Analysis Sexual Health

For LGBT Health, What Happens in Wisconsin Shouldn’t Stay in Wisconsin

Kenneth Katz

A recent study on LGBT healthcare in Wisconsin underscores the importance of passing a proposed law in California to improve the health of its LGBT residents. In doing so, California can teach Wisconsin a thing or two.

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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The results:

  • 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.

News Law and Policy

Wisconsin Can’t Enforce GOP’s Voter ID Law in November

Jessica Mason Pieklo

Republican lawmakers in other states, like Ohio, have turned up almost nothing during lengthy investigations into claims of voter fraud.

A federal judge in Wisconsin on Tuesday ruled that voters unable to comply with the state’s photo ID requirement be allowed to vote in November, striking a blow to conservative efforts to drive down Democratic voter turnout in the state.

Tuesday’s decision, issued by Judge Lynn Adelman, did not strike the law, but instead carved out an exception, ruling that voters who are unable to obtain an ID be permitted to sign an affidavit testifying to that inability and receive a ballot to vote. “Any voter who completes and submits an affidavit shall receive a regular ballot, even if that voter does not show acceptable photo identification,” according to Adelman’s decision. “No person may challenge the sufficiency of the reason given by the voter for failing to obtain ID.”

Conservatives in Wisconsin, including former Republican Party presidential candidate Gov. Scott Walker, proposed the measure, arguing it was necessary to prevent voter fraud.

Republican lawmakers in other states, like Ohio, have turned up almost nothing during lengthy investigations into claims of voter fraud.

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“Although most voters in Wisconsin either possess qualifying ID or can easily obtain one, a safety net is needed for those voters who can’t obtain qualifying ID with reasonable effort,” Adelman wrote. “The … affidavit option is a sensible approach that will both prevent the disenfranchisement of some voters during the pendency of this litigation and preserve Wisconsin’s interests in protecting the integrity of its elections.”

Adelman declined to apply the photo ID exception to the state’s August primary, ruling state officials would not have enough time to prepare for it.

The fight over Wisconsin’s voter ID law goes back to 2011, when attorneys from the American Civil Liberties Union and National Law Center on Homelessness and Poverty sued, arguing the law violated both the U.S. Constitution and Section 2 of the Voting Rights Act.

Adelman initially blocked the law, but the Seventh Circuit Court of Appeals reversed that decision and sent the case back to Adelman for another look. That left the requirement in place for Wisconsin’s presidential primary in April.

Tuesday’s ruling means those who were unable to comply with the photo ID requirement can still cast a ballot in the November 8 presidential election.

News Contraception

New Hawaii Law Requires Insurers to Cover a Year’s Supply of Birth Control

Nicole Knight Shine

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills.

Private and public health insurance must cover up to a year’s supply of birth control under a new Hawaii law that advocates called the nation’s “strongest.”

The measuresigned by state Gov. David Ige (D) on Tuesday, applies to all FDA-approved contraceptive medications and devices.

Hawaii joins Washington, D.C., which also requires public and private insurers to cover up to 12 months of birth control at a time.

Oregon passed a similar measure in 2015, but that law requires patients to obtain an initial three-month supply of contraception before individuals can receive the full 12-month supply—which the Hawaii policy does not.

“At a time when politicians nationwide are chipping away at reproductive health care access, Hawaii is bucking the trend and setting a confident example of what states can do to actually improve access,” Laurie Field, Hawaii legislative director for Planned Parenthood Votes Northwest and Hawaii, said in a statement.

Insurance companies typically cover only a 30-to-90-day supply of birth control, posing a logistical hurdle for individuals who may live miles away from the nearest pharmacy, and potentially causing some using oral contraceptives to skip pills. Both the American Congress of Obstetricians and Gynecologists (ACOG) and the U.S. Centers for Disease Control and Prevention recommend supplying up to one year of oral contraceptives at a time, as the Hawaii Senate Committee on Commerce, Consumer Protection, and Health noted in a 2016 conference report.

Fifty-sex percent of pregnancies in Hawaii are unintended, compared to the national average of 45 percent, according to figures from the Guttmacher Institute.

Women who received a year’s supply of birth control were about a third less likely to experience an unplanned pregnancy and were 46 percent less likely to have an abortion, compared to those receiving a one- or three-month supply, according to a 2011 study of 84,401 California women published in Obstetrics and Gynecology.

Reproductive rights advocates had championed the legislation, which was also backed by ACOG–Hawaii Section, the Hawaii Medical Association, and the Hawaii Public Health Association, among other medical groups.

“Everyone deserves affordable and accessible birth control that works for us, regardless of income or type of insurance,” Planned Parenthood’s Field said in her statement.