Washington Blade - May 17, 2002
Mike Fleming

The Gay & Lesbian Medical Association released two sets of guidelines for health practitioners on May 9.

The first calls for "cultural competence," urging doctors to create a comfortable clinical environment and "ask tough questions related to the sexual health of their patients," said Jason Schneider, an Atlanta doctor and GLMA board member who developed the two-part document.

"As providers, we may have good relationships with their patients, but it's not easy to talk about sexual behavior," Schneider said. "The more [doctors] do that, the easier it becomes, and the better the doctor is able to assess risk, make diagnoses and tailor STD prevention messages appropriately."

Many doctors don't realize that every patient is potentially at risk for sexual health until doctors ask the right questions, Schneider said.

"A doctor might not think to ask that middle-aged married man with children if he is having sex outside his marriage, much less if those partners are men," he said. "But we need to not make those assumptions and create an safe environment where -- even if the person doesn't answer truthfully the first time -- he can come back to that doctor later on because the question was asked in a non-judgmental way."

The GLMA also asked clinicians to incorporate sexual risks into their health assessment of patients.

"It's not enough to know that a male patient has sex with other men," Schneider said. "The second part of the document deals with understanding the stigma that many gay-identified men face that create barriers to proper treatment."

The GLMA document will be most helpful to practitioners who don't know if they serve gay patients, said Christopher Harris, GLMA's president.

"We have come to realize that there are physicians out there who provide care and really aren't as familiar with gay health concerns, and these are the people who need to be brought up to speed," Harris said.

CDC rules for gay men, too

The Centers for Disease Control & Prevention also targeted gay men last week in its release of the agency's first-ever "Sexually Transmitted Diseases Treatment Guidelines" for "men who have sex with men."

Previous CDC reports on STDs besides HIV and AIDS have been less specific, but an "alarming rise in syphilis, gonorrhea and chlamydia in men who have sex with men" necessitated the change, said Ron Valdiserri, deputy director of the National Center for HIV, STD & TB Prevention at the CDC.

"In terms of HIV counseling, the CDC has very much been on record about care providers being nonjudgmental toward gay patients," Valdiserri said. "On the STD side, it's not a new approach, but we have not focused past guidelines on that community because they have been more on medical diagnosis."

The CDC suggests that gay and bisexual men get tested at least once a year for HIV and other STDs as well as getting immunized against hepatitis. The CDC report concurs with GLMA recommendations that doctors should provide specialized care for gay patients, including asking about the gender of sexual partners and creating a safe clinical atmosphere.

"These guidelines are targeted directly to providers," Valdiserri said. "So it's also important to reach out to them and say, 'You shouldn't make assumptions about patients' sexuality and sex practices.'"

The GLMA's report wasn't planned to coincide with the CDC recommendations, but gay health experts applauded the government's inclusion of gay issues, Harris said.

FOR MORE INFO

Gay & Lesbian Medical Association

459 Fulton Street, Suite 107

San Francisco, CA 94102

415-255-4547

www.glma.org

"We are very pleased that the CDC is thinking along the same lines as the GLMA in developing a standard of care for gay men's health," Harris said.

But despite the new guidelines, health officials said the onus for the improved health of gay men falls on the patients themselves, Schneider said.

"Patients and doctors must both participate," Schneider said. "Patients should tell their doctors of their orientation and behaviors so they can design care that is appropriate for the patient."

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