Health : Focusing on LGBT Health – Really?

Thursday, February 16th, the White house held an LGBT conference in Philadelphia that was focused on health care issues facing our community.

Secretary of Health and Human Services, Kathleen Sebelius, headlined the conference.

In her address, Secretary Sebelius stated that the health care system was “especially broken for LGBT Americans”. Further stating: “All Americans, regardless of where they live, what age, sex, race, sexual orientation, or gender identity, have a basic right to get the health care they need here in the United States, and that’s a principle we are committed to fighting for in this administration.” Yes, we have the right, but does the administration have the capacity to provide for our rights?

Is it any wonder that the health care system is, as she stated, “especially broken for LGBT Americans”? The health care needs of gay men are rarely understood by physicians, nurses, aides, and often by the community itself.

In my opinion one of the most striking comment she has made (what I call a DUH moment – the sound made when a very smart stupid person has an awakening) was her statement regarding domestic HIV/AIDS prevention efforts: “frankly, what we’ve been doing is not very good.”

This admission is long overdue and obviously insufficient, what difference do words make when they are not backed by action?

What is being done to improve health care for gay men? Not much, and I don’t expect to see great changes any time soon. (Oh, wait, there is the great resource of cultural competency training and focus groups, let’s not forget them!)

The health care problem starts with research, which dictates much of program and care.

To quote Sebelius from a January interview: “The most frustrating thing is that there’s now very good data about how prevention can work, about how to reduce partner-to-partner transmission, early identification and treatment… And yet we have 50,000 new infections popping up. It just doesn’t make any sense.” It is amazing to me that with the amount of money, time and other resources spent on research that we ‘know so little’ of what is obvious to most gay men.

Government funded prevention efforts are almost always required to be condom focused and condom focused campaigns are not effective for gay men. Most gay men I know use some form of risk reduction strategy, strategies that may or may not include the use of a condom.

The core problem with the health care being provided to gay men, and not just sexual healthcare, is nothing more than simple politics and fear of honest talk about sex and sexual behaviors.

The government (as a reflection of America) just cannot deal with sex, especially ‘gay sex’. Nor can we as a nation of sexually repressed adults be honest enough about sexual behavior, same sex relationships, and the social determinants of health to have any effect on infection rates, the health of homosexuals and the many other health care concerns in our community – concerns that we face at significantly higher rates than heterosexual men.

It seems we have become content, allowing our health to slowly fail, our elders to live in fear and loneliness as our government slowly plots our demise through ignorance, fear of sex, and exclusionary practices.

So what now?


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  1. Kevin

    I don’t think the onus is on the government to prevent new HIV/AIDS cases in the gay community. Anything they come up with will be ineffective until WE act accept responsibility and act more responsibly.

    I don’t think it’s the government’s responsibility to educate gay men on the “safest” ways to have unsafe sex. Bad idea.

  2. tony

    Its seems this issue has struck home. I work in the healthcare profession I work with aids and elderly patients. yes they do live in fear but the utmost thing is that we all want to have love in its’e truest form not matter what the cost is. I think therapy for all that need it should be at healthcare cost and part of medicare and free to aids patients. I know because I speak from expereince. Im not Hiv+ because by the grace of the god/goddess it scares me. So me being a gay man you have to fix what’s upstairs (brain) because we have all faced some form of abuse in our lifetimes, so why not fix the problem. By the way I am a nurse.

  3. Ethan

    Is it sad that I just have given up caring about HIV and stds general? It mentally takes a toll on me just thinking about it contantly and worrying if I am infected or will be infected soon. I’m just at the point where I don’t care anymore because it really is just too much to tact on to everything else.

  4. Mikes

    My general sentiment is the federal government is a bunch is crap-first of all I find half or more of politician say as enticing as a recording deal-it seems great until you find out you’ll lose much of your rights and passion when they take over. Coming from a position where I was born into a free country but had no legal rights for 20 plus years because of my sexual preference I would say with no hesitation the the American government is a bunch is pre-packaged appealing group of partially empty words and History Channel like specials. I watched Oprah blame gay black men for barebacking while married and accusing them also while completely side-stepping the real issue of them hating their lives, being forced into the closet most likely by the black community-having probably no self esteem and living a lie to keep others happy, of course by Winfrey’s standards the world is a place that she can make perfect just by sitting on television and pointing fingers. I guess we should be happy we have an administration that “cares”, but ultimately I find it rude and the government should have been “here” for us-years ago, in fact in a free country people shouldn’t have to fight for their own freedom. Doctors can’t figure out how to treat gay men? Can they figure out how to treat males and females in particular, lets beam down some healers from the gay planet maybe they will have the intelligence to treat us correctly and wear gloves while they slide some fingers up our butts.

