Text last updated 15 October 2017
Links last updated 15 October 2017
Newsbiscuit | Unknown photographer | 14142
What this is about
This page contains information about the gay community’s experience of medical services and healthcare professionals and information on a number of medical topics of interest to the gay community.
In the UK there has been significant progress in the appropriate treatment of gay and lesbian people in the health service; activists in other countries may find this page useful as an indication of the minimum level of service they should expect in their own countries.
Health services as experienced by the gay community
The gay community worry about their health and how they will be treated by healthcare professionals. For many of us, healthcare of a life enhancing quality remains a dream, not a reality. We all have the right to appropriate and sufficient health care to preserve life. Our sexuality or wealth has nothing to do with that.
In “Good Medical Practice”, the General Medical Council of the British Medical Association tells doctors, nurses and all other healthcare staff how their patients should be treated. Similar advice is given to nursing staff by the Royal College of Nursing. Your Activist finds that the codes of practice are now widely followed by NHS staff.
Sometimes receptionists are not as well trained. One 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.
In 2012 Stonewall found that one third of gay and bisexual men who accessed healthcare services had a negative experience because of their sexuality.
One third of gay and bisexual men have not told their GP or healthcare professionals they are gay or bisexual. They are more likely to be out to their manager, work colleagues, family and friends than their doctor.
Just over a quarter of gay and bisexual men said their healthcare professional acknowledged they were gay or bisexual after they had come out, and just 1 in 10 were told that their partner was welcome to be present during a consultation. One in four said healthcare workers had given them information relevant to their sexual orientation.
The GP surgery for one in five displayed a policy stating that they would not discriminate against people because of their sexual orientation, while just under half of doctors had a clear policy on confidentiality.
Gay and lesbian patients can help services improve by suggesting ideas and improvements. If the service you receive does not meet the high standards of professionalism you are entitled to receive, and you have not been satisfied with the way you have been served, complain to the practice manager. All good surgeries should be able to give you a copy of their complaints handling procedures and policies. Don’t ask whether your partner is welcome to attend your consultation: just go in together. If there is a patients’ liaison committee, consider taking part.
How the gay lifestyle affects health
The gay lifestyle and the pressure society puts on gay people can cause health problems, especially for gay men. Having good health is important 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; if they have diabetes, are 80% more likely to die and 50% more likely to develop HIV Aids; if they have high blood pressure 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.
4 out of 5 deaths from liver disease were in people with hepatitis B or C. You can be immunised against Hepatitis B. Immunisation is free.
Smoking increases the risk of death from cardiovascular disease and non-AIDS cancers by 60% while having smoked doubles the risk. Smoking cannabis is 20 times more likely to cause lung cancer than smoking tobacco.
The NHS finds that sexually active gay men are more likely to get cystitis than other males. Cystitis, inflation of the bladder, is most noticed when passing urine, because the urine is too acidic. This can often be triggered by over consumption of fruit juices, spicy food or coffee, and is easily treated by drinking water and taking pain killers such as paracetamol.
Healthcare issues concerning gay men and lesbians
The main issues concerning gay men and lesbians 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 (although with improved NHS record keeping this is becoming less of a problem).
Gay Men Reluctant to see GPs
A decade ago Sigma Research found that less than half of gay men in the UK were out to their doctor, and a third would not wish their surgery staff to know they were gay. Only 7% of gay men went to their GP for a sexual health check or HIV test. Refreshment of this research is overdue.
In 2012 Stonewall found that one in four gay and bisexual men have never been tested for any sexually transmitted infection, and nearly a third of gay and bisexual men have never had an HIV test in spite of early diagnosis now being a public healthcare priority.
Identifying as gay to your GP
From 2019, depending on whether your health trust has opted in to the exercise, you may be asked by your GP to record your sexuality on your NHS records. This is to ensure you receive the correct health care, to ensure that all gay people receive appropriate treatment and to ensure that the NHS is meeting its diversity objectives. You do not have to state your sexuality if you do not wish to, it is optional.
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 usually has.
By law your G.U.M. clinic records cannot be shown to your doctor or insurance companies. The doctors in the clinics 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, but 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.
In July 2017 the World Health Organisation warned that a number of cases involving a superbug strain of gonorrhoea, an STD, which is resistant to all current treatments, have now been recorded. Gay men are warned to always use a good quality condom, even with sex toys, and make sure all sex toys are thoroughly cleaned before and after use.
Computerisation of records, privacy and opting out
You may be worried about the computerisation of patient records and the sharing of information between your GP’s surgery and the wider realms of the NHS, and researchers from charities, drug companies and the like.
The computerised ‘Patient Summary Care Record’ may be made available to other practitioners in the NHS. You have the right, on demand, to opt out from the sharing arrangements for the Patient Summary Care Record. Just ask at your surgery and they will record your instruction on the system.
Be aware that opting out means Accident and Emergency Departments will not have immediate access to your computer records in an emergency: they will have to telephone your doctor, to find out what medications you are on, for example. The service providing you with emergency care may request your specific permission to access the data, so that they can provide the care.
Contact your surgery and express your wishes.
