Sexually Transmitted Diseases

Resources

Hepatitis in LGBT Populations

There are five different viral strains of hepatitis, and each form causes inflammation in the liver, with some forms resulting in long term liver disease. The risk of contracting the disease is increased substantially based on behavior such as unprotected sex, sharing needles in intravenous drug use, contact with infected blood, body fluids, and feces. The American Liver Foundation reports (MSM) and intravenous drug users who are at high risk for HIV/AIDS are at equally high risk for Hepatitis B infection. (American Liver Foundation, 1997)

First, to overview each strain of the virus, Hepatitis A (HAV), the least severe of the strains, is transferred through drinking water or food that is contaminated with fecal matter. Also, HAV can be found in raw shellfish. A person can be infected with HAV via saliva or anal sex, and resulting symptoms are much like the flu. Hepatitis B (HBV) transmission occurs by coming in contact with an infected person's blood or body fluids such as semen, vaginal secretions, saliva, breast milk, tears, and open sores. HBV is not as easily detected because the carrier may be asymptomatic. The American Liver Foundation estimates that more than a million people carry HBV, and some 200,000 develop serious liver disease from HBV. (American Liver Foundation, 1997)

Hepatitis C (HCV) can cause cirrhosis or scarring of the liver. Chronic HCV can result in liver cancer. It is estimated that 3.9 million Americans are chronically infected with HCV, which is transferred through infected blood. Persons at risk for HCV are patients who had blood transfusions prior to 1990, intravenous drug users, health care workers, laboratory technicians, and those who have tattooing or body piercing.

Hepatitis D (HDV) is commonly found among intravenous drug users, and Hepatitis B must be present to be infected with HDV. Hepatitis E is different from the other strains and cases occur in developing countries more than the United States. Hepatitis B, C, and D strains can exist in the body indefinitely and longer after treatment.

The current treatment recommended by the Centers for Disease Control and Prevention (CDC) for chronic Hepatitis C includes interferon alpha-2b and interferon alpha-2a administered in a six month period. Approximately 10 to 15 percent of patients have sustained wellness following treatment. Others will have relapses of the disease.

Although it has been recommended that sexually-active gay and bisexual men be immunized against HBV since the 1980's, and HAV since the mid-1990's; the prevalence rate of vaccinations is not known. (Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concern, January 2000) In a 1996 study sample, the CDC found only 3 percent of young MSM (men who have sex with men) were vaccinated against HBV. In another study conducted by San Francisco's Department of Public Health, researchers found 20 percent of the 385 young MSM have previous or current HBV infection, and 3 percent were positive for anti-HB's alone (Lesbian, Gay, Bisexual, and Transgender Health, January 2000). Of the remaining 77 percent who were neither vaccinated or infected, 80 percent reporting having had anal sex or injecting drugs in the preceding 6 months (Lesbian, Gay, Bisexual, and Transgender Health, January 2000).

Not unlike other areas of health, lesbians and heterosexual women have not been the focus of clinical studies to examine their sexual practices and behaviors in relation to HIV/AIDS. The risk is similar to men for intravenous drug users and women who are exposed to anyone carrying the Hepatitis viral strains. This is particularly true for lesbian and bisexual women who are having sex with men, even occasionally. The National Lesbian and Bisexual Women's Health Survey reported 16 percent of 6,146 respondents were having sex with both male and female partners. Many women reported cases of sexually-transmitted diseases from their female partner including 135 reports of herpes, 102 reports of chlamydia, 100 contracted genital warts, 16 reported gonorrhea, 9 women contracted hepatitis, and one person was infected with HIV. (Lesbian Health, 1999)

Many women are unaware of hepatitis infection, especially if they are asymptomatic or they may be experiencing flu-like symptoms. After sustained symptoms, they may consult a physician, and not every health professional checks the blood on first visit to rule out possible hepatitis infection. Moreover, there are no studies examining female-to-female transmission of HIV, which could also provide statistics on the prevalence of hepatitis among lesbians. Again, more clinical trials should target LGBT persons to get a larger picture of how hepatitis is impacting this community.

