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A number of factors can create barriers to quality health care and preventive STD care for LGBTQ+ individuals. For one, negative stigmas in health services can discourage gay, lesbian, bisexual, pansexual and transgender people from getting quality STD education, testing and treatment.
“If clinics are not affirming of people’s gender and sexuality, they will not want to go there for care,” says Amanda Carey, nurse practitioner and manager of the sexual health department at Whitman-Walker Health. “In the medical community, the pervasive astigmatism and health disparities among the population are notable and involve almost every health issue from cardiovascular disease to cancers and, of course STDs, as well.”
When a door is shut to quality medical care, this lack of affirmation of one’s sexual orientation can snowball and result in psychological trauma. The CDC notes that stigmatism and discrimination against LGBTQ+ people can add to poor mental health and coping skills, resulting in a higher potential for substance abuse, “risky sexual behaviors” and suicide attempts. It can also affect the ability to maintain long-term relationships, which are proven to lower the chances of getting HIV and STIs. Also, stigmatism can result in reduced social support that negatively impacts health.
Sexual minority youth (SMY) who are lesbian, gay, bisexual, pansexual or unsure of sexual identity also experience health disparaties related to accessing STD testing and treatment. The CDC 2017 Youth Risk Behavior Survey showed an estimated 2.6 million SMY students are more likely to suffer from negative health outcomes like HIV and STDs.
Another risk factor is discrimination preventing LGBTQ+ individuals from getting tested for STDs. “On a systemic level, we do not offer enough STI testing availability,” Carey says. “I regularly see patients who say, ‘I’ve been looking and they want to charge me $500. This is the only place I can come for free.’ That is not great as a country, and as a system, we can’t make testing dependent on people having $500. As a country, we do not have the appropriate infrastructure.”
Cary adds, “If you can’t get people in the door, you can’t address issues like getting tested, wearing condoms and making sure you get necessary treatments.”
Men who are cisgender gay, bisexual or pansexual and can be at a greater risk fo HIV and STDs because of the prevalance of sexually transmitted infections among sexual partners, according to the CDC. Anal sex can result in greater exposure to STDs, as rectal tissue is thin and prone to tearing, Cary explains. She adds that using lubricant and condoms can reduce risk. And, men who have sex with men (MSM) tend to have more sexual partners in a lifetime, the CDC says.
In general, sexual networks are what can put the LGBTQ+ community at a higher risk for STDs, Cary says. “This is the biggest explanation for why there is a rise in HIV among black MFM, men who have sex with men. It’s not that they are doing riskier things, it’s that there is a higher prevalence of HIV in their sexual network they share.”
Men who have sex with men compromise more than half of those with HIV in the United States. This population experiences two-thirds of new HIV infections each year, according to CDC research. As a group, men who have sex with men have a greater chance of being exposed to STDs and, at the same time, experience challenges accessing medical care because of discrimination, hesitation to talk about sexual orientation and practices, and lack of affirming health care outlets that are open and welcoming.
Gay and bisexual men are also at a greater risk for hepatitis A and B and human papillomavirus (HPV), which is why the CDC recommends vaccination.
|STD||Who is affected?||Prevalence||Risks|
|Syphilis||Cisgender gay, bisexual and pansexual men||20 cases per 1,000 men (2019)||Sex (anal, vaginal, oral)|
|Syphilis||Gay, bisexual and other MSM||Account for 47% of primary and secondary cases||Sex (anal, vaginal, oral)|
|HIV||Gay, bisexual and other MSM||44% of men who have syphilis also have HIV||Sex, contaminated injection equipment|
|Gonorrhea||Gay, bisexual and other MSM||42 times higher than in heterosexual men||Sex (anal, vaginal, oral)|
Source: CDC STD fact sheet
The Gay & Lesbian Medical Association (GLMA) advises men having sex with men come out to health care providers to get the best care possible. Also, GMLA notes that “reducing the rate of HIV infection is one of the gay community’s great success stories” because there are treatments available. It’s important to seek care immediately after exposure to HIV to explore options, and to use prevention methods when in a relationship with someone who has HIV.
HIV and STDs disproportionately affect the LGBTQ community, as acknowledged by PFLAG. More prevention and treatment is necessary to prevent HIV and STDs from escalating. According to PFLAG, the prevention motto should be: education, test, treat and repeat.
