Caring for the LGBTQ Community (video)

According to the Centers for Disease Control and Prevention, members of the LGBTQ community may have an increased risk of several health issues. While HIV and AIDS often come to mind, concerns also include other sexually transmitted diseases (STDs), increased cancer risk and behavioral health issues.

In this video, San Diego Health host Susan Taylor talks about health concerns in the lesbian, gay, bisexual, transgender and queer population with Brian Kim, MD, a family medicine doctor and HIV specialist with the Scripps Coastal Medical Center Hillcrest, and Manish Champaneria, MD, a plastic surgeon at Scripps Clinic Del Mar who specializes in transgender surgery.

While there is still no cure for HIV and AIDS, new medications have made these viral infections more manageable.

“HIV is seen more as a chronic inflammatory disease than a death sentence,” says Dr. Kim. “There are still some challenges, including an increased risk of cardiovascular disease and more premature aging, but it’s come a long way.”

Dr. Kim recommends that gay men be tested for STDs as frequently as necessary, and at least annually, though patients can call to schedule screenings any time. Many gay patients who take pre-exposure prophylaxis (PrEP), a daily medication used to prevent HIV infection, are screened every three to six months as part of their care.

PrEP is very effective, but mistakes can happen. Condoms are still recommended to help prevent infections that are spread through body fluids, such as HIV, gonorrhea and chlamydia. However, condoms may be less effective in preventing diseases spread through skin contact, such as herpes and genital warts, because they don’t completely cover the skin.

Hepatitis A and hepatitis B are more prevalent in this community, so vaccinations to prevent these highly contagious diseases are recommended.

There is a higher risk of anal cancer and throat cancer among gay men, and screening options may include an anal pap smear or a more specific exam called an anoscopy that examines the lining of the anus for signs of pre-cancer or cancer. However, these screenings are somewhat controversial, and for the most part, cancer screening in the LGBTQ community is the same as in the general population.

Lesbians may have a slightly increased risk of obesity, breast cancer and possibly ovarian cancer. Obesity is believed to increase the risk of estrogen-dependent cancers. Also, lesbians use birth control pills less frequently, so they don’t get the protection from ovarian cancer that the pills can provide.

Behavioral health issues are common in this community, especially among members who fear discrimination or rejection.

“It’s unfortunate that despite all the progress that we’ve made, a lot of people still live in the closet, especially while they’re still young, and there is increased depression and anxiety,” says Dr. Kim.

“People who are actually the happiest are those who have completed their process of coming out and are able to live the lives that they wanted to live.”

Both doctors agree that the transgender community has specialized concerns, one of which is gender dysphoria.

“Gender dysphoria is feeling depressed or anxious about the gender that they were born into, but they identify with another gender,” explains Dr. Champaneria. “These patients can feel lonely, anxious, depressed, and it’s important to seek care from someone you trust and that you can openly and honestly discuss your issues and concerns with. That may be a mental health professional, a social worker, a psychiatrist, even a family medicine doctor.”

Dr. Champaneria says the first step in preparing for transgender surgery is making sure that the person is psychologically ready to transition to their ideal gender. That means dealing with anxiety, depression and other non-physical concerns before planning to make surgical changes.

Transgender care is definitely a multi-disciplinary team approach, adds Dr. Champaneria. Finding a physician who is part of the LGBTQ community is not mandatory, but seek practitioners who can prescribe hormones, help with mental health, provide surgical options and meet other needs.

“These teams kind of just start forming spontaneously over time,” Dr. Kim says. “We work together a lot, we share a lot of the same patients, so we start becoming our own community in that way as well.”