Health Hazards of Homosexuality

Homophobia, the socialization of heterosexuals against homosexuals and concomitant conditioning of gays and lesbians against themselves, is a legitimate health hazard. You can find the detailed analysis of this topic at www.ohanlan.com.

Homophobia negatively affects the social and health care environment of homosexuals so that they become at increased risk for health problems. Studies have shown higher lifetime rates of depression, attempted suicide, psychological help-seeking and substance abuse among homosexuals. This is attributed to chronic stress from societal hatred or to the ascription of inferior status that homophobia imposes. This type of life stress has significant health implications because of the associated frequent loss of familial support systems and the frequent concealment and suppression of feelings and thoughts. Though most gay and lesbian individuals are content with their orientation and function well in society, those who describe themselves otherwise cite victimization by violence, and familial, governmental, job or social discrimination as the reasons for their dissatisfaction. On the other hand, decreased levels of homophobia are associated with proactive coping style and decreased avoidant coping.

Psychological health: Increased difficulties with depression, suicidality, substance abuse and intimacy problems are a result of homophobia. Numerous studies have identified an increased suicide rate among gay and lesbian youth. The estimates from these studies vary, but fall into the range of 25-42%, which compares to 8-13% among high school students in general. Others have contested these findings and find rates comparable to rates in the general population. Debate continues because of the invisibility of most gay and lesbian youth. Studies of increased risk factors for suicide attempts before age twenty in gay and lesbian youth included

1) discovering same-sex preference early in adolescence, 2) experiencing violence due to gay or lesbian identity, 3) using alcohol or drugs to cope, and 4) being rejected by family members as a result of being homosexual.

The repeated association of suicide behaviors with these factors supports the experience of homophobia as a risk factor for this behavior.

One of the greatest health risks for homosexuals, especially gay and lesbian youth, is being the victim of physical assault. Violent crimes against gay men and lesbians have been observed, but are not regularly tracked as hate crimes because federal regulations do not require states to record homophobic violence as a hate crime. The 1996 Report of the National Coalition of Anti-Violence Programs described 2,212 instances of homophobic violence including harassment, threats, assault, vandalism, arson, kidnapping, extortion, and murder, over a twelve month period in the eleven cities they monitored, including New York, Minneapolis/St. Paul, Chicago, Denver, Boston, and San Francisco. According to a two year national study, when compared with homicides against heterosexuals, homicides against gay men and lesbians are more violent and more likely to involve mutilation and torture, and are more likely to go unsolved. The report concluded, "Each anti-gay episode sends a message of hatred and terror intended to silence and render invisible not only the victim, but all lesbians, gay men and bisexuals."

Quality data regarding risk profiles for and rates of breast cancer in the lesbian population is lacking. Three major lesbian health surveys all reported obstetrical nulliparity rates among lesbian respondents between 69 and 90%.19, 33, 34 Nulliparity is also a known risk factor for endometrial and ovarian cancers. Use of oral contraceptives reduces the risk for developing endometrial and ovarian carcinoma. Although no data is available documenting lesbian use of oral contraceptives, lesbians appear unlikely to have used any contraceptive extensively. In national studies, it has been shown that unmarried women have higher rates of cigarette abuse and lower rates of breast self exam, clinical breast exam, and screening mammography when compared to married women. Since lesbians are more likely to be counted as unmarried, this data suggests lesbians may utilize screening less often. One-fourth of lesbians over age 40 in a Michigan study had never had a mammogram. These studies support that lesbians have an increased risk of gynecological disease, but more importantly, because of a homophobia, there is avoidance of health care from what may be perceived correctly as an uncaring and disinterested group of health care providers. This in turn leads to a rate of increased problems with lesbian receiving prompt and sensitive care.

Physicians must understand that 3-6% of the patients they currently see, some 11 million Americans, are gay or lesbian, and that these individuals express part of the normal range of human sexuality, and deserve the highest standard of healthcare, as do all patients. This understanding should be taught in an organized curriculum in medical school and/or residency training programs which incorporates a literature-based understanding of orientation diversity. For example, the Temple University School of Medicine now provides its medical students and the medical community with a resource guide which addresses many of the issues described above.89 The American Psychiatric Association has sponsored "A Curriculum for Learning About Homosexuality and Gay Men and Lesbians in Psychiatric Residencies" which describes educational objectives, learning experiences, and implementation strategies for sound clinical practice.

Physicians, regardless of their sexual orientation, or political or religious affiliation, must provide the highest standard of care to all patients by discarding those views which science does not validate. Physicians have a responsibility to examine their attitudes about homosexuality and recognize those views which are not consistent with facts. Physicians have a unique opportunity to influence others in our society to align their attitudes with this objective information. Supporting the research-based education of adults and children about the diversity of sexual orientation will reduce the pervasive and harmful effect of homophobia. It will help to improve and maintain lesbian and gay individuals' self-concept and self-respect. Physician support for legislation that proscribes discrimination and provides legal recognition for the unions of lesbian and gay families will provide legal, societal, and financial and healthcare equity to this marginalized population. The resultant increased visibility of lesbians and gays will increase their familiarity in the community and promote greater understanding and acceptance. Improved access to health care, increased integration into family and society, and heightened life-satisfaction, productivity, and health will result when homophobia is recognized and confronted as the health hazard it poses to gay and lesbian individuals.