An NHS doctor at his keyboard. Photo: Computeractive
For many gay men and lesbians, healthcare of a life enhancing quality remains a dream instead of a reality. Every human being on this planet has a right to appropriate and sufficient health care to preserve their life. Their sexuality or wealth has nothing to do with their right.
How the Health Service treats gays
Here are the words of the British Medical Association, who regulate doctors:
In Good Medical Practice, the General Medical Council states that ‘You must not refuse or delay treatment because you believe that a patient’s actions have contributed to their condition. You must treat your patients with respect whatever their life choices and beliefs. You must not unfairly discriminate against them by allowing your personal views (this includes your views about a patient’s age, colour, culture, disability, ethnic or national origin, gender, lifestyle, marital or parental status, race, religion or beliefs, sex, sexual orientation, or social or economic status) to affect adversely your professional relationship with them or the treatment you provide or arrange. You should challenge colleagues if their behaviour does not comply with this guidance.’
Similar advice is given to nursing staff by the Royal College of Nursing.
The nursing care of lesbian and gay male patients or clients (downloads pdf file).
Those are all fine words but there are patches of the health service where they remain just that – fine words. The reality did not match the words for the gay patient who booked in at reception only to overhear a member of staff say to another, “That poof has come for his appointment.”
The National Health Service has come a long way in understanding the actual and unmet needs of gay and lesbian patients – not surprising, since so many gay men and lesbians have made it their career and can advise their colleagues – but the BMA and RCN both admit they still have more to do.
Gay and lesbian patients can help service practitioners improve by suggesting ideas and improvements. If the service you receive does not meet the high standards of professionalism you are entitled to receive you should complain to the practice manager in the first instance. All good surgeries should be able to give you a copy of their complaints handling procedures and policies.
The gay lifestyle can harm you
Unfortunately the gay lifestyle and the pressures of society on gay people can cause health problems for gay men in particular. Having good health is important for everyone, because the better condition your body is in, the better it is able to cope with infections and disease. Gay men who suffer from common health problems or who have generally poor health are more at risk than others in the population. Research in 2009 found that:
Gay men who contact HIV…
if they are under weight, are three times more likely to die of HIV;
if they have diabetes, are 80% more likely to die and 50% more likely to develop HIV Aids;
if they have high blood pressure (hypertension), they have a 50% raised risk of death in general, with 2.2 times the risk of death from cardiovascular disease and three times the risk of death from liver disease;
if they have Hepatitis C they are 45% more likely to die if they have liver-related health issues, which were four times more common in people with hepatitis C;
if they have Hepatitis B they are 30% more likely to die and have double the risk of liver death;
Eighty-three per cent of deaths from liver disease were in people with hepatitis B or C;
Smoking brings a 60% raised risk of death from cardiovascular disease and non-AIDS cancers, and having smoked, doubles the risk.
Note: you can be immunised against Hepatitis B.
Immunisation against Hepatitis B
Frightening, isn’t it, and it underlines how devastating poor health care and bad health can be to gay men in particular.
Healthcare issues concerning gay men and lesbians
There are an assortment of healthcare issues concerning gay men and lesbians. The main ones are:
access to healthcare;
confidentiality of records and information;
reluctance to access healthcare and advice;
equality of treatment;
recognition of family and partner;
prevention of disease and cancers;
discrimination against gay men giving blood and bone marrow;
cultural competence;
fear of harm from a homophobic member of staff;
frequent changes of doctor providing treatment and the need to come out to each new doctor.
Gay Men Reluctant to see GPs
For years gay men have been reluctant to go to see a GP. Nearly ten years ago Sigma Research found that less than half of gay men in the UK were out to their doctor,, while a third would not wish their surgery staff to know they were gay. Only 7% of gay men go to their GP for a sexual health check or HIV test.
GUM and sexual health Clinics
GUM clinics at hospitals in major cities have long been popular with gay men, and the clinics usually do not require prior appointments, nor do you have to be referred to them by a GP: you can just walk in. GUM clinics are an N.H.S. run clinic for all aspects of sexual health. You can go to any GUM clinic anywhere in the country. You will be seen by a proper doctor – you can ask to be seen by a male or a female doctor – and the doctor will look at your general health as well as your sexual health, but they are really there to provide sexual health services. They can refer you to other departments of the hospital for certain tests or procedures or support. They have a wider variety of resources and facilities available to them than an average GP in a GP doctor’s surgery would have.
