In the Sunday series, we bring to you this article from our archives from the most read section which throws light on dealing with LGBT patients in your practice.

With a significant presence of the Lesbian-gay-bisexual-transgender (LGBT) community in India,  LGBT healthcare is likely to be a common feature of primary care. 

A historic ruling by the  Supreme Court of India, earlier this year, confirmed the right of the country's Lesbian-gay-bisexual-transgender (LGBT) people to freely express their sexuality without discrimination.Although mired in legal controversy and issues, the Lesbian-gay-bisexual-transgender community now has a noticeable presence in India.

One of the critical issues for the LGBT community is getting healthcare in non-hostile environment which can accommodate some of their special needs. A huge challenge faced, is finding healthcare providers who can provide care without being judgemental, all this with a much higher disease burden in some cases than the heterosexual community.

In India, the prevalence of HIV is estimated to be 12 times higher among gay men than among other men overall. According to another study, nearly 31% of transgenders have attempted suicide before age twenty.

A trans-woman, Anirban Kundu, was denied care after a road accident in West Bengal solely because she was transgender. Many still feel reluctant to receive care, and there isn't adequate data to back up how many have been denied care.

Formally, the Medical Council of India has only acted against those doctors who have said they can “cure” homosexuality, however, has not taken proactive steps to address the problem of discrimination or instituted guidelines.

Due to the stigma associated with identifying oneself as part of the LGBT community, many such individuals have a higher incidence of alcoholism, cigarette smoking or have a higher incidence of some form of mental illness. 

With a dearth of adequate literature on approaching, treating and understanding the unique healthcare needs of the LGBT community here are a few wisdom pointers from around the globe that urge the clinicians to focus on humanity rather than on the patient's sexual orientation.

Essentially the primary care for LGBT patients is in many ways exactly the same as primary care for other patients except for certain unique healthcare needs.While policies are being built and consensus arrived at, the least a primary care physician can do is to create a practice environment that demonstrates awareness of and respect for LGBT patients needs.

Do not sound or act judgmental

  If the patient openly comes out to you as part of the community, remember that at that moment, you are a professional there to provide the best care you can. Do not let your biases cloud your diagnosis or judgement of the person. Most importantly, do not make assumptions or draw conclusions solely because the patient identifies himself as part of the LGBT community.Being judged owing to one's sexual orientation or facing even subtle forms of discrimination leads to avoidance of care among the LGBT community, often exacerbating their health problems.

Screen for chronic illnesses

Chronic illness care is one of the most critical health issues plaguing the LGBT community. They have a higher incidence of many chronic diseases including cancers, Hepatitis B and C, and even asthma, according to a report by the Kaiser Family Foundation. Many members of these communities may have these diseases due to being part of a historically discriminated community which has avoided care for fear of being discriminated.It would be wise top consider screening all the LGBT patients for the presence of any chronic ailments that may warrant urgent care. 

Sensitize your staff

Sensitize your staff and train them to treat the LGBT patient community with respect. In any documentation, ensure that they have a preference of being addressed by the correct pronouns, of having columns for their gender (at birth) and if they identify differently now. Again, belief systems of individual staff may be different, but ensure that their personal beliefs do not affect their professional behaviour.

Bring up topics about immunizations/special precautions they need to take

The LGBT community needs to take special care to prevent sexually transmitted diseases, hepatitis immunizations and screenings, substance abuse, certain forms of cancers such as the higher risk of prostate and colon cancer among gay men, gynaecological cancers among lesbian women infection by the Human papillomavirus among others. Among other issues, intimate partner violence, body image issues are frequently seen among the LGBT community. Doctors should be ready to address the concerns associated with these issues, or at least should update themselves whenever confronted with such a case.

Mental health issues

Due to the repeated and multiple experiences of discrimination and stress, these communities have a high burden of mental health issues especially depression, which can coexist and exacerbate substance abuse and addictions, often leading to other chronic morbidities. Doctors should address and refer patients to seek appropriate mental healthcare from qualified professionals. Addressing this issue is one of the most significant thing a medical practitioner can do.

In the Western world, multiple esteemed organizations including the AMA, large hospitals such as the Mount Sinai hospital system and the Gay and Lesbian medical association (GLMA) are formulating detailed guidelines related to caring, attending to and respecting the special needs for LGBT patients. These guidelines aim to sensitize and equip doctors to the unique problems faced by this community and possibly make their healthcare seeking experiences as pleasant as possible.

The Indian medical fraternity too, can take a leaf out of their book and sensitize its members to the needs of this community and create a better environment for them in our healthcare system. Currently, there are no official guidelines to help patients deal with LGBT patients. The People’s Union of Civil Liberties (PUCL) has recommended the MCI to institute guidelines regarding sensitizing doctors towards patients of a different sexual orientation. Various foundations such as the Naz Foundation, the Solidarity Foundation and many others offer help in dealing with these issues and in sensitizing doctors regarding the special needs of LGBT patients. The MCI, IMA and other apex bodies of the medical fraternity need to work with each other in sensitizing their members to treating LGBT patients.

Disclaimer-The author of this article is a public health researcher and the information and views set out in this article are those of the author(s) and do not necessarily reflect the official opinion of M3 India. Neither M3 India nor any person acting on their behalf may be held responsible for the use which may be made of the information contained therein.