from Medical Issues

The author, Pauline Freedberg, began her discussion of homosexuality and health care by observing: "Sexual minority groups are reluctant to seek conventional medical care and to reveal their sexual orientation to health providers because of the fear of stigma and discrimination. ... In addition to disease, acts of domestic violence are a significant health problem that contributes to the mortality and physical health morbidity of sexual minorities."

Freedberg says that adult victims of Same-Sex Intimate Partner Violence (SSIPV) are fearful of getting help because of concerns over their sex partner being exposed; they also fear rejection, discriminatory treatment, judgmental attitudes and substandard care if they reveal their sexual orientation to health care providers.

She also notes that because members of sexual minorities do not have distinguishing characteristics that are easily identifiable like other minority groups, they are difficult for health care providers to discern. In addition, "Sexual orientation is not synonymous with sexual behavior and both can change over time. For example, one study reports that 77%-95% of women surveyed self-identified as lesbian, yet lifetime behaviors for approximately 80% of these lesbians included having sex with men."

Freedberg briefly discussed the prevalence of homosexuality in our society and reported that the latest studies estimate a 4-10% rate, "However, because of the sensitive nature of homosexuality and the continued bias and discrimination against sexual minorities, underreporting is likely..."

She outlined 12 myths about homosexuality and health care. Those myths are:

1. Homosexuality is pathologic.
2. Homosexuals and heterosexuals have equal access to health care.
3. Health professionals provide unbiased care.
4. Sexual orientation and behaviors to not affect health care.
5. Health professionals recognize that some patients are homosexual.
6. Intimate partner violence is a heterosexual women's issue.
7. SSIPV victims' issues and barriers to seeking care are not unique.
8. Screening for SSIPV lacks guidelines and is too time consuming.
9. Conducting a sexual assessment is offensive to individuals.
10. All health professionals possess cultural competence.
11. Health professionals are educated about domestic violence and homosexuality.
12. Health professionals are aware of their own biases.

In Number 4, she says: "Fact: Gays and lesbians are at increased risk for certain conditions related to sexual behavior rather than sexual orientation. ... Studies also indicate that gay men and lesbians are at increased risk for particular types of cancer and sexually transmitted diseases, depression, and the adverse effects associated with substance abuse."

She concludes her study by noting: "Gays and lesbians live in a hetero-sexist society. Nearly all of the health risks and barriers to accessing and receiving care that sexual minorities experience are associated with marginalization and homophobia, not homosexuality. The problems gays and lesbians experience in the health care system are not due to their sexual orientation, but rather to the health care provider's reaction to it (Namenek, 2001). Therefore, education and training for health professionals that dispels the myths and provides facts about caring for individuals in sexual minority cultures is necessary to reduce the barriers."

Updated: 8 February 2008

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