The health of a nation, physically and emotionally, can only be as good as the health of its most vulnerable and stigmatized citizens. While culture, class, and religion are known to affect how illness may appear and be understood, sexual orientation has been less well researched or understood as a mediator of health and illness. Yet, as every gay, lesbian, or bisexual (GLB) person knows, developing a relationship with a medical or mental health provider that truly addresses the entire well-being of the person requires the provider not only to be tolerant but also knowledgeable about sexual orientation and its...

Lesbian and gay health care concerns are now well recognized as an integral part of good medicine. There is, however, a dearth of information and teaching on the subject, and many providers have not been able to access information except for individual articles in journals. For that reason alone, this book is such a welcome and significant addition to the basic core of medical knowledge. Even more important, this text brings awareness of the lack of consistent, appropriate medical interactions between physicians and other health care providers and our patients and then concisely informs us how to overcome this lack...

At first glance, the health care needs of someone who is gay or lesbian appear to be no different from those of the general population. Everyone needs age-appropriate health education and treatment as well as the opportunity to explore preventive measures that can help maintain health. However, population health acknowledges that specific populations, such as gays, lesbians, and bisexuals, may have particular health needs that should be recognized and addressed. To date, surprisingly few guidelines exist for the clinician who wants to provide competent, sensitive care or for the teacher who hopes to help trainees examine their own attitudes toward...

Homophobia is the most significant health risk facing lesbians and gay men (see Chapter 1). Fear of homophobia and discrimination – often based on past experience – can prevent gays and lesbians from seeking health care. It is up to health care professionals and the health care system to regain the trust of patients with diverse sexual orientations and behaviors. This chapter briefly examines some of the literature on the relationship between lesbian and gay patients and the medical profession and suggests concrete ways to improve the provider–client relationship (OʹHanlan et al., 1997).

Surveys of attitudes of health professionals...

Although diseases and morbidities do not occur more frequently in lesbians than in women in general (in fact, lesbians may be at lower risk for genital tract disease than heterosexual women), lesbians do have distinct health risks and needs. This chapter briefly discusses the relationships between sexual identity, behavior, and health care and explores the unique physical and sexual health care needs of lesbians.

Lesbians make up an estimated 1.4% to 4.3% of the female population; yet very few clinicians realize that, during an average day, they will provide care for one or two lesbian women. Physicians simply assume that...

Although gay and heterosexual men are physically and anatomically identical, the life expectancy of gay men is twenty to thirty years shorter. The current average age of mortality in gay men is under 50 (Jalbert, 1999). Although AIDS-related mortality is a factor in the shorter life span of gay men, it is not the only threat to their health. Gay men are also vulnerable to cancers, cardiovascular disease, and other sexually transmitted diseases.

With the AIDS epidemic, gay male health has focused primarily on sexually transmitted diseases, particularly HIV (Jalbert, 1999), and prevention and treatment of other diseases has been...

Adolescence is a vulnerable time for all youth, regardless of sexual orientation. All teens experience body changes, a growing desire for autonomy, an increasing interest in sex and sexuality, disenchantment with adults, changing relationships with parents and siblings, pressure from peers to use alcohol and drugs, and concerns about school, career, and relationships. In terms of health care, adolescents are an underserved population: since 1950, they are the only population group that has not experienced an improvement in their overall health. Much of the morbidity and mortality that occurs in this age group is related to risk behaviors (such as...

Effective diagnosis and treatment of sexually transmitted diseases (STDs) is vital to patient health, regardless of sexual identity or orientation. STDs, uncomfortable diseases in and of themselves, can also have long-term negative effects on fertility and make people more vulnerable to infections such as HIV. Those STDS, such as herpes or syphilis, that lead to ulceration or inflammation of the genitourinary tract increase the risk of HIV transmission in men and women. Timely and effective STD care has the potential to improve physical and reproductive health and to reduce the spread of communicable diseases, including HIV. In fact, in Tanzania,...

