Magic City AIDS Walk

Participants in the 2009 edition of the Magic City AIDS Walk braved rainy skies to come out to Caldwell Park Sunday, October 4, 2009. The event featured live music, food, entertainment, health information and the walk followed by a balloon release in remembrance of those lost to AIDS and HIV. Matilda Easterbrook, a student at Birmingham Southern and an AIDS Walk committee member, had her face painted in rainbow colors. (The Birmingham News / Jeff Roberts)

(JEFF ROBERTS)

Doctors need to talk to patients about gender identity and sexual orientation, in order to help close the health gaps between straight patients and those who are gay and transgender, said one expert during a Wednesday presentation at UAB.

Gay, lesbian and transgender patients face many health challenges. The community has high rates of suicide and substance abuse, and the majority of new cases of HIV still occur among men who have sex with men.

But few physicians talk to patients about sexual behavior, desires and issues of identity, said Dr. Harvey Makadon, director of the National LGBT Health Education Center at the Fenway Institute in Boston.

"You can see there's an avoidance of the intimate," Makadon said.

Doctors who don't talk about gender identity or sexual orientation may be missing out on a major part of patients' lives, and failing to address issues that may affect physical and mental health.

The statistics are daunting, especially in the transgender community. Transgender people endure high rates of violent crime, poverty and sexually-transmitted diseases. Nearly a third of transgender women have HIV, a rate that is 49 times higher than other adults of reproductive age, Makadon said.

Doctors who are comfortable treating transgender patients can help prevent major medical problems, Makadon said. It can be complicated, because some men who have sex with men don't necessarily identify as gay, and many transgender individuals may not be able to clearly define a gender identity, especially if they are young. But doctors need to be open to having those conversations, Makadon said.

"People are uncomfortable with things, and until people get to know people who are gay, lesbian and transgender, they are going to feel uncomfortable," Makadon said. "And how that manifests itself can affect someone's comfort level in terms of coming for care. And so we need to work on those issues if we are going to really make a difference."

Health problems may start early in life, as children and young teens struggle with sexuality. Gay, lesbian and transgender teens have rates of suicide that are two to three times higher than straight teens. Many also deal with parental rejection that can cause homelessness, which can lead to risky behaviors like substance abuse and sex work. As patients age, they may face other problems including isolation and a lack of family support.

Minorities who are gay and transgender have even higher rates of HIV infection, which is probably due to a lack of access to medical care, Makadon said. So it is important to make medical offices welcoming to everyone. He has been working with the Mississippi State Department of Health to improve its service to members of the gay, lesbian and transgender community. He may soon embark on a similar project in Alabama, Makadon said.

LGBT patients in the Birmingham area will also have their own healthcare center starting this fall with the opening of Magic City Wellness Center. That clinic is a collaboration between Birmingham AIDS Outreach and Medical AIDS Outreach of Alabama to address issues of access and communication like the ones raised by Makadon, according to a press release.

More than 50 percent of new diagnoses of HIV occur in the South, and Alabama is home to about 12,000 people living with HIV, according to the Centers for Disease Control and Prevention. Reducing those numbers will require more active involvement by doctors who must, in some cases, overcome personal biases.

"People frequently raise the conflict that's posed for them as healthcare providers between their commitment to caring for all patients and what they hear on church on Sunday," Makadon said. "Most people who I've had this discussion with say that the duty to care for everybody has to outweigh personal values. For people who continue to feel too conflicted, they probably shouldn't continue to be in a caring profession. That may sound harsh, but I do think it's a reality that if we do provide healthcare that we have to provide healthcare for everybody."