Healthcare and the LGBT community
|This article is an orphan, as few or no other articles link to it. Please introduce links to this page from related articles. (February 2013)|
|This article contains sections that are being transcluded from Wikipedia. Please visit the article there to make edits to those sections and support Wikipedia's work.|
||This article has multiple issues. Please help improve it or discuss these issues on the talk page.
LGBT topics in medicine are those that relate to lesbian, gay, bisexual and transgender people's health issues and access to health services. According to the US Gay and Lesbian Medical Association (GLMA), besides HIV/AIDS, issues related to LGBT health include breast and cervical cancer, hepatitis, mental health, substance abuse, tobacco use, depression, access to care for transgender persons, issues surrounding marriage and family recognition, conversion therapy, and refusal clause legislation, and laws that are intended to "immunize health care professionals from liability for discriminating against persons of whom they disapprove."
Studies show that LGBT people experience health issues and barriers related to their sexual orientation and/or gender identity or expression. Many avoid or delay care or receive inappropriate or inferior care because of perceived or real homophobia or transphobia, and discrimination by health care providers and institutions., in other words reason is negative personal experience, the assumption or expectation of negative experience based on knowing of history of such experience in other LGBT people, or both.
"Heterosexism can be purposeful (decreased funding or support of research projects that focus on sexual orientation) or unconscious (demographic questions on intake forms that ask the respondent to rate herself or himself as married, divorced, or single). These forms of discrimination limit medical research and negatively impact the health care of LGB individuals. This disparity is particularly extreme for lesbian women (compared to homosexual men) because they have a double minority status, and experience oppression for being both female and homosexual."
Especially with lesbian patients they may be discriminated in three ways:
- homophobic attitudes
- heterosexist judgements and behaviour
- general sexism - with focusing primarily male health concerns and services; assigning subordinate to that of men health roles for women, as for service providers and service recipients 
 Issues affecting LGBT people generally
Research from the UK indicates that there appears to be limited evidence available from which to draw general conclusions about lesbian, gay, bisexual and transgender health because epidemiological studies have not incorporated sexuality as a factor in data collection. Review of research that has been undertaken suggests that there are no differences in terms of major health problems between LGBT people and the general population, although LGBT people generally appear to enjoy poorer health, with no information on common and major diseases, cancers or long-term health. mental health appears worse amongst LGBT people than the general population, with depression, anxiety and suicide ideation being 2-3 times higher than the general population. There appear to be higher rates of eating disorder and self-harm, but similar levels of obesity and domestic violence to the general population; lack of exercise and smoking appear more significant and drug use higher, while alcohol consumption is similar to the general population. Polycystic ovaries and infertility were identified as being more common amongst lesbians than heterosexual women. The research indicates noticeable barriers between LGB patients and health professionals, and the reasons suggested are homophobia, assumptions of heterosexuality, lack of knowledge, misunderstanding and over-caution; institutional barriers were identified as well, due to assumed heterosexuality, inappropriate referrals, lack of patient confidentiality, discontinuity of care, absence of LGBT-specific healthcare, lack of relevant psycho-sexual training.
Research points to issues encountered from an early age, such as LGBT people being targeted for bullying, assault, and discrimination, as contributing significantly to depression, suicide and other mental health issues in adulthood. Social research suggests that LGBT experience discriminatory practices in accessing healthcare.
 Issues affecting bisexual people
Typically, bisexual individuals and their health and well-being are not studied independently of lesbian and gay individuals. Thus, there is limited research on the health issues that affect bisexual individuals. However, the research that has been done has found striking disparities between bisexuals and heterosexuals, and even between bisexuals and homosexuals.
It is important to consider that the majority of bisexual individuals are well-adjusted and healthy, despite having higher instances of health issues than the heterosexual population.
 Body Image/Eating Disorders
Youth who reported having sex with both males and females are at the greatest risk for disordered eating, unhealthy weight control practices compared to youth who only have same- or other-gender sex. Bisexual women are twice as likely as lesbian women to have an eating disorder and, if they are out, to be twice as likely as heterosexual women to have an eating disorder.
 Mental Health and Suicide
Bisexual females are higher on suicidal intent, mental health difficulties and mental health treatment than bisexual males. Bisexual women are twice as likely as heterosexual women to report suicidal ideation if they have disclosed their sexual orientation to a majority of individuals in their lives; those who are not disclosed are three times more likely. Bisexual individuals have a higher prevalence of suicidal ideation and attempts than heterosexual individuals, and more self-injurious behavior than gay men and lesbians.
