April 18, 2013
How can lesbian, gay, bisexual and transgender (LGBT) people get the most out of face-to-face visits with their medical providers?
Earlier this year, APICHA Community Health Center -- a community-based provider of quality health care, HIV prevention and education to communities of color, LGBT and low-income people in New York City -- hosted a workshop exploring this question. Entitled "10 Things LGBT People Need to Discuss With Their Health Care Providers," the workshop was part of APICHA's ongoing Project Connect program of community conversations. Delivering the presentation to a diverse audience from across the LGBT spectrum was Dr. Robert Murayama, APICHA's chief medical officer.
The workshop was broken down by population, though many of the issues raised cut across the entire LGBT community. For instance, stopping smoking and watching alcohol intake are important in the general population; but in LGBT communities this is of particular concern, Dr. Murayama asserted, as every segment of the LGBT population is reported to have higher levels of smoking, heavy drinking and substance use. Also across all groups, societal pressures, stigma, and other factors lead to high levels of depression and anxiety in the LGBT community.
Murayama not only advocated for moderation of smoking and drinking, but the adoption of healthy habits for all LGBT persons, including 20 to 40 minutes of exercise, three to five times per week, to work toward keeping a healthy heart.
He also busted the myth that there is one test that checks for all possible sexually transmitted diseases (STDs) a person might have. He emphasized the mantra: "If you have a hole, get it tested." You should always make sure you're being screened for all STDs, and testing should be area testing since not all STDs can be screened through the blood.
Of great concern for lesbians? Cancer screenings, especially for breast cancer and cervical cancer, Dr. Murayama said. Now, being a lesbian does not make one inherently at higher risk for either of these cancers. However, breast cancer risk can be tied to the amount of certain hormones in a person's system. After women have children, they produce less of the hormones estrogen and progesterone, which have been known to promote breast cancer cell growth; but because lesbians as a group are less likely to have children than heterosexual women, they may be at higher risk for developing breast cancer due to higher levels of estrogen and progesterone exposure. Also, cervical cancer is often diagnosed at a later stage due to lower rates of Pap smears among lesbians.
For gay and bisexual men, prevention is key for those who are HIV negative, as is antiretroviral treatment for those who are HIV positive. In order to stay negative, Dr. Murayama stressed correct and consistent condom use, as well as possibly taking advantage of pre-exposure prophylaxis. There have been minimal side effects with Truvada as PrEP, according to Dr. Murayama; those side effects have included kidney problems and bone loss. He also noted that Truvada was chosen as the first drug to be used as PrEP because of its minimal side effects.
Though excessive alcohol and substance use hold dangers for all LGBT folks, Dr. Murayama pointed out the impact that alcohol and other substances can have on gay and bisexual men, whose inhibitions may be lowered while under the influence -- and the subsequent danger of HIV risk behavior.
Liver problems are also of concern for gay and bisexual men -- especially in the form of hepatitis A, B and C, and cirrhosis. Though chronic hepatitis B and C are now treatable, all sexually active adults should get immunized against hepatitis A and B. (There is no vaccine against hepatitis C). Dr. Murayama informed the crowd that, if you ask your doctor, you can get the hepatitis A and B vaccines together. Hepatitis B is transmitted through blood and other bodily fluids, and can be transmitted through sexual activity. Hepatitis A results from oral-fecal contact and is mostly transmitted through improperly prepared foods, or foods that have been handled by employees who have not washed their hands. Hepatitis C and B are chronic, while hepatitis A is acute, which means infection is shorter but can be more severe.
Dr. Murayama also reiterated the importance of getting checked for all STDs, as many can make it easier to contract HIV due to the inflammation they cause. Also, some STDs, specifically HPV (human papillomavirus), can cause cervical cancer in women -- and anal cancer in women as well as men.
The discussion of trans health reiterated many points that had already been fleshed out earlier in the workshop, including concerns around HIV risk, which for transwomen -- who, according to a large recent study, are nearly 50 times more likely to be HIV positive than general populations worldwide -- is a significant issue. Dr. Murayama did make a special comment about the use of silicone injections by the trans population. The U.S. Food and Drug Administration banned silicone injections in 1991, but they're still used outside of medical settings where the quality of the silicone isn't assured. Murayama said that, though silicone often gives the initial feminizing effects that patients want to see in their bodies, long-term side effects can be extremely dangerous. Once silicone is injected, it cannot be removed, unless it is a product made of silicone like a buttock or breast implant. (Dr. Murayama also informed the crowd that, when originally conceived, breast implants were not meant to stay in for life.) He also stressed the importance for transwomen of receiving regular Pap smears and anal Pap smears.
Dr. Murayama ended by outlining some specific questions a person should ask their doctor when getting care or being prescribed medications. Read those important questions in Part Two of this report.
Mathew Rodriguez is the editorial project manager for TheBody.com and TheBodyPRO.com.
Follow Mathew on Twitter: @mathewrodriguez.