Addressing the Health Needs of


Gay and Lesbian Patients


Minority Health Perspective by Matthew Murguia


Closing the Gap, The Problem of Accessing Health Care • August/September 1999


When it comes to gay and lesbian health issues, the first 

topic that often comes to mind is HIV/AIDS. But as more 

and more research shows, gay and lesbian health issues 

include more than AIDS. 

While gays and lesbians suffer from the same health issues as 

other individuals, issues such as substance abuse, mental health, cancer, suicide, and smoking may affect gays and lesbians disproportionThe Gay and Lesbian Medical Association (GLMA) also recently 

highlighted the need for more research on this issue in its response to 

the U.S. Department of Health and Human Services’ draft Healthy 

People 2010 (HP2010) for the nation. 

Nearly 400 comments on the need to address gay and lesbian 

health issues were submitted during the public comment period, 

many by GMLA and its members. GLMA was especially concerned 

ately. We don’t know for sure because not enough research has 

been done. 

Combine these concerns 

with health care access issues that 

racial and ethnic minorities face 

and the social stigma that still surrounds homosexuality, and you 

“The issue of cultural competency as it relates 

to gays and lesbians may be a new concept for 

many, but it is an important step in ensuring 

effective provider-patient interaction.” 

that gay and lesbian health issues 

were only addressed in the objectives related to HIV/AIDS. 

GLMA recommended that 

measures dealing with sexuality be 

incorporated into HP2010 areas 

such as sexually transmitted diseases, injury/violence prevention, 

end up with a potent mix of factors that impact the health of gay and 

lesbian minorities. 

Last year, the policy committee of the Gay and Lesbian Medical 

Association discussed the “Catch 22” that lesbian, gay, bisexual, and 

transgender patients face. First, in order for their specific health needs 

to be adequately addressed, gays and lesbians must discuss their sexual 

orientation with their health care provider. But by doing so they risk 

facing hostility, denial of care, and substandard care. 

Unless a gay or lesbian patient knows that a health provider will 

treat them with the same respect and dignity that all patients deserve 

(and the literature suggests that the health field is still not gay “friendly”), 

many gays and lesbians will continue to conceal their sexual orientation, especially in situations where the patient does not get to choose 

the doctor. 

Other articles in this issue of Closing the Gap highlight the challenges of improving access to health care for racial and ethnic minorities. Issues such as insurance coverage, cultural and linguistic competency, institutional policies, and the “isms” are all important. However, 

rarely is homophobia or training on gay and lesbian issues addressed 

in medical schools or health care settings. 

Not enough data 

The lack of training for health professionals may be due in part to 

a lack of data about specific health care needs of gays and lesbians, and 

whether being gay or lesbian increases one’s risk for certain diseases or 

health conditions. 

A recent report from the Institute of Medicine, Lesbian Health: 

Current Assessment and Directions for the Future, underscored that while 

lesbians were not at higher risk for any particular health problems 

because of their sexual orientation, some risk factors for certain diseases 

may be more common among lesbians. One key finding of the report 

was the lack of data on the role that sexual orientation 

may play in access to health care. 

substance abuse, access to quality health services, health communication, and tobacco use. 

Other public comments focused on a report that showed that up 

to one third of youth who attempt suicide do so because of issues 

dealing with sexuality, and the need for HP2010 to track this health 

measure. 

Dangerous assumptions 

Without data, health care professionals operate in a vacuum that 

may lead to assumptions about patients and their needs, including 

assumptions about a person’s sexual orientation. This in turn may 

mean that treatment decisions are based on assumptions and not on 

fact. 

For example, health care professionals may assume that because a 

person is male and married, he has not engaged in sexual activity with 

other males. Or, health professionals may assume that because a woman 

acknowledges she is a lesbian, she has not engaged in sexual activity 

with men. This may mean that a full sexual history will not be obtained, and risk factors for STDs and other issues may not be identified. 

In Health Care News of Gay Men and Lesbians in the United States 

(Report 89 of the Council of Scientific Affairs), the American Medical 

Association (AMA) committed to taking a leadership role and called 

for educating physicians on the current state of research in and knowledge of homosexuality, along with the need to record an adequate 

sexual history. 

