LGBTQI+ and health care: do they deserve more attention from medical universities?

This article was exclusively written for The European Sting by Ms. Elena Colonnello, a 5th year medical student in the International Medical School (IMS) of Rome Tor Vergata, Italy. She is affiliated to the International Federation of Medical Students Associations (IFMSA), cordial partner of The Sting. The opinions expressed in this piece belong strictly to the writer and do not necessarily reflect IFMSA’s view on the topic, nor The European Sting’s one.

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LGBTQI+ is a common acronym across social media and television. However, a careful analysis of the literature reveals that little is known about this community, especially in terms of specific health demands. Nowadays, the pairing “LGBTQI+ and HIV” is obsolete, also at the light of recent epidemiological data which show that the LGBTQI+ community is, to a larger extent, aware of the exposure to this risk factor. However, if  thinking about the greater prevalence of HIV seropositivity is reductive and perhaps even prejudicial, it is true that the community is exposed to certain risk factors, which derive not from sexual orientation per se but from the resulting behaviors, sexually-related and not. Epidemiological data show that there are other conditions prevalent in the LGBTQI+ community, but less explored. Among the most relevant, an increased incidence of depression and suicidal behavior, drug use, smoking, eating disorders. Sadly, what it’s most surprising is that these conditions tend to assume a chronic course also due to the lower tendency of members of the LGBTQI+ community  to rely on health care  services. In light of these evidences, it is spontaneous for medical students to ask themselves about the factors that can constitute a barrier to health care and to the treatment of the specific needs of the LGBTQI+ population. One factor may be explained by looking at the skills and knowledge of health professionals, often not adequately specific to offer culturally appropriate and high-quality assistance to the LGBTQI+ community. The key role in providing a higher-quality formation and sensitization to the topic should be played, first,  by Universities which, on the contrary, pay very little attention to the teaching of sexuality in general, psycho-sexology and medical sexology, and even less to the unique aspects of the health of the LGBTQI+ community. In fact, there is a higher tendency to forget that, beyond 3^rd generation drugs and advanced technology, communication between patient and healthcare worker is the real fulcrum of an effective therapy; a lack of empathy between patient and operator is significantly associated with a lower therapeutic efficacy, due to a decrease in adherence to the doctor’s prescriptions and to a reduced rate of compliance. In the case of LGBTQ+ people, this happens because many operators are not specifically trained to provide them assistance, nor they are aware of their specific health needs. Nonetheless, a lack of knowledge is also often associated with a certain degree of homophobia and stigmatization, and the potential causal relationship between the two aspects is worth to be mentioned. Therefore, the natural consequence of asking ourselves if we are prepared to deliver dignified and non-discriminatory health care is to advocate the need for more attention from medical universities to this challenging and sensitive topic. References

• Conron KJ, Mimiaga MJ, Landers SJ. A Population-Based Study of Sexual Orientation Identity and Gender Differences in Adult Health.American Journal of Public Health. 2010;100(10):1953-1960. doi:10.2105/AJPH.2009.174169.

• Institute of Medicine (US) Committee on Lesbian, Gay, Bisexual, and Transgender Health Issues and Research Gaps and Opportunities. The Health of Lesbian, Gay, Bisexual, and Transgender People: Building a Foundation for Better Understanding. Washington (DC): National Academies Press (US); 2011. Reviewers

• Lambda Legal’s Survey on Discrimination Against LGBT People and People Living with HIV: When health care isn’t caring. Lambda Legal, 2010, available at http://www.lambdalegal.org/ health-care-report
• Ciocca G, Niolu C, Déttore D, Antonelli P, Conte S, Tuziak B, Limoncin E, Mollaioli D, Carosa E, Gravina GL, Di Sante S, Di Lorenzo G, Fisher AD, Maggi M, Lenzi A, Siracusano A, Jannini EA. Cross-cultural and socio-demographic correlates of homophobic attitude among university students in three European countries. J Endocrinol Invest. 2017 Feb;40(2):227-233

About the author Elena Colonnello is a 5th year medical student in the International Medical School (IMS) of Rome Tor Vergata, Italy. She is a member of the Tor Vergata district of IFMSA since three years, being actively involved in projects aimed to sensitization and public awareness of LGBTQI+ topics and public health issues. She proposed a project she is currently running in collaboration with a colleague of her and the Endocrinology and Medical Sexology team of her University: an observational study about knowledge and attitudes towards homosexuality among medical students and health professionals.