 Substance abuse
Female adolescents who report relationships with same- and other-sex partners have higher rates of alcohol abuse and substance abuse. This includes higher rates of marijuana and other illicit drug use. Behaviorally and self-identified bisexual women are significantly more likely to smoke cigarettes and have been drug users as adolescents than heterosexual women.
Bisexual women are more likely to be nulliparous, overweight and obese, have higher smoking rates and alcohol drinking than heterosexual women, all risk factors for breast cancer. Bisexual men practicing receptive anal intercourse are at higher risk for anal cancer caused by the human papillomavirus (HPV).
 HIV/AIDS and Sexual Health
Most research on HIV/AIDS focuses on gay and bisexual men than lesbian and bisexual women. Evidence for risky sexual behavior in bisexually behaving men has been conflicted. Bisexually active men have been shown to be just as likely as gay or heterosexual men to use condoms. Men who have sex with men and women are less likely than homosexually behaving men to be HIV-positive or engage in unprotected receptive anal sex, but more likely than heterosexually behaving men to be HIV-positive. Although there are no confirmed cases of HIV transmitted from female to female, women who have sex with both men and women have higher rates of HIV than homosexual or heterosexual women.
In a 2011 nationwide study in the United States, 46.1% of bisexual women reported having experienced rape, compred to 13.1% of lesbian women and 17.4% of heterosexual women, a risk factor for HIV.
 Issues affecting transgender people
 Access to health care
Transgender individuals are often reluctant to seek medical care or are denied access by providers due to transphobia/homophobia or a lack of knowledge or experience with transgender health. Additionally, in some jurisdictions health care related to transgender issues especially sex reassignment therapy is not covered by medical insurance. However the Principle 17 of The Yogyakarta Principles affirm that "States shall (g) facilitate access by those seeking body modifications related to gender reassignment to competent, non-discriminatory treatment, care and support.
Forty states do not fund sex reassignment surgery through Medicaid.
In the National Transgender Discrimination Survey 19% said they had been refused healthcare by a doctor or other provider for being transgender. Trans people of color were more likely to have been refused healthcare. 36% of American Indian and 27% of multi-racial respondents had been refused healthcare compared to 17% of white respondents.
19% of respondents had no health insurance compared to 15% of the general population. They were also less likely to be insured by an employer. Undocumented non-citizens had particularly high rates of non-coverage (36%) as well as African-Americans (31%), compared to white respondents (17%).
28% said they had been verbally harassed in a healthcare setting. 2% of respondents reported being physically attacked in a doctor's office. Transgender people particularly vulnerable to being assaulted in a doctor's office were African-Americans (6%), those who engaged in sex work, drug sales or other underground work (6%), those who transitioned before they were 18 (5%), and those who were undocumented non-citizens (4%).
In 2004 Venkatesan Chakrapani reported that hijras 'face discrimination in various ways' in the Indian health-care system, and sexual reassignment surgery is unavailable in government hospitals in India.
In a report on hijra social exclusion in Bangladesh by Sharful Islam Khan et al , it was said that health facilities sensitive to hijra culture are virtually non-existent in Bangladesh.
Cancers related to hormone use include breast cancer and liver cancer. In addition, transmen who have not had removal of the uterus, ovaries, or breasts remain at risk to develop cancer of these organs, while trans women remain at risk for prostate cancer.
 Mental health
According to Rebecca A. Allison, trans people are "particularly prone" to depression and anxiety: "In addition to loss of family and friends, they face job stress and the risk of unemployment. Trans people who have not transitioned and remain in their birth gender are very prone to depression and anxiety. Suicide is a risk, both prior to transition and afterward. One of the most important aspects of the transgender therapy relationship is management of depression and/or anxiety." Depression is significantly correlated with experienced discrimination. In a study of San Francisco trans women, 62% reported depression.
41% of the respondents of the National Transgender Discrimination Survey reported having attempted suicide. This statistic was even higher for certain demographics - for example, 56% of American Indian transgender respondents had attempted suicide. In contrast, 1.6% of the American population has attempted suicide. In the sample all minority ethnic groups (Asian, Latin@, black, American Indian and mixed race) had higher prevalence of suicide attempts than white people. Number of suicide attempts was also correlated with life challenges - 64% of those surveyed who had been sexually assaulted had attempted suicide. For example, 76% who had been assaulted by teachers or other school staff had made an attempt.
In 2012 the Scottish Transgender Alliance conducted the Trans Mental Health Study. 74% of the respondents who had transitioned reported improved mental health after transitioning. 53% had self-harmed at some point, and 11% currently self-harmed. 84% of the sample had experienced suicide ideation and 48% had made a suicide attempt. 3% had attempted suicide more than 10 times. 63% of respondents who transitioned thought about and attempted suicide less after transitioning. Other studies have found similar results.