  5. Terry

    Awareness, Education, Prevention, Support… We must keep awareness up. It still astounds me that I encounter young men who have no clue what safe sex is. Harm reduction is something they have never heard of. Total lack of education is the problem. The education needs to be targeted at young gay men. Stigma still gets in the way… They will not ask questions in school if it outs them as being gay. Many are taking great risks that they have no clue about how great a risk they are taking. Most when informed of what is safer will choose a much safer method. Many feel an overwhelming sense of worthlessness because of the constant religious attacks on gays. With the hundreds and hundreds of sins listed in the Bible I find it astounding that we focus so much on one sin. Until we teach our children they are worthy, and teach them what is safe, encourage them into life long monogamous relationships, we will not see decreases in AIDS in the gay population. We must target test high risk population, get them on meds and teach them how to stop the spread. We now have the knowledge, we must just implement the process and end this disease, take a look at the state of IL who had a 3.3% decline in AIDS incidence while increasing testing, especially target testing nearly a decade ago. While other states adhered to the abstinence only message they allowed aids to spread. Condoms the way they are taught in school fall on deaf ears to Men who have sex with men. They think it is to stop pregnancy and somehow miss the message… Some may get it before they are aware of their sexuality… and some may not realize its importance. I recently encountered a 19 year old man who had no clue about how HIV spread and was at high risk. His response was why dont they teach that in school… Fortunately he tested neg. Now he knows and will be a teacher to others… Lets keep our fingers crossed, that we educate our children about the aspects of sex… all sex… And the gay community needs to be teachers to each other… Presume everyone is an idiot and tell them everything you know… Spend a little time online learning about safe sex… And if you are HIV poz be sure and protect your partners… We can end AIDS…

  6. Rory

    One of the problems with sexual health here in the United States is the FEAR and DISGUST society as a whole places on comprehensive sex education. Rather than teach children from a young age about safe sex, STDs, masturbation, physicals, abuse, etc…we allow Hollywood to do the teaching and force unrealistic requirements on people (abdtinence only education).
    As a country, sexual health has a long way to go — not just for the LGBT community but all walks of life in general.

  7. popeye

    Just don’t go have sex with the first idiot that put his ass up in the air for you. Think with the big head not the little head.

  8. mikah

    My issue with this is the whole its all the governments fault side. Its not the governments responsibility to put the condom on. You have to make that decision. If you feel that the person is telling the truth when they say they are negative then do as you wish. Even seeing proof of results is not enough because the person just may have not converted at the time of the test. I am HIV+ and I do not blame anyone but myself because I chose to bare back. It comes down to the decision a person makes. This is no issue to be looking for a scape goat in. This is an issue where the person to blame was the person who made the choice. Bad things also happen to good people but wasting time by finding someone to blame is not right. I enjoy life so much more since my diagnosis because I finally believed that I could die. There is so much beauty in the world so stop blaming. And stop looking to the government. It only takes one person to ignite the spark of change. Will you be that person?

  9. Craig

    I don’t think it is up to the government, I do believe this should be a topic in sex education classes in H.S to help educate the young LGBT community about safe sex and the consequences involved in having unsafe sex.

  10. sjohnson

    yeah, let the gov’t educate us the way we should be….isn’t that like the pot calling the kettle black! ignorance is not education and edu is a huge failure in the US. it’s the individual that refuses to believe that he/she will become ill. until the mindset of these idiots don’t change then disease will run rampant in “st7″domm and well as the gay community.

  11. Greg

    There is ample scientific evidence by now that men who are HIV+ whose viral load is consistently undetectable do NOT transmit virus to others. THAT should be the message to ALL gay men, so that those who are scared to find out what their status is will rush down to get tested. Secondly, the medical profession ought to get men who are HIV+ on medications immediately, rather than waiting for certain markers like CD4 counts. The more HIV+ men on medications, the fewer the transmissions. If every singly HIV+ man in the US were on medication now, the rate of transmission would drop to nearly nothing in the gay population. The rate will never get down to 0% because there are certain populations who are extremely difficult to reach. Illegal aliens are not going to rush down to get tested or treatment. Inner city drug users are not going to rush down and get tested. However, these are not the primary sources of infections among gay men. The primary source are UNTESTED and UNTREATED gay men who are telling other gay men that they are negative, when in fact they simply don’t know their status.
    I don’t believe that young gay men deliberately don’t practice safe sex. I think that they, like women who get pregnant out of wedlock, slip up occasionally. But unfortunately, that’s all it takes. It’s not fair to put all the onus on them – alcohol and drugs can certainly impair judgment and 95% of Americans use them. As long as some politicians, lots of the public, and even other gay men lay all the blame on those who have become HIV+, rather than treating this like tuberculosis, where the government makes itself responsible for testing everyone and going around making treatment available, for free if necessary, there will continue to be unnecessary new infections.

