April is STD Awareness month. This article is one in a series published by Rewire in partnership with the National Coalition of STD Directors, focused on aspects of STD prevention, treatment and funding and the public health implications of neglecting STDs.
What happens in Wisconsin matters in California. And I’m not talking about the union wars.
What I am talking about, rather, is a recently published Wisconsin study, and what that study means for a bill related to lesbian, gay, bisexual, and transgender (LGBT) health that the California State Senate is now considering.
In the Wisconsin study, 271 HIV-negative gay and bisexual men were asked whether their doctor knew they engaged in same-sex sexual behavior, and whether their doctor had followed Centers for Disease Control and Prevention (CDC) guidelines by recommending testing for sexually transmitted diseases (STDs) and HIV and vaccination against hepatitis A and B.
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- Only about 30 percent said their doctors knew that they engaged in same-sex sexual behavior.
- Among men whose doctors knew that they engaged in same-sex sexual behavior, doctors recommended HIV testing, STD testing, and hepatitis A or B vaccination in only 59 percent, 50 percent, and 32 percent of cases, respectively.
- Men whose doctors did not know that they engaged in same-sex sexual behavior were much less likely to get those recommendations – four times less likely for HIV testing, three times less likely for STD testing, and two times less likely for hepatitis A and B vaccination.
The Wisconsin study is not the first to document deficiencies in LGBT healthcare, particularly for LGBT persons who have not disclosed their orientation to their doctors. But it is concerning, especially since men who have sex with men in the U.S., according to CDC, are over 40 times more likely than straight men to get HIV and syphilis. A host of other health concerns – some related to sexual health, some not – are also specific to LGBT persons.
The nation has taken notice.
The federal government’s Healthy People 2020 program specifically targets LGBT health, as does a recent Institute of Medicine report. The American Medical Association (AMA) has recognized that LGBT persons have unique healthcare needs and face substantial health disparities.
That brings us back to the California State Senate, which now has an important opportunity to act to improve LGBT health.
California Senate Bill 747 (SB 747) would require licensed healthcare providers – including physicians, nurses, and others – to complete a two- to five-hour course on cultural competency, sensitivity, and best practices for providing adequate care to LGBT persons. The content of the course would be modeled on continuing education materials developed by the Gay and Lesbian Medical Association (GLMA).
SB 747 was introduced by State Sen. Christine Kehoe (D-San Diego) in February and is sponsored by Equality California, an LGBT advocacy organization. Supporters include numerous healthcare providers and individuals and eight other organizations, including the California STD Controllers Association and GLMA.
Four clinicians’ associations in California have registered formal opposition to the bill, arguing (variously) that clinical training programs already adequately address LGBT health issues, that educational requirements should be directed only to training programs or to primary care doctors, or that states should not impose any content-specific continuing education requirements.
Those arguments don’t stand up.
First, LGBT health is not an educational priority in U.S. medical schools. Over half of medical schools surveyed in 1998 included no information about LGBT persons. And a quarter of medical schools surveyed in 2003 taught about sexual health, including taking a sexual history, for only six or fewer hours.
Second, focusing on current trainees would miss older healthcare providers, who need it the most. Data from the Wisconsin study showed that older providers are, in fact, more likely not to know that their gay or bisexual patients engaged in same-sex sexual behaviors. Furthermore, LGBT health concerns span a wide spectrum of diseases and conditions and include aspects of care, such as patient intake forms, common to the vast majority of healthcare providers.
Third, the burden posed by the bill’s requirements is small, and it should be balanced against evidence suggesting that such requirements can in fact be effective. Education can improve knowledge and attitudes toward LGBT health. That’s why the AMA has launched educational outreach efforts to physicians regarding LGBT health, and the Wisconsin study investigators and others have recommended prioritizing LGBT education for all healthcare providers. Importantly, continuing education requirements for healthcare providers have effectively changed provider practice patterns in other areas of healthcare.
So far, fortunately, SB 747 is doing well. Earlier this month the State Senate’s Committee on Business, Professions and Economic Development voted 6-2 in favor of the bill. The bill’s next stop is a hearing before the Senate’s Appropriations Committee, set for May 2.
By enacting SB 747 into law, California can – and should – demonstrate its commitment to leading the nation in improving the health of its LGBT residents. In doing so, California can teach Wisconsin a thing or two.