Older citizens in the gay community
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.
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,” said Dr Vivienne Nathanson of the BMA. Doctors as well as patients face discrimination based on sexual orientation.
The NHS estimates 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 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 the truth. The changes in the law apply to England and Wales, Scotland and Northern Ireland.
In many other countries the ban remains in force, but following Britain’s move, there are now pressure groups in other countries to have the ban lifted or modified, and in some countries it now has been.
A working group of the Advisory Committee on the Safety of Blood, Tissues and Organs reviewed the deferral period in which men cannot give blood within 12 months of having sex with another man, and concluded that it should be reduced to three months.
Improved testing measures can establish whether someone has HIV, hepatitis B, hepatitis C or syphilis inside three months.
Their recommendation was accepted by the Government and on 23 July 2017 it was announced that the revised deferral period of three calendar months comes into effect from the autumn of 2017.
Comparing the health of the gay community with the health of the general community
Stonewall found that over half gay and bisexual men have a normal body mass index compared to less than a third of men in general.
Only one in four gay and bisexual men are overweight or obese compared to seven out of ten men in general. Only one in four gay and bisexual men get 30 minutes of exercise five or more times a week compared to four in ten men in general. One in four gay and bisexual men think they have “fair” or “bad” health, compared to one in five men in general.
Most gay and bisexual men have never discussed heart disease with a healthcare professional and four out of five have never discussed high blood pressure or high cholesterol.
UK Health Minister Steve Brine has announced the timetable for a major trial into pre-exposure prophylaxis (PrEP) drug Truvada.
Truvada is a pill taken before sex which has already been shown to reduce the risk of infection with HIV in high risk persons by 86%.
The trial is expected to begin during August 2017, and at least 10,000 people are expected to be enrolled over the next three years of the trial.
Up to £10 million has been made available to fund the three year trial.
Daily Mail, No date: HRT patches may help prostate cancer
Royal College of Nursing (downloads pdf)
Avert, No date: Hepatitis A B and C explained
Health Educational Journal, No date: Overcoming barriers for older gay men in the use of health services: A qualitative study of growing older, sexuality and health
NHS Healthy Weight calculator
Horncastle News, No date: NHS ‘failing gay and bisexual men’
50 ish, No date: The 7 Most Common STDs that Middle-aged Men Catch
Avert, No date: UK HIV and AIDS Statistics Key Figures
Malecare, No date – Prostate cancer and doctors
NHS Choices, No date: Cystitis
Macmillan Cancer Care, No date: Understanding the PSA test
BBC News, 16 July 2003: Masturbation ‘cuts cancer risk’
BBC, 20 June 2005: Gay patients’ discrimination fear
Guardian, 18 July 2010: People with HIV face more problems from living longer
National Aids Map, 6 Jan 2011: UK Gay Men’s Sex Survey: new data on age, strategic positioning, condom failure and HIV testing
Daily Telegraph, 10 April 2011: Homosexual men allowed to give blood but sex banned for decade
Guardian, 24 Apr 2012: NHS is failing gay and bisexual men
Guardian, 10 June 2012: Medical body in fight to extend HPV vaccination to gay men
US News, 20 July 2012: Biology Leaves Gay Men Highly Vulnerable to HIV: Study
BBC News, 4 August 2012: Edinburgh study pinpoints prostate cancer ‘growth’ gene
NHS Choices, 10 Oct 2012: Does high blood pressure cause prostate cancer?
Pink News, 30 January 2013: Terrence Higgins Trust launches postal HIV home sampling kits
Channel 4 News, 1 Feb 2013: Level of HIV infection among gay men ‘not falling’
Guardian, 31 March 2013: Surviving prostate cancer: a prostate surgeon’s story
CBC, 18 May 2013: WHO concerned coronavirus spreading person to person
BBC News, 2 Sep 2013: Shingles jab campaign for people in their 70s
Independent, 19/01/14: Experts warn of rise in gay ‘slamming’
The Independent, 2 Feb 2014: Cervical cancer vaccine for girls must be given to gay men due to increase in anal cancer, says BMA
BBC, 18 Feb 2014: Giant NHS database rollout delayed
Independent, 23 Feb 2014: Thousands of HIV patients go hungry as benefit cuts hit
Guardian, 8 April 2014: First British study of ‘chemsex’ reveals gay men taking serious risks with their health and with HIV after using drugs
BBC News, 11 April 2014: Prostate cancer tests miss severity in half of cases
Independent, 17 May 2014: Make new HIV protection pill available on the NHS, say sexual health campaigners
LGBT Aging Center, undated: Ten things gay men should know about heart disease [downloads pdf]
American Heart Association, 26 June 2015: LGBT health disparities the ‘next frontier’
The Register, 7 July 2016: UK.gov’s hated Care.data project binned
Independent, 6 May 2017: Government set to make it easier for gay men to give blood
Guardian, 7 July 2017: Untreatable Gonorrhoea superbug spreading around the world, WHO warns
Guardian, 23 July 2017: Gay men to be able to donate blood three months after sex
Refinery, 15 October 2017: NHS England Sexuality Guidelines