  12. spLAt

    It isn’t the governments failure to teach safer sex. Everybody pretty much knows that condoms are necessary. As a sexually active gay man who first experienced sex before HIV and AIDS and got the safe sex message very early in the game, I’ve seen over the past ten years or so a very deliberate effort to undermine HIV prevention. How often have you received online hookup message asking you to bareback? How often have you pulled out the condoms only to be met with a sneering “oh–do we have to use those?” How often have you heard other guys say how much “hotter,” “more real,” or “natural” unsafe sex is? How many times have you seen or heard safer sex advocates referred to as “condom Nazis?” And the final and most important question: how often did you have the balls to say something when faced with these situations? It almost seems like those of us who care about HIV transmission are a very very small minority these days, and if we don’t speak up the unsafe sex proponents win by default. Unless you think transmitting a potentially fatal virus is hot there isn’t anything hot, sexy, natural, or more real about “bareback” or “raw” sex. They are just buzzword euphemisms to avoid saying “unsafe.”

  13. Chris


    If the government was plotting exclusionary practices – as it was during the beginning of the AIDS epidemic and unfortunately the epidemic was so intense and concentrated and government response was so bad that a lot of gay men wrote off the government forever as an ally for their health and well-being – why would it be holding a conference on LGBT health? That simply doesn’t make sense. Wouldn’t you say that the government holding a conference on LGBT health and acknowledging LGBT populations as having dignity and being worthy of health care and equal access is a good thing? I’m not saying one conference is going to change anything, but your attitude about the government slowly plotting the demise of LGBT people is both empirically unjustified because it has no basis in quantitative research, empirical evidence or even reality and also problematic because it adds fuel to a fire of “us versus them” mentalities that it seems many non-heterosexual folks have. Frankly, a lot of heterosexual allies I know are doing more for the gay community than gay people are. So if we’re going to sit around and bitch about conferences that are organized – organized for the sake of US as sexual minorities – while we propose no alternative that involves working together with others and apparently feel content cordoning ourselves off into some kind of social isolation where we still pretend we’re “special” just because we’re different, that isn’t going to get us anywhere. We have a lot of reasons to be angry about the lack of cultural competence that still exists among health care providers – and by the way I worked as a health care provider and advocate for LGBT health for four years in a heterosexually dominated medical environment so I can tell you plenty about this subect – but what good is it going to do to bite the hand that feeds? Instead it makes more sense to come up with collaborative ways to forge alliances with heterosexual allies and speak more as one voice in order to do something about these problems. That needs to be guided by data, evidence-based best practices, research, and advocacy that shows us to be professional, competent and able to make change.

  14. Charles

    When will people, mainly adults, accept responsibility for their own actions; those who knowingly, willingly and carelessly engage in dangerous sex practices? Where is it written that the government is the best agency to educate and provide care for those who are infected with HIV and AIDS? Identify any area, outside of the military, that the government is effective and efficient in carrying out programs and providing services, within budget and at the necessary levels for those receiving the services? Where is it written that the government shall be responsible for the health care of its citizens? #1 Is education. #2 is prevention. How that gets delivered has failed by the government and within the educational structure, which, by the way, is run by the government. Therefore, the government has failed across the board. Community based organizations are best able to deliver services and educate the citizenry. Get the government out and keep it out. Take responsibility. Teach the children early on, at home, by the parents and/or guardians. Some sexual awareness education in schools … OK if the goal is prevention and abstinence AND health education/awareness. The more you rely on government, the more dependent you become on the government; a government that is unable and unwilling to protect you, support you, educate you, provide services to you and to acknowledge there is a problem and fails to effectively and efficiently address the problem and arrive at real solutions. The government cannot and will not be able to do this. Only you … Oh yes, by the way (again), government for the people, of the people and by the people. “We the People!”

  15. Skye

    I thought most people were getting sexual education and safe sex is promoted? I mean most of the time people don’t, and I’m not going to lie with the gay community we need to think about drinking and substances that cloud our judgement. We can do more educating which most hookup/dating sites do but it’s up to the individuals to pay attention and practice safe sex. I’m not hatin just stating what I’ve seen. Carry condoms, be safe and for god sakes tell the truth I live in Alaska and right now we’re having issue’s with HIV spreading among the community and on post because people aren’t telling others and not taking care of their medical condition it’s a sad thing to hear but it is happening. All we can do is offer more education but it does start with every individual to ask questions like. Have you been tested? Do you have condoms and lube? even if they say their clean still play safe cause you never know HIV for instance takes 25 to a few months to become active enough for a test to react. An HIV test only picks up that the virus is in the blood when the body makes enough anti bodies to show a positive result otherwise it’s undetectable.