Trans women appear to be at greater risk than trans men and the general population of dying of suicide.
Personality disorders are common in transgender people.
Gender identity disorder is currently classed as a psychiatric condition by the DSM IV-TR. The upcoming DSM-5 removes GID and replaces it with 'gender dysphoria', which is not classified by some authorities as a mental illness. Until the 1970s, psychotherapy was the primary treatment for GID. However, today the treatment protocol involves biomedical interventions, with psychotherapy on its own being unusual. There has been controversy about the inclusion of transsexuality in the DSM, one claim being that Gender Identity Disorder of Childhood was introduced to the DSM-III in 1980 as a 'backdoor-maneuver' to replace homosexuality, which was removed from the DSM-II in 1973.
Transgender individuals frequently take hormones to achieve feminizing or masculinizing effects. Side effects of hormone use include increased risk of blood clotting, high or low blood pressure, elevated blood sugar, water retention, dehydration, electrolyte disturbances, liver damage, increased risk for heart attack and stroke. Use of unprescribed hormones is common, but little is known about the associated risks. One potential hazard is HIV transmission from needle sharing. Cross-sex hormones may reduce fertility.
 Injectable silicone
Some trans women use injectable silicone, sometimes administered by lay persons, to achieve their desired physique. This is most frequently injected into the hip and buttocks. It is associated with considerable medical complications, including morbidity. Such silicone may migrate, causing disfigurement years later. Non-medical grade silicone may contain contaminants, and may be injected using a shared needle. In New York City silicone injection occurs frequently enough to be called 'epidemic', with a NYC survey of trans women finding that 18% were receiving silicone injections from 'black market' providers.
 Sexually transmitted infections
Trans people (especially trans women - trans men have actually been found to have a lower rate of HIV than the general US population ) are frequently forced into sex work to make a living, and are subsequently at increased risk for STIs including HIV. According to the National Transgender Discrimination Survey, 2.64% of American transgender people are HIV positive, and transgender sex workers are over 37 times more likely than members of the general American population to be HIV positive. HIV is also more common in trans people of color. For example, in a study by the National Institute of Health more than 56% of African-American trans women were HIV-positive compared to 27% of trans women in general. This has been connected to how trans people of color are more likely to be sex workers. Research suggests that trans women of color engage in more sexual risk behaviour than their white counterparts.
A 2012 meta analysis of studies assessing rates of HIV infection among transgender women in 15 countries found that trans women are 49 times more likely to have HIV than the general population. HIV positive trans persons are likely to be unaware of their status. In one study, 73% of HIV-positive trans women were unaware of their status.
Latin American trans women have a HIV prevalence of 35%, but most Latin American countries don't recognize transgender people as a population. Therefore there are no laws catering to their health needs.
Transgender people have higher levels of interaction with the police that the general population. 7% of transgender Americans have been held in prison cell simply due to their gender identity/expression. This rate is 41% for transgender African-Americans. 16% of respondents had been sexually assaulted in prison, a risk factor for HIV. 20% of trans women are sexually assaulted in prison, compared to 6% of trans men. Trans women of color are more likely to be assaulted whilst in prison. 38% of black trans women report having been sexually assaulted in prison compared to 12% of white trans women.
In a San Francisco study, 68% of trans women and 55% of trans men reported having been raped, a risk factor for HIV.
 Substance abuse
Like gay and bisexual men and women, trans people are more likely than the general population to use substances. For example, studies have shown that trans men are 50% more likely, and trans women 200% more likely to smoke cigarettes than other populations. It has been suggested that tobacco use is high among transgender people because many use it to maintain weight loss. In one study of trangender people, the majority had a history of non-injection drug use with the rates being 90% for marijuana, 66% for cocaine, 24% for heroin, and 48% for crack. It has been suggested that transgender people who are more accepted by their families are less likely to develop substance abuse issues.
 Issues affecting lesbians
 Breast cancer
According to Katherine A. O’Hanlan, lesbians "have the richest concentration of risk factors for breast cancer [of any] subset of women in the world." Additionally, many lesbians do not get routine mammograms, do breast self-exams, or have clinical breast exams.
 Depression and anxiety
As with gay men, depression and anxiety are thought to affect lesbians at a higher rate than in the general population, for similar reasons.
 Domestic violence
Domestic violence is reported to occur in about 11 percent of lesbian homes. While this rate is about half the rate of 20 percent reported by heterosexual women, lesbians often have fewer resources available for shelter and counselling.
