with partner decisions regarding care, other biologic families may ignore and reject partner wishes, even when wishes have been discussed and documented by the gay patient. In 2010, the U.S. Department of Health and Human Services adopted a rule that requires “any hospital receiving Medicare or Medicaid funds to have written visitation policies that prohibit discrimination on the basis of sexual orientation and gender identity” [114]. The rule also stipulates that a patient must be informed of their right to visitation by anyone they wish, including (but not limited to) a friend, a domestic partner (including a same-sex domestic partner), a spouse (including a same-sex spouse), or any member of their family. Immunization Vaccination needs for gay and lesbian individuals are not so different from the general population, except that gay and bisexual men are at increased risk for contracting viral hepa- titis [107]. Accurate data regarding the success of vaccination campaigns is not available. Existing information has suggested that vaccination rates for men who have sex with men are low [115]. Few men are vaccinated against hepatitis B, even though the vaccine has been available since the mid-1980s [115]. Attitude, social norm, perceived risk of contracting the virus, expectancies regarding the outcome of vaccination, interaction between risk perception and outcome expectancies, and perceived vulnerability have been found to be predictors of vaccination intention [116; 117; 118]. Healthcare providers should include vaccination histories as part of their patient assessment and recommend vaccinations as indicated. The use of interviewing techniques that demonstrate a nonjudgmental attitude and awareness that a patient may be gay, even if he is in a heterosexual marriage, is also important. Sexually Transmitted Infections and HIV/AIDS STIs among the general population are well-known health problems. Stigmas associated with STIs and LGBTQIA sexual behaviors have made determining the prevalence rates of STIs in men who have sex with men difficult; however, these men appear to be at more risk than the general population [119]. The relatively high incidence may be related to multiple fac- tors including individual behaviors, the number of lifetime or recent sex partners, rate of partner exchange, and frequency of sex without use of a condom [119]. Also problematic is the increased incidence of drug resistance. Gonorrhea in men who have sex with men has been reported to be resistant to fluoroquinolones [120]. AIDS has been diagnosed for more than half a million men who have sex with men. More than 300,000 have died since the beginning of the epidemic. Men who have sex with men comprised 67% of all new HIV infections in 2022 and account for more than half of the 1.2 million existing infections, even though only about 2% of men in the United States reported having sex with other men [121; 122]. While a decline in the rates of STIs in gay and bisexual male groups was reported
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MDDC1026
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