Local HIV service organizations and LGBTQ+ advocacy groups can help point you to accepting health care resources where you can feel comfortable, Cary suggests. “While organizations might be focused on HIV, they likely have other STI testing services that might be more affirming,” she says.
Ultimately, it’s critical to focus on seeking sexual health care based on your current anatomy, sexual partner(s) and sexual activity. As the GLMA says, if you do not feel comfortable discussing these issues with your health care provider, it’s time to find a new one. A local LGTBQ+ advocacy organization can help connect you with resou
Women who are cisgender lesbian, bisexual and pansexual could be exposed to unique risk factors related to STDs, depending on sexual partners and activity. The rate of women having sex with women (WSW) getting STDs is comparable to heterosexual women.
STDs do not discriminate, though LGBTQ+ individuals can feel discriminated against when seeking health care for STD prevention or treatment. As the County of Los Angeles Public Health Department points out, cisgender lesbians might have had sex with men in the past, and could carry STDs from previous relationships; and bisexual or pansexual women who could be having sex with men and women carry a similar risk.
The CDC reports STD data specific to gay, bisexual and other men who have sex with men (MSM), but there is no targeted research from the CDC speaking to only women who are lesbian, bisexual or pansexual. What we do know is that STDs are on the rise for all populations, which includes LGBTQ+ women.
Research reported in The Top Issues for LGBT Populations Information and Resource Kit by the Substance Abuse and Mental Health Services Administration (SAMHSA) shows that bisexual women are more likely to engage in higher-risk sexual behaviors such as having sex with a man who has sex with men and has multiple partners, or having sex with an HIV-positive male. Lesbian and bisexual women with larger numbers of female partners are more likely to get vaginal infections, the report notes.
Cary points out that sexual networks are largely the reason for higher incidences of STDs in the LGBTQ+ community. Who you are having sex with, and who they are involved with, can increase the risk of STIs.
|STD||Who is affected?||Prevalence||Risks|
|HPV||Women having sex with women (WSW)||13% to 30%||Sharing bodily fluids|
|Bacterial vaginosis||WSW||No hard data||Sharing bodily fluids|
|Syphilis through oral sex||WSW||No hard data||Sharing bodily fluids|
|HIV||Transgender women||27.7% among all transgender women and 56.3% among black transgender women||Sex and sharing infected injection equipment|
Source: CDC STD special populations
Women who are lesbian, bisexual or pansexual should be open with health care providers about sexual behvior and orientation. If the provider is not accepting, find a new one. Some progressive health care organizations have dedicated programs that address LGBTQ+ health in an affirming way, such as Whitman-Walker Health and Fenway Health. To find health care resources that are LGBTQ friendly near you, consider reaching out to local advocacy groups or HIV support centers that can offer referrals or offer STD education, testing and treatment.
Transgender and non-binary people can face discriminatory experiences that impact access to health care and, as a result, STD prevention and testing resources. An Oxford Academic Clinical Infectious Disease monitoring report studying STI testing among transgender women living with HIV acknowledges that this population experiences stigma and discrimination in health care, employment and housing – all experiences that can boost the risk of acquiring HIV and STIs.
According to the CDC, about 1 million people in the United States identify themselves as transgender, and this population makes up 2% of new HIV diagnoses. Most of those cases were transgender black/African American people, according to research.
STD prevention and testing is important for all individuals, and a steady increase in STI cases across the board tells us that regardless of your gender or sexual orientation, more education and proactive measures are necessary.
There’s a lack of data collection pertaining specifically to transgender individuals and STI/HIV incidence, though studies suggest that HIV is highest among transgender women of color, according to a report citing STD concerns for transgender and non-binary people by SAMHSA. Some studies also suggest disparities in access to treatment.
The U.S. Department of Health and Human Services Office on Women’s Health reports that transgender women are more at risk for HIV and STIs, and are less likely to have health insurance.
The unique risks transgender and non-binary people experience related to STDs stem from some of the negative societal beliefs, which can discourage those in this community from seeking out health care and wellness resources. From dealing with non-affirming health care providers to managing the cost of care without insurance, transgender and non-binary individuals also can feel uncomfortable “coming out” to a provider or discussing sexual behaviors that a health professional should know about to advise on prevention and testing.