 Physical fitness
 Substance abuse
As with gay men, lesbians often have high rates of substance use, including recreational drugs, alcohol and tobacco. Studies have shown that lesbian and bisexual women are 200% more likely to smoke tobacco than other women.
 Issues affecting gay men
 Anal papilloma
Human papilloma virus, which causes anal and genital warts, plays a role in the increased rates of anal cancers in gay men, and some health professionals now recommend routine screening with anal pap smears to detect early cancers.
 Depression and anxiety
According to GLMA, "the problem may be more severe for those men who remain in the closet or who do not have adequate social supports. Adolescents and young adults may be at particularly high risk of suicide because of these concerns. Culturally sensitive mental health services targeted specifically at gay men may be more effective in the prevention, early detection, and treatment of these conditions." Researchers at the University of California at San Francisco found that major risk factors for depression in gay and bisexual men included a recent experience of anti-gay violence or threats, not identifying as gay, or feeling alienated from the gay community.
 Diet and fitness
Men who have sex with men are at an increased risk of sexually transmitted infection with hepatitis, and immunization for Hepatitis A and Hepatitis B is recommended for all men who have sex with men. Safer sex is currently the only means of prevention for the Hepatitis C.
 Sexually transmitted infections
The first name proposed for what is now known as AIDS was Gay-related immune deficiency, or GRID. This name was proposed in 1982, after public health scientists noticed clusters of Kaposi's sarcoma and Pneumocystis pneumonia among gay males in California and New York City.
Men who have sex with men are more likely to acquire HIV in the modern West, Japan, India, and Taiwan, as well as other developed countries than among the general population, in the United States, 60 times more likely than the general population. An estimated 62% of adult and adolescent American males living with HIV/AIDS got it through sexual contact with other men. HIV-related stigma is consistently and significantly associated with poorer physical and mental health in PLHIV (people living with HIV).
Black gay men have a greater risk of HIV and other STIs than white gay men. However, their reported rates of unprotected anal intercourse are similar to those of men who have sex with men (MSM) of other ethnicities.
 Substance abuse
Studies have shown that gay men use substances, including recreational drugs such as poppers and marijuana; alcohol; and tobacco at a higher rate than the general population. Dr. David McDowell of Columbia University, who has studied substance abuse in gay men, wrote that club drugs are particularly popular at gay bars and circuit parties. Studies have shown that gay and bisexual men are 50% more likely to smoke than other men.
 Issues affecting intersex people
Including intersex under LGBT can be controversial, with some intersex people identifying with LGBT and some not; some argue I[who?] should be included as LGBTI. Intersex people may identify as heterosexual, lesbian, gay, bisexual, trans or no such labels, and so experience some of the issues related to these groups; however, intersex people can also have a variety of health issues from birth onwards that are unique to intersex people. There are a range of ways people can be intersex, so between different types of intersex people there can be different health issues that relate to their situation. For more information, see the article on intersex.
 Health of LGBT people of color
In a review of research, Balmsam, Molina, et al., found that “LGBT issues were addressed in 3,777 articles dedicated to public health; of these, 85% omitted information on race/ethnicity of 9 participants”. However, studies that have noted race have found significant health disparities between white LGBT people and LGBT people of color. LGBT health research has also been criticized for lack of diversity in that, for example, a study may call for lesbians, but many black and minority ethnic groups do not use the term lesbian or gay to describe themselves.
 See also
|Some content in this article from Wikipedia's WikiProject LGBT studies|
|The Wikipedia article is Healthcare and the LGBT community|
|Special thank you to participants of Wikipedia's WikiProject LGBT studies!|
- Health disparities
- Healthcare inequality
- Tamsin Wilton
- Steven Epstein (academic)
- LGBT people in prison
- "About GLMA". Gay and Lesbian Medical Association. Retrieved 2008-12-28.
- "GUIDELINES FOR CARE OF LESBIAN, GAY, BISEXUAL, AND TRANSGENDER PATIENTS". Gay and Lesbian Medical Association. Retrieved 2008-12-28.[dead link]
- Handbook of health behavior research, David S. Gochman, p.145
- Handbook of health behavior research, David S. Gochman, chapter 7, Health behaviour in lesbians, (Homophobia and heterosexism in healthcare system), pp. 145-147
- [Heterosexism in Health and Social Care, Julie Fish, 2006]
- S. Trettin, E. L. Moses-Kolko, and K. L. Wisner. Lesbian perinatal depression and the heterosexism that affects knowledge about this minority population.