Resources

Featured Resource: GLMA White Paper
http://www.glma.org/policy/whitepaper/hpwp.html
This report discusses the health of lesbian, gay male, bisexual and transgender (LGBT) individuals. This grouping includes diverse and varied populations that often share little more than society's stigma and prejudice. Stigma, however, as well as a range of other social and cultural factors, are forces that impact both the health of LGBT people and the ability of health care providers to care for them in myriad ways.

Hepatitis C, by Dr. C. Everett Koop
http://www.epidemic.org

Hepatitis, What is it?
http://www.glma.org/hepatitis/whatis.html

Obesity and Eating Disorders in LGBT Populations

One-third of American adults battle with obesity, and not unlike the larger society, this problem is experienced by significant numbers of LGBT persons. Besides genetic predispositions, there is a host of psychological and cultural factors attributed to obesity in LGBT populations. Obesity is associated with overeating, which is linked to mental health, i.e. depression, Post-Traumatic Stress Disorder (PTSD), dissociative behavior, and other problems. Given the preponderance of media and advertising images in the larger society that designates thinness as the standard of beauty, it is not surprising that for many LGBT people, the dichotomy between body image and actual body size and shape plays a significant role in the development of eating disorders. Moreover, many closeted LGBT persons experience a myriad of mental health concerns as a result of homophobia in mainstream society. For some bisexual and transgender persons this can also happen within the LGBT community. Similarly, LGBT persons who are from communities of color experience racism within the ranks of LGBT populations.

There have been numerous studies, which examine linkages between eating disorders, gender, and sexual orientation. Some studies reveal homosexual men and heterosexual women are more likely to have eating disorders. (APA Monitor, 1997) A 1988 study hypothesized that "if eating disorders result from dissatisfaction with one's body stemming from the discrepancy between one's real body type and a socially-prescribed body type, then heterosexual women and gay men would be the most predisposed to eating disorders." (Web site-Mental Health) In this study, the hypothesis was true.

It should be noted that often lesbians are stereotyped as women who are not as concerned about their physical appearance. Yet, a 1992 study published in the International Journal of Eating Disorders (vol. 11, no. 3, pp. 253-259) comparing lesbians, heterosexual women, gay men, and heterosexual men revealed that lesbians and heterosexual women were more discontent with their body images, they and engaged in dieting more than gay or heterosexual men. Researchers of the study add, "while heterosexual women and gay men said they were more concerned with their weight than lesbians or heterosexual men, gender was a more salient factor than sexual orientation on most variables." (Brand, Rothblum, et al., 1992)

In a study that examined bulimia nervosa and binge eating among 203 lesbians, the rate of bulimia nervosa was similar among heterosexual women and lesbians, but binge eating occurred more often. (Heffernan, International Journal of Eating Disorders, 19/2: 127-138) The study adds, "self-esteem was significantly related to body esteem, and actual-ideal weight discrepancy was associated with body dissatisfaction."

From 1980 to 1994, a study was conducted at Massachusetts General Hospital in which 135 men were treated for eating disorders. Of this number, 27 percent identified as homosexual, and 42 percent of bulimic patients identified as gay or bisexual men. (Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concerns, January 2000, p. 29)

When exploring eating disorders and body images among LGBT youth, a 1988 survey of 30,000 Minnesota students (grades 7-12) (Neumark-Sztainer, Story, Resnick, et al., 1998) found that "homosexual boys were more likely to report a poor body image, frequent dieting, binge eating, and purging or vomiting. However, lesbian girls were more likely to have positive body images than their heterosexual counterparts, but are no less likely to report disordered eating behaviors such as bingeing or purging." (Rogers, Resnick, Mitchell, et al., 1997)

Clearly, greater investigation is needed to better understand and effectively address the links between obesity and eating disorders among LGBT persons.

Featured Resource: GLMA White Paper
http://www.glma.org/policy/whitepaper/hpwp.html
This report discusses the health of lesbian, gay male, bisexual and transgender (LGBT) individuals. This grouping includes diverse and varied populations that often share little more than society's stigma and prejudice. Stigma, however, as well as a range of other social and cultural factors, are forces that impact both the health of LGBT people and the ability of health care providers to care for them in myriad ways.

