American College of Physicians statement

In April 2015, the American College of Physicians (ACP) publicly recognized that there are disparities in health care experienced by the LGBT community and made a series of recommendations to achieve equity for LGBT patients in the healthcare system.163 The 9-point position paper recommended that medical schools, hospitals, and all medical facilities adopt gender identity as part of nondiscrimination policies. It urged comprehensive transgender healthcare inclusion in public and private health insurance plans. They advocated that the definition of family should be inclusive of all those of the patient’s choice, regardless of biological relationship. The ACP also announced its support for civil marriages of same-sex couples, more research into health disorders of LGBT patients, and recruitment of LGBT medical students, residents, and practicing physicians. In addition, the ACP announced its opposition to the conversion, reorientation, or reparative therapy of individuals with LGBT identity.

Conclusions

A pervasive heterosexual bias exists in healthcare delivery in the United States. LGBT individuals have unique health problems and make up a sexual minority that is underserved. Taking a detailed sexual history is important in order to assess risk of health problems for LGBT patients. Questions should be specific in order to identify the anatomic sites from which to collect specimens for STD testing and cancer screening. Clinicians need to be sensitive that patients may not be comfortable talking about their sexual history, sex partners, or sexual practices until trust is developed.


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Specific issues should be taken into consideration for MSM, WSW, and transgender persons. MSM are at particularly high risk for many STDs, HIV infection, and anal cancer. It is important to dispel the commonly held belief that the transmission of STDs in WSW is negligible. Women are infrequently advised about how to engage in safe sexual activity with other women. Also, WSW erroneously believe they do not need cervical cancer screening and Pap tests. Transgender individuals have a higher rate of STDs and HIV, compared with the general population. For transsexual individuals, clinicians need to be aware of the specific types of surgical procedures that have been performed. It is important to screen transsexual individuals according to their unchanged anatomy as well as their reconfigured anatomy. Within the whole LGBT community, mental health issues are common, often due to the prejudice these individuals face at the hands of others.

Alexandra Gillespie is an honors student at Villanova University, and Theresa Capriotti, DO, MSN, CRNP, RN, is a clinical associate professor at the Villanova University College of Nursing in Pennsylvania.

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