Such stories, in addition to highlighting ongoing issues of discrimination, make me wonder about access to health care among LGBT individuals. If a same-sex couple is worried about being denied visitation rights, is a same-sex attracted man or woman less likely to seek health care in general for fear of discrimination? Taking a step back from that, are LGBT persons less healthy overall than their heterosexual counterparts? Do health disparities exist based on sexual attraction/behavior/identity? (For more on health disparities, you can nerd out and read this article from the National Institutes of Health.)
The topic of health disparities has been on my mind for several weeks now. Just going off of recent RFAs (that's requests for applications, and I really will try to avoid jargon), disparity seems to be a huge buzzword at NIH these days. There’s been a lot of work on health disparities based on race and ethnicity, a bit based on socioeconomic status, and very little based on sexual minority status.It’s kind of startling, particularly given that recent estimates hold that same-sex attracted individuals make up a considerable minority of the American populace. Just because I think it’s interesting, I’ll link to this article on estimated numbers of LGBT individuals worldwide.
While not quite the 10% estimated by Kinsey, the more recent projection of 8+ million is nothing to scoff at. Further, those numbers indicate that there are more LGBT persons living in the U.S. than persons of Asian descent.
So there is at least an indication of inequality in health care access and (perhaps) physical health among sexual minorities. There are a lot of LGBT individuals potentially impacted by this inequality. But what do I actually mean when I talk about health disparities? What form might these disparities take? I am thinking of two major areas of physical health disparity that are observable in sexual minority populations:
1. Sexually transmitted infections and HIV. This one’s a gimme. Though rates of HIV infection are rising among other populations, including women and African Americans, same-sex male sexual contact remains the #1 vector for HIV transmission in the U.S., and men who have sex with men (or MSM) remain the group most impacted by the HIV epidemic. Beyond just HIV, MSM are more heavily impacted by syphilis (which has been all but eliminated among other sociosexual groups), Hepatitis C, etc. So you have more same-sex attracted men affected by sexually transmitted infections than heterosexual men. A clear disparity.
2. Cancer. This one is more of a surprise. With HIV, the vector of transmission and the increased incidence rate are tightly linked. HIV in the U.S. has historically been viewed as a “gay disease” (and, in the 80’s, a Haitian/hemophiliac/drug use disease). But cancer can strike anyone, at any time, for any reason! California has signs posted everywhere that entering any building (including our apartment complex!) can expose you to known carcinogenic agents!There is no immediately apparent reason why LGBT individuals would be more likely to be diagnosed with cancer. And yet, according to Ulrike Boehmer, they are.
Gay men are nearly twice as likely to report a cancer diagnosis as heterosexual men, in fact. And though lesbian women are no more likely to report having cancer than heterosexual women, their health post-cancer is worse. Another clear disparity.
I didn’t know what to make of this finding, and so I acquired my own gigantic population-based dataset (albeit not as big as Boehmer’s). And I replicated the finding: gay men are more likely to report a cancer diagnosis than straight men. They are not more likely to report any other health issue, including hypertension, diabetes, high cholesterol…though, of course, they are more likely to report having had an HIV test in the past year.
So what are we to make of this difference? Why would gay men be more likely to report cancer diagnoses than straight men? And what keeps the incidence of HIV infection so disproportionately high among MSM?