Cancer and LGBT Populations

It is believed that LGBT populations are generally at greater risk for certain forms of cancer because they see physicians less often for preventative and diagnostic care. Stigmatization rooted in homophobia causes significant numbers of LGBT people to hide their sexual orientation, and consequently they are less likely to seek the care of health professionals. For example, there are reported cases of lesbians experiencing inadequate care during gynecological exams after disclosing their sexual orientation. (Norman Institute, 1999) Under such circumstances, lesbians are not as inclined to see physicians and have screenings as regularly as their heterosexual counterparts. While marginalization effects the rate at which lesbians will seek medical care, a Boston Lesbian Health Project survey found that those surveyed have "healthy behaviors in general and utilize routine health screening." (Women & Health, February 1999)

The National Cancer Institute estimates that one in eight women will develop breast cancer in her lifetime before 50 years of age. (Institute of Medicine, Lesbian Health, 1999) Although much greater study is needed, lesbians are believed to be at higher risk for breast cancer as a result of smoking, inadequate diets, obesity, fewer pregnancies, and they are less likely to seek early diagnosis screening. Researchers postulate that hormonal changes during pregnancy and the production of breast milk help to protect the woman's body against breast cancer. (Norman Institute, 1999) Lesbians continue to face obstacles in the social welfare system when opting to adopt children. Today, more and more lesbians are choosing parenthood through insemination. Even with the recent increase in inseminated pregnancies, lesbians are not as likely to have children, and therefore they will ovulate during the menstruation years more than heterosexual women. Researchers theorize that the development of certain cancers are linked to how often a woman ovulates, according to a study published in the Journal of the Gay and Lesbian Medical Association. To date, however, there are no epidemiological findings to support the assumption that lesbians are a high-risk group for developing breast cancer. Yet, there is a perception in the lesbian community that they are more likely to develop cancer than heterosexual women. (Lesbian Health, 1999)

Lesbians are at risk of cervical cancer, although heterosexual women are at greater risk since this form of cancer is usually associated with unprotected sex with multiple male partners and sexual intercourse at an early age. (Lesbian Health, 1999) It should be noted that most lesbians have a previous sexual history with male partners. Human Papillomavirus (HPV) can cause genital warts, which are linked to cervical cancer. Although some studies reveal no significant difference, some research data indicate that lesbians get Pap tests less frequently than heterosexual women. (Lesbian Health, 1999)

In the earliest years of the AIDS epidemic, the rate of Karposi's sarcoma (KS) was thousands of times greater among gay men than the general population. (Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concern, January 2000) Along with KS, non-Hodgkin's lymphoma rates increased significantly between 1973 and 1987, according to a study published in 1991. While KS rates have reduced significantly due to antiretroviral therapies, non-Hodgkin's lymphoma continues to effect HIV-positive persons at a higher rate.

In addition to KS and non-Hodgkin's lymphoma, gay men are at higher risk for anal cancer. A research study found anal cancer was associated with a history of anal intercourse. (Daling, et al., 1987) Also, gay men are among the high-risk groups for HPV, which is related to a history of receptive anal intercourse, use of recreational drugs anally, and multiple sex partners.

Transgendered persons are also at risk for cancer development due to many of the aforementioned reasons experienced by lesbians and gays, but to a greater extent. Gender definitions are changing in today's society as evidenced by "non-conformity" to traditional notions of female and male. In 1999, the American Public Health Association put forth recommendations to address the specific health needs of transgender persons including usage of the terms MtF [Male to Female] and FtM [Female to Male] to refer to transgender individuals. (Lesbian, Gay, Bisexual, and Transgender Health: Findings and Concern, January 2000)

Certainly many more clinical studies are needed to effectively examine the prevalence of cancer among LGBT populations, and to seek avenues of prevention and wellness.

Featured Resource: GLMA White Paper
http://www.glma.org/policy/whitepaper/hpwp.html
This report discusses the health of lesbian, gay male, bisexual and transgender (LGBT) individuals. This grouping includes diverse and varied populations that often share little more than society's stigma and prejudice. Stigma, however, as well as a range of other social and cultural factors, are forces that impact both the health of LGBT people and the ability of health care providers to care for them in myriad ways.