It may take repeated visits before addressing sexual health in detail. It is also important to recognize that some LGBT youth may be reluctant to openly discuss matters of sexual health and sexuality without first establishing a trusting relationship with their provider. If they do not, they risk losing valuable opportunities both to provide a safe and accepting setting for youth to voice concerns and questions and to intervene for those youth in crisis. It is the health care provider’s responsibility to openly discuss matters of sexual health, including sexual orientation, sexual behavior, and gender identity, with patients. Hadland and colleagues’ article, “Caring for LGBT Youth and Families in Inclusive and Affirmative Environments,” in this issue, for review of appropriate terminology used to describe gender identity and sexual orientation.ĪPPROACH TO SEXUAL AND REPRODUCTIVE HEALTH CARE FOR LESBIAN, GAY, BISEXUAL, TRANSGENDER YOUTH Health care providers, equipped with knowledge and expertise, have the opportunity to mitigate these sexual health inequities with each valuable patient encounter. For example, many women who have sex with women (WSW) have current or past male partners, and data show they may be less likely to use effective contraception and are at increased risk for pregnancy. 9 Similarly, it is important to remember that for LGBT youth, sexual behavior does not necessarily align with reported sexual attraction and identity, which are other aspects of sexual orientation that may change over time. Although rates of unprotected anal intercourse are similar between African American and other MSM, African American MSM are more likely to experience structural barriers such as unemployment, lack of health insurance, incarceration, or lower educational attainment levels that may act as barriers to care and thus increase the risk of HIV. Racial disparities also play a role in the increased incidence of HIV in young men and transgender women of color who have sex with men. For MSM, the anatomy and immunology of the rectal mucosa lead to a higher biologic susceptibility to STIs and HIV. It is important to remember that the high STI rates in LGBT youth are not necessarily due to an increased number of partners or frequency of sex.
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8Īlthough providers need to be aware of the epidemiology of STIs in LGBT youth, they should use caution in making assumptions about their patient’s sexual practices. A review of studies estimated that HIV prevalence for transgender women was nearly 50 times as high as that of other adults. 7 Young transgender women (YTW) are particularly vulnerable to HIV. Over the past decade, HIV incidence in young MSM of color has increased by 87%. Although MSM accounted for only 4% of the male population in the United States in 2010, 6 they represented 78% of new HIV infections among men and 68% of total new infections. 5 Adolescent MSM have also been disproportionately affected by HIV. These behaviors may partly explain why although the overall incidence rates of gonorrhea, chlamydia, and syphilis have decreased among adolescents in the last 15 years, they have increased among adolescent men who have sex with men (MSM). 4 Compared with heterosexual youth, LGBT youth were about half as likely to have used a condom at last intercourse (35.8% vs 65.5%). 3 In addition, according to Youth Risk Behavioral Surveillance data, compared with heterosexual youth, LGBT youth are more likely to be sexually active, to have earlier sexual debut (before age 13), and have 4 or more sexual partners.
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They are at significantly higher risk of sexual assault and abuse than their heterosexual peers. LGBT youth also face significantly different sexual health outcomes related to sexual assault, STIs, HIV, and teen pregnancy. Pachankis’ article, “Stigma and Minority Stress as Social Determinants of Health Among LGBT Youth: Research Evidence and Clinical Implications,” in this issue). It is likely that these health inequities arise from individual, interpersonal, and structural stigma, which promote barriers to care (see Mark L. 1 They are often subject to stigmatization, isolation, and societal and parental rejection.
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Data demonstrate that LGBT youth are more likely than their heterosexual counterparts to experience a wide array of health inequities, many of which predispose them to an increased risk of sexually transmitted infections (STIs) and human immunodeficiency virus (HIV).