LGBTQ Health Guide: Sexual Minority Men
This blog post is the second in Blue Cross & Blue Shield of Rhode Island’s (BCBSRI) three-part series addressing important health topics for sexual minority women, sexual minority men and transgender individuals. Studies show that members of the LGBTQ+ community don’t always receive the same level of healthcare as their heterosexual counterparts. This disparity is often attributed to actual or anticipated discrimination or lack of access to health coverage. We encourage you to be as open as possible with your healthcare provider(s) to ensure you get the best, most appropriate care. Below are some health concerns you may want to discuss with your healthcare provider.
The Office of Disease Prevention and Health Promotion’s most recent Healthy People initiative outlined the past decade’s health goals in the United States and flagged several physical, mental and sexual healthcare disparities impacting men in the LGBTQ+ community.
Much of the care for gay, bisexual, queer and other men who have sex with men, reflects the standards of recommended care for all men. However, there are nuances in both medical and behavioral health for sexual minority men that should be addressed.
These unique factors can negatively impact their healthcare unlike their straight counterparts. Healthcare providers might lack the knowledge, training or willingness to treat patients, while sexual minority men may have concerns over confidentiality and compassion from the provider. Quality care involves mutual respect and understanding, so the possibility of a disconnected relationship may prevent sexual minority men from seeking testing or prevention and treatment services that they may need, furthering the risk of poor health.
Individual health risks are shaped by factors beyond sexual orientation — including family history, age and geography — but it's important for healthcare providers to understand and screen for health concerns that may be more common for sexual minority men.
Eating disorders – Gay and bisexual men are more likely to experience body image issues, resulting in a higher number of eating disorders. According to the National Eating Disorder Association (NEDA), gay males are thought to represent only five percent of the total male population, but among males who have eating disorders, 42 percent identify as gay.
Prostate, testicular and colon cancer – While skin, prostate, lung and colorectal cancers are four of the most prevalent cancers for all men, the American Cancer Society cites studies suggesting that sexual minority men are less likely to get routine care and screenings, increasing their risk of certain cancers.
Depression and anxiety – Homophobia, stigma and discrimination may have negative effects on sexual minority men’s mental health that their heterosexual counterparts don’t endure. Research shows that, compared to other men, gay and bisexual men have higher chances of having major depression, bipolar disorder and generalized anxiety disorder. But like everyone else, sexual minority men can be successfully treated for mental health disorders if connected to the right resources.
Alcohol, substance and tobacco use – Substance use disorders affect 20 to 30 percent of the LGBTQ population, compared to 8.4 percent of the general population, according to the Substance Abuse and Mental Health Services Administration. Isolation and lack of supportive services as a result of homophobia, stigma and minority stress increase the risk for alcohol, tobacco and substance abuse among sexual minorities. LGBTQ-specific treatment centers are sensitive to the needs of this community, and healthcare providers can put patients in touch with the right ones.
Sexually transmitted infections – Compared to heterosexual men, gay, bisexual and other men who have sex with men are affected by higher rates of HIV and other sexually transmitted diseases. According to the Center for Disease Control and Prevention (CDC), sexual minority men make up more than half of the people living with HIV in the United States and experience two thirds of all new HIV infections each year. Routine checkups can help identify HIV or STI status and reduce the likelihood of unknowingly spreading these diseases to sexual partners.
Domestic violence – Most studies have found that the prevalence of intimate partner violence among sexual minority men is not significantly higher than the U.S. general population. However, research shows that LGBTQ+ people face barriers to seeking help that are unique to their sexual orientation and gender identity. These include legal definitions of domestic violence that exclude same-sex couples; the dangers of outing oneself when seeking help and the risk of rejection and isolation; and lack of, or survivors not knowing about, LGBTQ+-specific or LGBTQ+-friendly assistance, resources or service providers.
The increase in LGBTQ drop-in centers, gay-straight alliances, gay sports leagues/teams, LGBTQ community centers and LGBTQ-inclusive healthcare locations like BCBSRI’s Safe Zones have created more safe spaces to access support and healthcare. Improving access to inclusive healthcare regardless of sexual identity is critical to providing the best healthcare possible for all men.
Matt Collins, M.D., MBA, is executive vice president and chief medical officer, and Guillaume Bagal, is diversity & inclusion lead, Blue Cross & Blue Shield of Rhode Island