Infectious-disease physician Dr. Marc Tack speaks on the most pressing concerns for this often underserved population.
By Laurie Yarnell
The 16th annual National LGBT Health Awareness Week takes place this year March 26‑30. Created in 2003, the event is dedicated to increasing awareness and improving the overall health of the LGBTQ (Lesbian, Gay, Bisexual, Transgender and Questioning) community.
Marc Tack, DO, is the Medical Director of Infectious Disease at HealthAlliance Hospital: Broadway Campus and HealthAlliance Hospital: Mary’s Avenue Campus, both in Kingston and members of the Westchester Medical Center Health Network (WMCHealth). Here, he addresses key sexual- health issues for these patients. Many of these health concerns apply to all sexually active people. For more health tips on sexual health visit www.cdc.gov/sexualhealth.
What is the most pressing concern for the LGBTQ community when it comes to sexual health?
Finding a physician with whom he or she can comfortably discuss his or her sexuality. Patients need to feel that they can ask questions and discuss issues without being judged. And they need to be provided facts based on science and be counseled on risk avoidance.
What steps can they take to prevent sexual diseases?
Understanding how to advocate for themselves and understanding the true risks regarding sexually transmitted diseases is critical to staying healthy. There’s a segment of this community that at times has low self-esteem, and we need to help empower them to protect themselves and avoid STD exposure. In addition, physicians need to identify patients practicing high-risk behavior and counsel them, as well as bring them in for frequent screenings. PrEP or Pre-Exposure Prophylaxis — the use of anti-HIV medications to keep HIV-negative people from becoming infected — and other interventions, such as hepatitis vaccination, can lower risks. Providing access to free condoms is also an important step.
What symptoms should trigger a visit to a physician?
“Rashes, sexual discomfort, lesions, discharge, any unexplained weight loss, fever, fatigue or changes in behavior should trigger a doctor’s visit. And any exposure such as a sexual assault or a broken condom should lead to an emergency room visit, as there are potential interventions to protect a patient from HIV and other STDs — but time is critical.”
According to the Centers for Disease Control and Prevention (CDC), gay and bisexual men make up an estimated 2 percent of the U.S. population but account for 70 percent of new HIV infections. In addition, more than half of all new HIV infections occur among MSM, or “men having sex with men.” Why is the percentage of this population with HIV increasing?
There is a young generation of gay and bisexual men growing up in an era when HIV is perceived to be a chronic and treatable disease, and they’ve never experienced the devastation of the early AIDS epidemic. Men who survived the early epidemic are now often focused on different issues, such as same-sex marriage and gay rights, and do not wish to be identified as a community by the AIDS epidemic. Unfortunately, the advances we have made in treating HIV over the past 20 years have led to an ambivalence among young MSM.
What can these patients do to protect themselves from HIV?
They need to make good decisions and understand that HIV is still a very significant disease that will alter and likely shorten their lives — and it is avoidable. They should have an open discussion with a physician about risk aversion, safe sex and use of condoms. PrEP, the use of a daily medication to lower the transmission of HIV, also provides an opportunity to lower risk.
How is HIV treated in these patients?
HIV is treated essentially the same way across all patient types. There are many medication options available, and an experienced HIV provider will establish a relationship with a patient in which he or she could have an open discussion about which treatment choice will best fit the individual patient. It is not a one-size-fits-all process.
What other STDs are most prevalent within LGBTQ communities?
For MSM, there has been a significant increase in the rates of syphilis and gonorrhea. Transgender men and women will be at risk for STDs depending on his or her individual sexual practices. A transgender person who identifies herself as a woman and has unprotected sex with men will be at risk for infections such as syphilis, herpes, gonorrhea and HIV. Each situation would need to be evaluated on an individual basis with appropriate counseling regarding risk reduction. Lesbians are generally at relatively low risk for STDs if they are in a monogamous relationship, although there is still the risk of herpes.
According to the CDC, while anyone who has sex can get an STD, sexually active gay, bisexual and MSM are at greater risk. Why are STD rates so high for them?
There are several reasons. 1) There is a higher prevalence in this group, so the risk of exposure is higher. 2) There is a significant amount of substance abuse in this population, leading to suboptimal decision-making. 3).The use of condoms is not needed for birth control — only STD prevention — and thus requires an open discussion. 4) Anal intercourse inherently has a higher risk of STD transmission. 5) There is a culture of having multiple partners in a segment of this population that leads to increased risk of exposure.
What can these patients do to protect themselves from other STDs?
Condoms and “safe sex” are the first line of defense. Understanding the risk, getting appropriate vaccinations and regular physician visits are all steps a person can take to lead to better sexual health.
The LGBTQ community is far from a “one-size-fits-all” group. For more information about staying healthy sexually for lesbian, gay, bisexual, transgender and questioning patients, refer to the resources offered at www.cdc.gov/lgbthealth/.