LGBTQ+ Health Care Needs: What Are They?

Mental health is a major focus of care among LGBTQ+ individuals. Many people in the LGBTQ+ community are at higher risk for depression and anxiety, often stemming from fear of discrimination or actual experiences of rejection.

“It’s unfortunate that despite all the progress that we’ve made, there is still a lot of discrimination,” says Brian Kim, MD, a family medicine physician and HIV specialist at Scripps Coastal Medical Center Hillcrest.

“A lot of people still live in the closet, especially while they’re still young, and there is increased depression and anxiety in the community,” Dr. Kim says. “It’s something that we definitely pay attention to when we see our patients. We check in with them.

“The people who are actually the happiest are the people who have completed their process of coming out and are able to live the lives that they wanted to live. We see more issues with people who have not been able to come out because of fear of discrimination or rejection,” he adds.

According to the American Cancer Society, lesbian and bisexual women may have a higher risk of breast, cervical, and ovarian cancer. Surveys show they are less likely to receive routine health care, including screening tests, compared to other women.

They are more likely to smoke, be overweight, use drugs or alcohol, and have children later in life, which are cancer risk factors in women.

Transgender individuals often struggle with gender dysphoria. “Gender dysphoria is feeling depressed or anxious about the gender you were born into, but you identify with another gender,” explains Dr. Champaneria.

“These patients can feel lonely, anxious, depressed. It’s important for them to seek the correct care for that, meaning a mental health professional, a social worker, a psychiatrist, even a family medicine doctor.

“Access can be a problem. But once they find the right physicians and the right practitioners — who can help prescribe their hormones, who can help them with their mental health and finding the right surgeons — that will provide them the best care possible.”

Transgender individuals may seek medical and surgical treatments, including hormone therapy and gender-confirming surgery, as part of their care. Prior to surgery, individuals should be emotionally prepared for their gender affirmation process, accordng to Dr. Champaneria.

Anyone who is sexually active can get an STI. However, certain groups are at higher risk. They include gay and bisexual men, and transgender women.

The most common STIs are chlamydia, gonorrhea and syphilis, which are bacterial infections. STIs are also caused by viruses, including HIV and human papillomavirus or HPV.

STIs are very treatable, especially when caught early, including HIV, the virus that causes AIDS. While there is still no cure for HIV and AIDS, new medications have made them easier to handle.

Pre-exposure prophylaxis (PrEP) is a prescription drug that helps prevent HIV infection. Postexposure prophylaxis (PEP) is for those who don’t have HIV but may have been exposed to it.

“With the evolvement of newer anti-retrovirals, we’re really not seeing the death sentence that we used to see in the past with HIV. It’s become more of a chronic disease, very manageable,” says Dr. Kim.

“There are still some challenges with HIV,” he adds. “There is increased risk of cardiovascular disease, and more premature aging with HIV, but besides that, it’s come a long way.”

Dr. Kim recommends those at highest risk to be tested for STIs as often as needed, and at least once a year.

Condoms are recommended to prevent infections spread through body fluids, including HIV, gonorrhea and chlamydia. However, they may not be as effective in preventing diseases like herpes and genital warts that spread through skin contact.

Gay, bisexual and other men who have sex with men are at higher risk of anal and throat cancers from HPV. The HPV vaccine can help prevent these types of cancer.

Screening may involve an anal pap test. An anoscopy may also be performed. This test examines the lining of the anus for signs of pre-cancer or cancer.

This population is also at higher risk of getting viral hepatitis, including Hepatitis A, B and C, which are liver diseases. Vaccinations are recommended for hepatitis A and B. There is no vaccine for Hepatitis C, but there are new treatments that work well.

Health care providers sensitive to LGBTQ+ needs can be found in many places. Scripps has repeatedly been recognized as a leader in LGBTQ health care equality.

The LGBTQ+ Healthcare Directory is a free online list of medical professionals who have an understanding of the unique health concerns of LGBTQ+ individuals.

Dr. Champaneria says it’s helpful if LGBTQ+ people can find a physician who is sensitive to their health needs or is a member of their community.

“It would be great if they are part of the LGBTQ community but that’s not a mandatory requirement. Just make sure you are comfortable with whoever you seek care with,” he says.

Watch the San Diego Health video with host Susan Taylor discussing LGBTQ+ health issues with Drs. Champaneria and Kim.