The Preconceived Patient
#PrideMonth #Pride2018
As a gay man, I’ve noticed that there are a lot of misunderstandings about how being gay relates to health, especially sexual health. Hopefully by reading this, you will gain some insight into this unfortunately taboo topic.
I’d like to start off by acknowledging that there are quite a few gay stereotypes out there, ranging from something you see on Modern Family or RuPaul’s Drag Race, to propaganda about spreading the “gay agenda.” When approaching a homosexual patient, friend, or family member, please throw those preconceived notions out the window.
Here’s a fair rule for just about any interaction you’ll ever have in life: don’t make assumptions about a person before you actually meet them.
People often think I’m heterosexual when we first meet, and tend to be surprised when they find out that I am gay. I don’t seem to fit many people’s idea of a typical “gay guy” in the way I look and act. This is frustrating, because this sort of bias is endemic and carries over into healthcare settings as well. People will often approach someone differently based on their sexual orientation.
During the “AIDS epidemic” there was a correlation between being a gay male and HIV infection. To reiterate, this is correlation, not causation. For those who may not understand the difference, here is an example of correlation: Hamburger sales and polar bear deaths have both increased over the last 20 years. Therefore, polar bear deaths must cause an increase in hamburger sales. Sounds silly, right?
HIV was able to spread quickly through the homosexual population for two main reasons: the prevalence of unprotected sex, and the smaller population of gay communities. The thought of using condoms to prevent STI’s wasn’t very prevalent at the beginning of the AIDS epidemic. Instead, condoms were used primarily to prevent pregnancy, and since biological males cannot become pregnant, condoms generally didn’t seem necessary to gay men. Compounding that fact, gay communities tend to be fairly small. Epidemiologically, STI’s spread through small populations faster than they would in a larger population. In conjunction with the lack of barrier-based protection (compared to the sexually active heterosexual population who used it to avoid pregnancy), the chances of spreading an STI are much higher in gay populations.
“Remember, a man loving another man doesn’t increase his risk for HIV infection; unsafe sexual practices do.”
Today, with increased awareness, safer sexual practices, and treatment/prophylactic options, the AIDS epidemic has been greatly diminished. The risk of infection is by no means gone, but it would be incorrect to assume that a gay person is at an increased risk of HIV infection because they are gay. Being gay does not automatically mean that a person engages in high-risk sexual activities. For all you know, they may be monogamous and in better health than most of the country. Remember, a man loving another man doesn’t increase his risk for HIV infection; unsafe sexual practices do.
So, as a physician, ask about sexual practices the same way you would ask a heterosexual man.
“Are you sexually active? Are your partner(s) male or female? Do you use condoms? Have you ever been screened for STIs?”
You’ll come to find that people’s answers might surprise you. For those who are at high risk, prophylactic treatment options now exist. PrEP, or Pre-Exposure Prophylaxis, is a once daily pill that helps prevent HIV infection. Such options should be discussed among individuals engaging in high risk sexual activities.
If someone expresses concern about HIV or other STI’s, don’t be afraid to bring these options up. Just be aware that this may be a sensitive subject to some people, and should not be taken lightly.
Remember, a gay man is someone’s brother, father, son, or best friend. He may be a construction worker, a lawyer, a doctor, or a business owner. Most importantly, he is a person who wants to live a long and healthy life, just like anyone else.
Information of PrEP: https://www.cdc.gov/hiv/risk/prep/index.html
Thomas Rehder
Osteopathic Medical Student - 2nd year (OMS II)
College of Osteopathic Medicine
Pacific Northwest University of Health Sciences