Identification of LGBT Needs in the Exam Room

A physician performs a routine checkup on a pa...

A physician performs a routine checkup on a patient at the medical clinic. (Photo credit: Wikipedia)

Last time you were in an exam room, did you feel that the attending physician received all the information needed to gain an accurate perspective of your plight? Did you share everything you felt you should, no matter how personal? Did said physician even ask about anything, aside from the usual short list of inquiries we are all too familiar with in that particular setting?

If you are a physician, do you really get the answers you need from your patients? Or perhaps it is just too uncomfortable when talking about sexual health and behaviors. More likely, they do not disclose the details out of discomfort, or even fear.

LGBT persons have shown to have some unique healthcare needs, sometimes experiencing disparities in care. LGBT patients are often uncomfortable or inhibited from talking openly with healthcare providers about sexual orientation, gender identity, and sexual behaviors. Certain sexual behaviors do not automatically define that patient as LGBT, and not all LGBT patients are going to have similar sexual behaviors. Truthfully, it’s not about whether a person is a member of the LGBT community or not. It’s about the individuals choices and behaviors that could be putting their health at risk, as well as the health of others. In order to cover everyone’s needs, patients must speak openly with providers. Providers must delve into the patients behaviors and understand where the risk behavior is at for each patient. I am going to lay out a few examples, ideas, and suggestions for physicians, as well as patients.

In any healthcare position, you will find people from diverse backgrounds and lifestyles. Different interests, tastes, and mindset. The right approach will reassure patients that the provider is knowledgeable, genuine, concerned, confidential and accepting. This enables the patient to open up and discuss the very private matters of sexual behavior, often in this society a ‘taboo’ subject.

Ask the patient to tell a bit about themselves. As the patient, make sure you indulge your sexual partner(s), safe sex practices, and concerns. Some behaviors have an amount of risk attached to them that is often unknown to the patient.  A physician might ask “Do you have any questions or concerns about your sexuality, sexual orientation or sexual desires?”. Use gender-neutral terms and mirror the patient’s terminology to better understand how they identify. For example, asking “do you have a partner or spouse?” “Are you currently in a relationship?” “What do you call your partner?” are all good ways to decide how the patient will identify without offending them with clinical terms which may sound cold and ‘labeled’. From here the in-depth sexual questions begin: “Are you sexually active?” “When you have sex, do you have sex with men, women or both?” “Are you and your partner monogamous?” “How many sexual partners have you had in the past year?” “Do you have vaginal sex, anal sex, or both?”. These and many more are the key to finding out just what unique needs your particular patient might have.

It is important to differentiate between sexual identity and sexual behavior. Providers need to discuss sexual behavior with patients regardless of sexual identity in order to define risk-assessment, ascertaining what activities they engage in and to learn what they are doing to prevent the transmission of disease.

And for the majority of readers, as  patients we have a personal responsibility to find the courage to openly discuss in confidence all of our behaviors and desires with our doctors, nurses, therapists and counselors, etc. This is extremely important. We cannot rely on someone to read our thoughts and know the truth.

Stand up and be proud of yourself. I can almost guarantee that the person treating you has heard it all. And if they haven’t, they will soon enough.

HIV-positive Women Find Support In Dating Again

 

Being HIV-positive is a challenge. Being HIV-positive and single is often a nightmare. We all want to love and be loved, but the barriers- social and psychological- for HIV-positive persons are high. From The Seattle Times:

 

Like many women with HIV/AIDS, Nicole Price worried about love and life, post-diagnosis. She now counsels HIV-positive women on forging romantic relationships, knowing each time out that disclosing one’s status can be a deal-breaker.

 

In 2000, Nicole Price’s ex-boyfriend fell ill. They had recently ended a five-year relationship, so she went to see him in the hospital. He had AIDS.

English: HIV positive dating

She got tested. She was 24.

“It was the longest two weeks of my life,” said Price, now 37. We thought we would get back together because we both had it.”

At the time of her diagnosis, Price was using meth and living in California when her mother, a Bothell resident, learned about a Seattle-based support group for HIV-positive women.

Within two years, she packed her bags for Bothell for a fresh start.

Like many women with HIV/AIDS, Price worried about love and life, post-diagnosis. Once she settled here, she became increasingly involved with the support group, BABES Network-YWCA, eventually rising to program manager. Price now counsels HIV-positive women on forging romantic relationships, knowing each time out that disclosing one’s status can be a deal-breaker.

“They can stop having sex altogether and never do it again,” Price said. “Some of our women have chosen to be in a lesbian relationship. Actually quite a few of our women have. I think they feel that betrayal. They feel like maybe they got betrayed, and now they have issues when it comes to men.”

Trusting a sexual partner and dealing with rejection are regular topics at BABES.

Through peer counseling, support groups, educational lectures and retreats, BABES tackles the challenge of maintaining relationships — especially romantic ones — after testing positive. Women take part in mock disclosures, an exercise meant to ease the stress of telling a partner about being HIV-positive.

“I encourage women to date when they’re ready. I ask them questions to see if they’re ready. When do you want to disclose your status? Are you ready for the response?” said Brenda Higgins, a BABES peer advocate.

“I’m never ready for the response I’m getting,” she added. “There’s really no way of preparing someone with that.”

 

Read the full story here

Facebook: The Next Tool In Fighting STD’s?

Makes sense to me.

Salon.com: 

Imagine being able to download a Facebook app that would alert you to your sexually transmitted infection risk based on your friend’s status updates. This may sound far-fetched, and it still is, but as some researchers shift their focus to risk among friend groups, as opposed to just sexual partners, social networks are rapidly becoming a tool to prevent the spread of  (Sexually Transmitted Infection) STIs.

Peter Leone, a professor of medicine at the University of North Carolina’s Center for Infectious Diseases, is one of those experts. Earlier this month, he spoke at an international health conference and underscored the importance of exploring such possibilities. Real-world social networks — in other words, a person’s circle of friends and sexual partners — have already proved to be strong predictors of STI risk, he says. It follows that sites like Facebook, which convene all of those real-world connections in one virtual setting, have huge potential in this arena.

Leone found that when sexual partners of patients newly diagnosed with HIV came in for testing, 20 percent turned up HIV-positive. It might seem counter-intuitive to extend the targeted test circle to those a newly diagnosed patient is merely friends with, but people in the same social circle often sleep with the same people, and might engage in similar risk-related behavior. Instead of looking at people within a particular at-risk demographic, this approach allows them to target known clusters of infection.

Makes you think of the people on your “Close Friends” list a bit differently, doesn’t it?

Full story here