Because of the rate of HIV among transgender and non-binary individuals, a health care professional might suggest pre-exposure prophylaxis (PrEP), a pill that can prevent HIV in individuals who who have a high risk of getting infected. Studies show that the daily pill is 99% effective at preventing a person taking it from getting HIV through sex. Another strong preventive measure: proper, consistent use of condoms.
Discussing current anatomy, sexual partners and sexual activity with a trusted health care provider is critical for receiving proper prevention, testing and treatment for STDs and HIV. If you’re not comfortable sharing information about sexual activity and sexual orientation with your current providers, consider seeking out LGBTQ resources that can help.
The teen years are often challenging for any young person: dealing with peer pressure, expectations at home and school, and transitioning into a phase of more independence and decision-making. For LGBTQ youth, this time in life can be especially difficult facing social stigma about sexual identities and choices. You may face discrimination, harassment, family disapproval, social rejection and even violence. All of this can negatively impact physical and mental health, the CDC reports.
LGBTQ youth are at increased risk of HIV, syphilis and other STDs, according to the CDC. Also, adolescent lesbian and bisexual females are more likely to get pregnant than heterosexual peers. Transgender teens are more likely to attempt suicide than cisgender peers.
Sex education in schools often glosses over LGBTQ health issues. In fact, Planned Parenthood says the lack of comprehensive STD health education puts LGBTQ youth at risk. LGBTQ students need information about how to protect themselves and others from STIs and HIV, and affirming resources for prevention, testing and treatment where they will not feel stigmatized.
For LGBTQ teens, finding support from peers and family is important for maintaining healthy sexual relationships that can ultimately prevent negative outcomes such as STDs or HIV. The CDC reports that research among young gay men proves that a positive relationship with parents helps teens make healthy choices like using condoms and avoiding risky partners.
Families can find support and resources to help LGBTQ teens through organizations including PFLAG. The CDC also provides LGBTQ Youth Resources, including insight about STD prevention, testing and treatment.
As an LGBTQ teen, talking about sex with a health care provider can feel uncomfortable. Many teens, regardless of sexual identity, hesitate to discuss sexual history and activity with doctors. However, it’s critical to be honest and open. Discuss current anatomy and sexual partner(s), sexual activity. If a health care provider is non-affirming or expresses negative feedback, look for another health care professional by reaching out to LGBTQ advocacy groups or looking for an STD testing site near you through this helpful CDC tool.
While STDs are on the rise and have been for the last six years, there are effective ways to protect against sexually transmitted infections. The CDC recommends taking these steps to stay safe and healthy.
The CDC provides these STD testing recommendations for LGBTQ+ individuals who are sexually active.
|Who should get tested||What to test for||How often to test|
|Sexually active cisgender gay, bisexual, pansexual and transgender individuals||HIV||Once a year (minimum)
3 to 6 months for sexually active bisexual and gay men
|All pregnant women; sexually active LGBTQ individuals||Syphilis||At least once a year|
|Sexually active cisgender gay and bisexual men||Gonorrhea||Once a year; 3 to 6 months if with multiple partners|
|Sexually active cisgender gay and bisexual men||Chlamydia||Once a year; 3 to 6 months if with multiple partners|
|All adults and adolescents age 13 to 64||HPV||At least one time|
|LGBTQ+ individuals having receptive anal sex or who have been a “bottom” in the last year||Chlamydia and gonorrhea of the rectum||At least once a year; more frequently if with multiple partners|
|LGBTQ+ individuals who have had insertive anal sex or oral sex||Chlamydia and gonorrhea of the penis or urethra||At least once a year; more frequently if with multiple partners|
|Adults between 1945 and 1965 with “risk behaviors”||Hepatitis C||At least once a year|
|LGBTQ+ individuals who have given oral sex||Gonorrhea of the throat||At least once a year; more frequently if with multiple partners|
Source: CDC Which tests should I get?
Learn more about preventing STDs and STD testing, including at-home drug testing options. Here are some respected resources you can depend on for information.
This expert contributed information and recommendations for this guide:
Amanda Carey, nurse practitioner and manager of the sexual health department at Whitman-Walker Health