AMA states that these efforts should start in medical school, but 

must also be part of the continuing medical education. It also stressed 

the need to educate physicians about recognizing the physical and 

psychological needs of gay and lesbian patients. The AMA encouraged physicians to seek out local or national experts in the health care 

needs of gay men and lesbians so that all physicians will achieve a 

better understanding of the needs of this population. 

continued on page 2>>>> 

Office of Minority Health Resource Center 1 U.S. Department of Health and Human Services 
Addressing the Health Needs of


Gay and Lesbian Patients


Minority Health Perspective by Matthew Murguia


Closing the Gap, The Problem of Accessing Health Care • August/September 1999


Steps toward improvement 

One area where additional work is 

needed is in the training of health care professionals on how to interact with gay and 

lesbian patients in a fair and nonjudgmental 

way. The issue of cultural competency as it 

relates to gays and lesbians may be a new 

concept for many, but it is an important step 

in ensuring effective provider-patient interaction. 

The first step in this process will be for 

health care providers to learn about the specific health care needs of gays and lesbians, 

and then to put that training into practice. 

Training could be offered to current students 

through the current health professions training programs educational system, and for 

those who are already involved in health care 

delivery, offered as CME and CEU credits 

required as part of ongoing staff training. 

Nine ways to improve care for gay and 

lesbian patients 

1.	 Make sure all staff—from the janitor to 

the doctor—understand that a patient’s 

known or perceived sexual orientation 

should not have any effect on how patients are treated or services provided. 

2.	 Teach health care providers to ask about 

sexual history rather than make assumptions about a patient’s sexual orientation. 

3.	 Promote the use of “gender-neutral” 

terms between patient/provider to enhance the level of communication. 

4.	 Make and distribute gender-neutral 

brochures and materials so the patient 

will feel more comfortable and can identify with health messages. 

5.	 Consider posting a statement of nondiscrimination based on sexual orientation in the patient waiting and exam 

rooms. 

6.	 Prior to taking a sexual history, repeat a 

pledge of confidentiality. 

7.	 Participate in training on gay and lesbian health concerns conducted by local gay and lesbian health organizations. 

8.	 Make an on-site resource directory available for use in referrals to other providers in case a patient decides to obtain a 

specific service elsewhere. 

9.	 Conduct patient satisfaction surveys 

with gays and lesbians who have disclosed their sexual orientation to determine if there are ways to improve health 

services. 

All patients, regardless of sexual orientation, face myriad challenges in navigating the 

health care system. Regardless of whether a 

patient has private insurance or receives services through publicly funded sources, each 

deserves to be treated with dignity and respect. It is in the best interest of both the 

provider and patient. 

Specific action should be taken to ensure that all patients, regardless of sexual orientation, feel free to share risk factors without concern for how a health care provider 

will react. Research that focuses on health 

needs of gays and lesbians must be enhanced 

so that special needs can be identified and 

addressed. That research must be translated 

into practice.

New Study on Patient/Physician Relationships 

African American patients rated their visits as less participatory than whites in models adjusting for age, gender, education, marital status, health status, health status, and length of the patient-physician relationship, according to a study published in the August 11, 1999 issue of the Journal of the American Medical 

Association (JAMA). 

Researchers also found that patients seeing physicians of their own race rate their physicians’ decision 

making (PDM) styles as more participatory. 

Researchers conducted a telephone survey between November 1996 and June 1998 of 1,816 adults 

aged 18 to 65 years. 

This study shows that female physicians had more participatory visits with patients than male physicians. The authors suggest that all patients prefer participatory visits because patient satisfaction was linked to 

PDM scores for patients across all ethnic groups. 

Researchers recommend patient and physician interventions to improve communication in primary 

settings. This requires interventions that empower minorities to become more involved and active consumers 

of care, along with increasing the number of minority physicians. 

The authors also state that communication training programs for medical students, residents, and practicing physicians emphasize the importance of understanding our increasingly diverse population.

Office of Minority Health Resource Center	 2 U.S. Department of Health and Human Services