Marion County Public Health Department, Epidemiology Request DR2370
Prepared by: Sara J. Hallyburton and Tammie L. Nelson, MPH, CPH
The Marion County Public Health Department’s Ryan White Services Program oversees Ryan White Part A, C, and Minority AIDS Initiative grants in the Indianapolis-Carmel Metropolitan Statistical Area (MSA). These programs serve the needs of persons newly infected or living with HIV and out of care and/or uninsured or medically underserved.
About LGBT Health: People who identify as lesbian, gay, bisexual, or transgender fall under the umbrella term known as LGBT. While grouped under this acronym, each individual within the LGBT community differs in race, ethnicity, age, socioeconomic status, and identity.1 They are bound together as social and gender minorities by shared experiences of discrimination and stigma.1 Individuals within the LGBT community experience social inequality, which can be associated with less than adequate health status and an increased risk for health problems as compared to their heterosexual peers.2 The viewpoints and needs of this group should always be considered in public health efforts to improve health and reduce health disparities.2
HIV in Men Who Have Sex with Men (MSM): Although anyone, LGBT or not, can be infected with HIV, MSM are disproportionately affected. According to the Centers for Disease Control and Prevention (CDC), 13-24 year old MSM remain the most heavily affected population with HIV.3 The number of new HIV infections among U.S. MSM increased 12% from 2008 to 2010; with a 22% increase in those ages 13-24.3 While MSM represent roughly 7% of the U.S. male population, they accounted for 78% of new HIV infections in men.3 Not all men who identify as gay and bisexual with HIV are getting the health care they need. Of gay and bisexual men with HIV, only: 77.5% were linked to care (received their first HIV primary care visit within 90 days of diagnosis); 50.9% stayed in care; 49.5% received a prescription for antiretroviral therapy (ART); and, 42% are virally suppressed (Figure 1).
HIV among Transgender People: People who identify as transgender are also considered at high risk for HIV in the U.S.4 According to the CDC, transgender women are at high risk for HIV infection, and Black/African American transgender women have the highest HIV positivity rate from among all race/ethnicities.4 There have been many challenges in the prevention and treatment of HIV in transgender people. Currently, efforts are being taken to improve the quality of HIV data collected on transgender communities.4 In addition, the CDC and its allies are looking into a high-impact prevention approach to promote the goals of the National HIV/AIDS Strategy and increase the success of current HIV prevention approaches among transgender people.4 Visit HIV among Transgender People to learn more about what the CDC is doing in this area.
Creating a Welcoming Environment for LGBT Patients: LGBT health care training could be more thorough during medical and nursing school programs. In fact, a recent report stated that an average of only five hours is spent on LGBT issues during clinical training at medical schools in the U.S. and Canada.1 That said, there are many resources available to aid clinicians in the understanding and care of LGBT patients; some examples follow.1
Implementing Curricular and Institutional Climate Changes to Improve Health Care for Individuals Who Are LGBT, Gender Nonconforming, or Born with DSD: A Resource for Medical Educators – Association of American Medical Colleges (2014)
Advancing Effective Communication, Cultural Competence, and Patient- and Family-Centered Care for the Lesbian, Gay, Bisexual, and Transgender (LGBT) Community – The Joint Commission (2014)
The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding – The National Academies of Sciences, Engineering, and Medicine (2011)
The Health of Sexual Minorities Public Health Perspectives on Lesbian, Gay, Bisexual and Transgender Populations – Meyer & Northridge (2007)
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Sources:
1 Ard, K., & Makadon, H. (n.d.) Improving the health care of lesbian, bisexual and transgender (LGBT) people: Understanding and eliminating health disparities.
2 Centers for Disease Control and Prevention. (2014). About LGBT Health.
3 Centers for Disease Control and Prevention. (2015a). HIV incidence – Men who have sex with men.
4 Centers for Disease Control and Prevention. (2015b). HIV among transgender people.
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