By law your G.U.M. clinic records cannot be shown to your doctor or insurance companies. They are used to seeing gay men and lesbians in confidence. You do not have to give them your real name if you do not want to. However they may need to write to you – for instance if you need a scan appointment or similar – and it helps if you do give them your real name and address. They will not disclose those details.
But if you are referred to the clinic by a GP, that does not apply and the clinic will write to your GP to tell him what treatment they have given you.
Computerisation of records
Some gay patients may have worries about the computerisation of patient records and the sharing of information between their GP’s surgery and the wider realms of the NHS. There is a computerised ‘Patient Summary Care Record’ which can be made available to other practitioners in the NHS. The patient has the right, on demand, to be removed from the sharing arrangements for the Patient Summary Care Record. Just ask at your surgery and they will note your wishes.
Healthcare of older gay men and lesbians
In his study Overcoming barriers for older gay men in the use of health services: A qualitative study of growing older, sexuality and health, David Clover found that older gay men and lesbians may view health services with caution, having experiences of, or expectations of, discrimination or poorer quality care or treatment. Older gay men may not disclose their sexuality to health providers and may find some needs unmet, particularly around areas of partner and other social relationships. Policy makers and practitioners need to address the current silence around ageing and sexualities in health services policy. Services need to consider whether they are best responding to the needs of older gay men in their communities, ensure cultural competence, and make efforts to demonstrate that they are seen as open to or accepting of gay men, and to recognise the particular needs that older gay men may experience.
Prostate Cancer
As many gay men who have been living with HIV get older, more and more of them are now being diagnosed with prostate cancer. Malecare identifies the need for doctors and carers to be aware of the needs of gay male patients who may have no family support network, the need to ask questions to allay fears that the treatment will affect the patient’s sexlife, etc. Offer your patient the opportunity to speak with you, alone…even if he presents with his wife and declares him in a heterosexual marriage. Many men do not consider themselves gay, but they do enjoy sex with other men, often in secret. We all want our patients to feel comfortable reporting their symptoms from their own person context and set of goals. … Our gay patients face a special challenge in reporting their goals and symptoms. With very little preparation, we all can make our gay patients feel safe, listened to and well treated.
Prostate cancer kills about 10,000 men a year in the UK and more than half of those cases are diagnosed in men over the age of 70. It is the most common form of cancer in men.
The prostate is a small gland that is found only in men. It is as big as a walnut and is found between the penis and the bladder. It surrounds the urethra, the tube that carries urine from the bladder to the penis, and its main function is to help produce semen. The prostate provides a fluid into semen during ejaculation that activates sperm and prevents them sticking together. The fluid has high concentrations of substances including potassium, zinc, fructose and citric acid, which are drawn from the bloodstream.
The gland does not stop growing, although it grows very slowly; difficulties arise when it gets big enough to put pressure on the urethra, causing problems in urination. That condition is known as benign prostatic hyperplasia or prostate enlargement.
Many men live with that condition with no symptoms and never need treatment. In itself it is not cancer. But cancer can develop in the prostate. If the cancer spreads from the prostate – a fast growing cancer needing urgent treatment – symptoms appear such as bone and back pain, loss of appetite, pain in the testicles and unexplained weight loss.
There is a blood test called the prostate-specific antigen (PSA) test which can determine whether your prostate is likely to develop problems. There is a web site with more information about the PSA test here. The PSA test is not perfect but it’s the best test we currently have. It is not a test for prostate cancer. It’s a test for abnormalities of the prostate, one of which may be cancer.
The Department of Health says that any man over 50 who would like the PSA test can contact their GP who will then discuss the pros and cons of the test with them. If the man decides he would like to go ahead with the test then his GP will arrange it for him. Alternatively, the PSA test is widely available for a small charge at many pharmacies and private clinics.
There are a range of treatments available for the condition. Most patients at first go on to an “active watch” where they have regular tests to measure the rate of growth and determine whether other treatments are appropriate for them.
A naturally occurring chemical called lycopene, which is found in tomatoes, tomato sauce, watermelon, pink grapefruit, guava, and apricots is thought to help defend the body against prostate cancer, but experts agree that further research is required.
Research in 2003 found that cancer-causing chemicals could build up in the prostate if men do not ejaculate regularly. Those who had ejaculated the most between the ages of 20 and 50 were the least likely to develop the cancer.
The protective effect was greatest while the men were in their 20s.
