Post-election, many of us in the medical field have become ever more aware of the somber sentiments expressed by the groups that were rhetorically and literally targeted throughout the election cycle. Many of us are women, immigrants, people of all faiths, people of color, refugees, disabled individuals and members of the LGBT community. We understand that policies and hateful rhetoric impact us, impact our colleagues, impact our families and impact our patients. We can see how the communities we serve have already started to be affected by this election.
The history of the HIV/AIDS epidemic is marked by devastating losses and a disease burden that persists to this day. Though slow to emerge, both government policy and pharmaceutical research began to address the epidemic, and the resulting combinations of antiretroviral cocktails and outreach programs have helped make HIV infection a manageable, if inconvenient, chronic condition. In 2012, however, the FDA approved a drug that had the potential to shift both the American and global strategies regarding HIV and AIDS.
The interpersonal ease needed to establish trust between patient and provider might come easily to some, but is only the first barrier. As physicians and physicians-in-training, we ask patients to disclose uncomfortably thorough social and sexual histories which often go beyond the limits of our own experiences. Then we critique them, offering suggestions for risk reduction based on our medical expertise. In order to do this effectively, we are asked to know a lot about communities to which many of us are not members.
As a native New Yorker, I was thrilled when last month Governor Cuomo announced plans for an executive order that prohibits discrimination against transgender people. This executive order would apply to issues such as employment and housing, expand existing anti-discrimination protections to include gender identity, transgender status and gender dysphoria.
In July 2015, I attended a three-day Movement for Black Lives Convening in Cleveland, Ohio, where I — along with the other attendees — was charged with articulating how I would support making spaces safer and more inclusive toward trans, gender-queer, gender nonconforming, intersex and two-spirit people. On the second day, in a plenary session with approximately 800 people in the auditorium, we were asked to turn to the person next to us and state what we were planning to do when we got home to act on our commitments.
“Are you sexually active?” / His stethoscope gleamed in the light / Of the hospital room.
Just last month, the Supreme Court issued a ruling declaring bans on same-sex marriage illegal. While many hail this as a major step in the quest for equality, equity in health outcomes is still lacking in the lesbian, gay, bisexual, and transgender community. Many clinicians and prospective clinicians do not receive significant training in how to address the unique needs of members of the LGBT population.
“Which one of you idiots gave my patient a homosexual dose of diuretic?” Unbelievably, this is what the senior surgeon “growled” at Dr. Pauline Chen and her cohort during surgery training, according to her article in The New York Times entitled “Does Medicine Discourage Gay Doctors?”
By way of 1992 policy, men who have had sex with men (MSM) any time since 1977 are ineligible for blood donation. We believe the current policy is possibly justified, but certainly inconsistent with other CDC donation policies, and the the American Medical Association and the American Association of Blood Banks appear to agree. Here we will focus primarily on the latter issue, as it pertains to everyone’s health more so than only the degrading feeling that non-infected gay men likely endure when attempting to give lifesaving resources back to their community.
Starting an LGBTQ student group… Leading sensitivity or safe-space training sessions… Overhauling the LGBTQ health curriculum… Planning and promoting a visiting lecture series… These are but a few of the tried-and-true techniques to promote a safe and enriching environment for medical students and faculty of sexual and gender minority groups. They’re also a lot of work. If you’re short on time and resources but care a whole hell of a lot about promoting LGBTQ health …
Approximately 3-5% of the population in the United States identifies as homosexual or as having sex with a person of the same gender at some point in their life. That is approximately eight to 12 million individuals. In comparison, the population of Boston, MA is around four million people. Los Angeles, CA has a population of approximately 10 million. These statistics suggest that engaging in sex with a partner of the same gender or being transgender is not uncommon.
Let’s keep it real: this is a long piece and you have to study, dear medical student. But just for a moment, I’ll ask you to think upon your own LGBT medical education experience. Do you feel prepared? Do you know what to ask? Do you know how to ask it? The answers to these questions may vary from an enthusiastic “yes” to “I have to study now” to “…no.” Regardless of where you fall, …