HIV raises a number of complex issues and creates challenges for the people infected, clinicians, and other caregivers. This chapter discusses testing issues, counseling, and the role of primary care practitioners in treatment. Because of the rapidly evolving nature of HIV care, specific treatment protocols will not be covered. For up-to-date approaches to treatment, consult the following websites: AEGIS (www.aegis.com); AIDS Knowledge Base (www.hivinsite.ucsf.edu/Insite); The Body (www.thebody.com); CATIE (www.catie.ca).

Testing is a significant part of HIV care and prevention. It is the means by which people with HIV are diagnosed and are then able to receive the care they need....

Throughout the twentieth century, the attitudes of mental health professionals toward gay and lesbian sexuality generally followed the prevailing mores of the times, informed by dominant religious and judicial doctrine. The notion of bisexuality was largely ignored. Psychotherapists working within a homophobic and heterosexist culture, intellectual tradition, or institution have traditionally considered homosexuality to be an illness to be cured or sublimated. In fact, it was only in 1973 that the American Psychiatric Association removed homosexuality from its list of mental disorders. In 1975 the American Psychological Association adopted a resolution which stated that ʹhomosexuality per se implies no impairment...

Alcohol and drug use are serious issues in the lesbian and gay communities. This chapter looks at patterns of alcohol and drug use and discusses interventions that can be used to change addictive behaviors and reduce risk.

What is the incidence of substance use among gays, lesbians, and bisexuals? There appears to be no definitive agreement on levels of alcohol, tobacco, and drug use, and the literature provides a mix of findings, as outlined below.

Gay men and lesbians account for twice as many reported alcohol problems as heterosexuals – despite similar patterns of heavy drinking in each population (McKirnan...

For many lesbians and gay men, body image is part of their personal and sexual identity. This chapter looks at body image and body modifications.

Lesbian women are significantly heavier, have a significantly higher weight ideal, and aspire less to thinness than do heterosexual women (Herzog et al., 1992). Heterosexual women tend to be more concerned with appearance and weight, have higher levels of weight-related anxiety, and are more likely to diet than their lesbian counterparts (Gettleman & Thompson, 1993). Normal-weight lesbians demonstrate a higher level of body satisfaction than normal-weight heterosexual women (Herzog et al., 1992). Lesbians are also less...

Like all other people, lesbians and gay men must negotiate personal identity in the context of a series of relationships. This chapter looks specifically at the issues associated with same-sex couples, abusive relationships, workplace relationships, gay and lesbian friendships, and parenting and relationships with children.

Between 45% and 80% of lesbians and 40% and 60% of gay men are in steady relationships. Although these figures are quite high, they may underestimate the actual numbers of gays and lesbians in long-term couples because they are based on studies of a younger cohort (ʹSame-Sex Couples,ʹ n.d.). Gay and lesbian couples struggle with...

Physicians and other health care workers treating gay and lesbian patients often make a common error: they assume that the experience of being gay is similar for all and that progression through developmental milestones and responses to mainstream societal influences are fixed or shared. However, there is no one way to formulate a gay identity or self-concept. Color, race, religion, political milieu, family dynamics, gender, stature, able-bodiedness, and family obligations all play a role in sexual and societal affiliation. Yet mainstream urban gay culture does little to challenge this notion of a common gay identity. Community newspapers, magazines, even pornography...

The health care systemʹs ability to care for lesbian, gay, and bisexual patients is shaped by the training system, the practice environment, and the research agenda. This chapter explores the issues the health professions face in their collective mission to train skilled and compassionate caregivers, support their gay, lesbian, and bisexual colleagues, and conduct research relevant to the populations they serve.

Health care professionals spend many years in training. During those years, they learn much of the content they need to practice within their discipline, and they develop attitudes and values that will shape how they practice. The content of...

Because in most jurisdictions same-sex couples cannot legally enter into marriage, they are excluded from rights enjoyed by married couples and must take steps to protect themselves, their partners, and their families. Legal implications of this difference in rights may profoundly affect same-sex partners and their children (Gruskin, 1999). Differences in rights can also have a serious impact in health care settings. For example, in the absence of documented instructions, a same-sex partner may have no say in the selection of health care providers or treatment facilities and no role in treatment decisions. He or she may also be denied...