Fighting discrimination in the NHS
“Everyone has the right to be treated equally, regardless of their sexual orientation. Doctors and patients should feel safe and confident when they are in hospitals and surgeries,” says Dr Vivienne Nathanson, the BMA’s Head of Science and Ethics launching new BMA Guidance. The BBC reports that doctors as well as patients face discrimination based on sexual orientation. This discrimination is now illegal and doctors must do more to fight it, says the BMA.
The NHS currently uses an estimate that at least 1 in 20 of the population are lesbian or gay – so an increased awareness that colleagues and patients may not be heterosexual is crucial to treating each other sensitively and respectfully.” said Dr Rachel Hogg, co-chair of the Gay and Lesbian Association of Doctors and Dentists
Gay men Giving Blood
The UK Government decided in April 2011 that the outright ban amounted to discrimination and breached equality laws. The amended rules took effect on 7 November 2011 and permit donations from gay men who have abstained from oral or anal sex with or without a condom for one year. It is noted that donors will be trusted to tell staff the truth.
In most other countries the ban remains in force, but following Britain’s move, Gay Activist hopes that other countries will also make their rules less discriminatory.
It should be noted that the ban on gay men giving blood is not the end of the matter; gay men also face other donation issues. Gay men who wish to donate bone marrow cannot do so via the NHS but may do so through the Anthony Nolan Trust, who require a lifestyle questionnaire to be completed by donors.
Eating disorders and homosexuality
Ideal body: or, peer pressure, eating disorder, mental health issue, body image issue?
There is widely reported evidence that gay men are up to twice as likely as straight men to face problems with eating and their self-image and weight, and be dissatisfied with their bodies. Eating disorders can be brought on by gay culture (the need to have attractive and thin bodies, defined muscles etc); identity and sexuality crises, and problems accepting that you are gay.
Research in 1990 concluded that gay men weighed significantly less and were more likely to be underweight and to desire an underweight ideal weight than straight men. Compared to the heterosexuals, homosexual men were less satisfied with their body build, and scored significantly higher on the “Drive for Thinness” scale of the Eating Disorders Inventory.
A 2002 International Journal of Eating Disorders report found that 20 percent of gay men are anorexic, and 14 percent suffer from the related eating disorder bulimia. Source.
That research was updated in 2011, and found that 48% of gay men would sacrifice a year or more of their lives up in exchange for their perfect body. 10% of gay men would agree to die more than 11 years earlier if they could have their ideal body now. Nine in ten gay men admit they enforce “unrealistic” images of lean and muscular men in conversation. Only a third of straight men said they would give a year or more for an ideal body shape, and 77% admitted buying into the body image ideal. Gay respondents were consistently more affected by body concerns and more likely to make body comparisons than straight men, and were also significantly more likely to use what the study authors called “body talk”: speech that implicitly or explicitly reinforces or endorses the traditional western standard of male attractiveness: tall, lean, muscular, toned body with clear skin and a full head of hair. Source.
The warning signs of anorexia are:
You have lost 15 to 20 percent of your body weight.
Friends say you’re too skinny, but when you look in the mirror, you can’t see it.
You’re preoccupied with thoughts about food and calories.
When you’re hungry but don’t eat, you feel a sense of victory.
You weigh yourself a lot.
You feel bloated or nauseated after eating only a small or normal amount of food.
You feel cold when the air temperature is normal.
Anorexia is a serious disease that causes unnecessary suffering and, in extreme cases, even death. Treatment options are available; start by talking to your doctor. Recovery will greatly benefit your health, make you look and feel much better.
Bullying causes problems later in life
Research published in 2011 indicated homophobic bullying is directly linked to long-lasting physical and psychological conditions in gay men and lesbians.
The signs of a stroke or mini stroke
Every year, 65,000 people in the UK will experience a stroke or a mini stroke. Sometimes the effects only last for a short time, then pass, and in those cases medical attention is not always sought. Here are the warning signs that you must get the person suffering the symptoms to a doctor immediately:
The Stroke and mini-stroke warning signs (FAST signs)
Face: facial weakness – can the person smile? Has their mouth or eye drooped?
Arm: does it show weakness? – can the person raise both arms?
Speech: problems – can the person speak clearly and understand what you say?
Time: time to call 999
Other symptoms of a mini stroke or a stroke include weakness, numbness, pins and needles on one side of the body (an arm, leg or face), blurred or disturbed vision in one or both eyes, sudden memory loss or confusion, slurred speech, or difficulty finding words.
Other sources
NHS Healthy Weight calculator enables you to calculate roughly how healthy you are from your height and your weight.
Page updated 5 May 2012
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