  16. Steven

    I hope we all realize that this is just the administration pandering to the gay community for votes. They couldn’t really give a rat’s @$$ about any of us. Health of the LGBT community is each of OUR responsibility, not theirs. In all seriousness, we need a culture change.

  17. Billly

    I think a topic we should also be discussing with our peers in the community is the role alcohol and drug use play in the transmission of HIV. I drank heavily for years, took chances, and when I finally became ill with AIDS I realized that it was in deed my fault. If I knew the statistics regarding drug/ irresponsible alcohol use I bet they would tell us that a large part of transmissions happen during these types of behaviours. I sure wish I knew more about how to deal with this in our community. This is nothing new of course bur how are we able to deal with this in an effective way?

  18. stephan

    Chris – Despite my comments, I truly do not content that the government actively ‘plots’ exclusionary practices, but I do content that LGBT community members are excluded, if not in physical presence in the social presence and decision making. I will also concede that there are LGBT community members physically at the table – BUT when LGBT community members are included as staff, participants, advisors, etc., they must adhere to the ‘corporate culture’ (demonstrated as social norms) and the true spirit of the LGBTQI community is absent. I have not only witnessed this first hand but, sadly, I have also participated in it – sipping the Kool-Aid in order to stay in the game, thinking that I could create real change by being on the ‘inside’. Obviously, I am throwing up that Kool-AID I sipped.

    When the TRUE spirit, including the sexual being, of the LGBT community is present in public health it is usually relegated to the dark corners, considered to be representative of a ‘marginal group’ and excluded from any high level decision making.

    Conferences, yes, I have been to a few (hundred). What happens at conferences, really? What comes from them? Who goes to them? Is it the field level staff that deals with LGBT members daily who attend and present on their experiences and needs of themselves and those they serve? No, it is directors, managers, researchers, and presenters, all gathered at an cerebral orgy, mentally masturbating each other off – with fruitless results. Where is the impact for gay men without mental health support, the gay and black HIV-Positive teens with no medication, or the transsexuals that are being mistreated by their primary care doctor?

    My comment: “It seems we have become content, allowing our health to slowly fail, our elders to live in fear and loneliness as our government slowly plots our demise through ignorance, fear of sex, and exclusionary practices.” Was an attempt to point out that there are huge factors that prevent prevention and intervention activities from working, and that these issue lie at the broadest level – the social level.

    The government has no capacity to understand the true spirit of the LGBTQI community, if not simply because of its physical makeup, because of its unwillingness to truly engage only the ‘white washed’ LGBT community. I will also content that we as community members are just as exclusionary, usually as defense and the result of the physical, mental and emotional harm that has been inflicted upon us by public health (inside and outside the organizational).

    In most of public health – common sense has completely left the room – completely and the void has been filled with hot air.

    Regarding your statement: “while we propose no alternative that involves working together with others…” my question to you is: “How many times do you knock on a closed door, that when opened get slammed in your face?” I cannot count how many alternatives I and many others like me have proposed – just in my area of expertise, technology, do you have any idea of the number of barriers that must be overcome to just send an email to a person possibly infected with HIV that does not know they have been exposed? Do you honestly understand what cultural commentary training looks like in a department of health on the field level? The frame work of program is so narrow what can be proposed that has the possibility of working? And who is standing up to change this extremely narrow framework? Certainly no one in the system or they would not be in the system for long! (Case in point)

    There are alternatives that have been proposed, enjoy the conference, spent the money, greet the press and enjoy the PR, but prove to me that something of lasting value comes from it, show me with data how the LGBT community improves because of the conference!

    I hope, with all my heart, that you can show evidence of how this conference will facilitate lasting change in the health of the LGBT community.

  19. Blah-Blah-Blah

    the government is pandering the LGBT community? I think aside from being somewhat true, be thankful “Obama” took gay issues to the forefront his minimal support helped turn the black community into sweeties, not only did they finally get a “black” President but he supports in part the very thing they hate and have tried to destroy for years which is homosexuals…its seems trivial but trust me it altered their self and social perceptions for good. Really sit and think about, its bigger than anyone can imagine and saved us years of prolonged annoying arguments and frustrations.
    Dick Cheney and GOP heavy hitters are the people responsible for prompting gay marriage legislation in Maryland recently, the GOP stands to lose on that issue within their own party two fold so I do not think they are pandering, on the contrary however I still find the federal government to be an insult, I even think they understand this.
    And really who panders the LGBT community the most for money and adoration? RECORD LABELS-this is correct and a short list of pop star (mogul) that love to make super sweet productions to get the almighty gay dollar, which is fine if I couldn’t personally list multiple names of people whom are broke in the gay community whom never got paid while persons such as these moguls made big bucks off underground artists, gay people or craftspeople.

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