Tuesday 30 May 2017

STDs and the LGBTQ Community

STD rates are on the increase; some may be attributed to online dating with an increase in opportunities for a “hook up” and is something that may impact the LGBTQ community more. Even though we say the LGBTQ community, treating it as a single group, STD rates and impact differ between each group within the LGBTQ community. 

Female to female transmission of STD is lower than in any other group (including those having heterosexual sex).

A study published by the American Journal of Public Health shows that “viral STD rates among bisexual-identifying women aged 15 to 44 years were almost three times higher than women who have sex with women exclusively.” But while we know that transmission rate is lower in female-female exclusive relations, this does not mean transmission can’t occur. Whenever there is any genital contact there is a risk. There is a risk with oral sex, contact with menstrual blood, vaginal secretions, or if there is use of sex toys.

Male to male transmission rates are the highest risk.

The CDC stated, “In 2014, gay, bisexual, and other men who have sex with men accounted for 83% of primary and secondary syphilis cases where sex of sex partner was known in the United States.”  Men who have sex with men (MSM) accounted for 63% of the estimated new HIV infections in 2010. The data shows that the rate of HIV in men who have sex with men (MSM) are 44 times higher than rates among heterosexual men and more than 40 times higher than women. According to the CDC “in the United States, approximately half of MSM with primary and secondary (P&S) syphilis were also living with HIV. In addition, MSM who are HIV-negative and diagnosed with P&S syphilis are more likely to be infected with HIV in the future.”

Homophobia, stigma and discrimination negatively influence the health of gay, bisexual, and other men who have sex with men, contributing to the spread of STDs in the LGBTQ community according to the CDC, this includes: 

  • Sex education classes don’t usually include discussions on non-heterosexual sexual activity.

  • Patients are less likely to mention their sexual orientation to the healthcare providers.

  • Healthcare providers may have their own bias against LGBTQ – therefore will not discuss safe sex practices.

  • STD testing and treatment have a stigma attached to them.

Higher rates of HIV and STDs among MSM increases the chances of meeting an infected partner and becoming infected. Why? People are not asking the important question of STD status before initiating sexual activity. Or safe sex practices are not being done - like not using condoms and having anal sex – both of which increase STD risk.

Case Scenario: Patient, (let’s call him AC), comes into the emergency room with “just not feeling right.” This has been going on for months, he can’t see a primary care physician because he has no insurance and doesn’t make enough to pay out of pocket. He presents with non-emergent symptoms – weakness, some weight loss and general malaise. Labs done showed low blood counts, the exam revealed anal warts, that led me to order an HIV screen. Rapid HIV comes back positive. Ultimately this young man is found to be HIV positive. Hopefully, if he can navigate the healthcare system or someone takes the time to help him he may qualify for Medicare/Medicaid. If not, he surely cannot afford the expensive HIV medications and ultimately, he may die.

What You Can Do About It  

  • Get tested regularly after a sexual encounter with someone new

  • Talk to your doctor about safe sex practices

If you suspect you may have an STD, besafemeds offers a discreet STD treatment option from the privacy of your own home at an affordable price, even if you don't have health insurance. ER Physician Dr. Segun Ishmael, who has over 20 years of healthcare experience, founded besafemds in 2016 to increase access to healthcare to those who are unable to unwilling to seek treatment, thus stemming the spread of STIs.



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