- Meads, C; Pennant, M; McManus, J; Bayliss, S (2009). A systematic review of lesbian, gay, bisexual and transgender health in the West Midlands region of the UK compared to published UK research. Unit of Public Health, Epidemiology & Biostatistics, West Midlands Health Technology Assessment Group.
- King, M; Semlyen, J; See Tai, S; Killaspy, H; Osborn, D; Popelyuk, D; Nazareth, I (2009). Mental disorders, suicide, and deliberate self harm in lesbian, gay and bisexual people: a systematic review of the literature. Department of Mental Health Sciences, Royal Free and University College Medical School, University College London.
- Rates and predictors of mental illness in gay men, lesbians and bisexual men and women, British Journal of Psychiatry, (2004) 185: 479-485
- Rivers, I (2001). "The bullying of sexual minorities at school: Its nature and long-term correlates.". Educational and Child Psychology (18(1)): 32–46.
- Rivers, I (2004). "Recollections of Bullying at School and Their Long-Term Implications for Lesbians, Gay Men, and Bisexuals". Crisis (25(4)): 169–175.
- Wilton, Tamsin (2000). Sexualities in health and social care: a textbook. Open University Press. ISBN 0-335-20026-5.
- Wilton, Tamsin (1999). "Towards an understanding of the cultural roots of homophobia in order to provide a better midwifery service for lesbian clients". Midwifery (Harcourt Publishers) (15(3)).
- Wilton, T.; Kaufmann, T. (2001). "Lesbian mothers' experiences of maternity care in the UK". Midwifery (Harcourt Publishers) (17(3)).
- Russell, S. T., and Joyner, K. (2001). Adolescent sexual orientation and suicide risk: Evidence from a national study. American Journal of Public Health, 91, 1276-1281.
- Robin, L., Brener, N. D., Donahue, S.F., Hack, T., Hale, K., and Goodenow, C. (2002). Associations between health risk behaviors and opposite-, same-, and both-sex sexual partners in representative samples of Vermont and Massachusetts high school students. Archives of Pediatrics and Adolescent Medicine, 156, 349-355.
- Koh, A. S., and Ross, L. K. (2006). Mental health issues: A comparison of lesbian, bisexual and heterosexual women. Journal of Homosexuality, 51, 33-57.
- Mathy, R., Lehmann, B., & Kerr, D. (2003). Bisexual and Transgender Identities in a Nonclinical Sample of North americans: Suicidal Intent, Behavioral Diffulties, and Mental Health Treatment. Journal of Bisexuality, 3, 93-110.
- Balsam, K. F., Beauchaine, T. P., Mickey, R. M., and Rothblum, E. D. (2005). Mental health of lesbian, gay, bisexual and heterosexual siblings: Effects of gender, sexual orientation, and family. Journal of Abnormal Psychology, 114, 471-476.
- Udry, J. R., & Chantala K. (2002).Risk assessment of adolescents with same-sex relationships. Journal of Adolescent Health, 31, 84-92.
- Eisenberg, M. E., and Wechsler, H. (2003). Substance use behaviors among college students with same-sex and opposite-sex experience: Results from a national study. Addictive Behaviors, 28, 1913-1923.
- Ford, J. A., and Jasinski, J. L. (2006).Sexual orientation and substance use among college students. Addictive Behaviors, 31, 404-413.
- Russell, S. T., Driscoll, A. K., and Truong, N. (2002). Adolescent same-sex romantic attractions and relationships: Implications for substance use and abuse. American Journal of Public Health, 92, 198-202.
- McCabe, S. E., Hughes, T. L., Bostwick, W., and Boyd, C.J. (2005) Assessment of difference in dimensions of sexual orientation: Implications for substance use research in a college-age population. Journal of Studies on Alcohol & Drugs, 66, 620-629.
- Case, P., Bryn, A. S., Hunter, D. J., Manson, J. E., Malspeis, S., Willett, W. C., & Spiegelman, D. (2004). Sexual Orientation, Health Risk Factors, and Physical Functioning in the Nurses' Health Study II. Journal of Women's Health, 13, 1033-1047.
- Daling, J. R., Madeleine, M. M., Johnson, L. G., Schwartz, S. M., Shera, K. A., Wurscher, M. A., Carter, J. J., ... McDougall, J. K. (2004). Human papillomavirus, smoking, and sexual practices in the etiology of anal cancer. Cancer, 101, 270-80
- Jeffries, W. L. and Dodge, B. (2007). Male bisexuality and condom use at last sexual encounter: Results from a national Survey. Journal of Sex Research, 44, 78-289.
- Zule, W. A., Bobashev, G. V., Wechsberg, W. M., Costenbader, E. C., & Coomes, C. M. (2009). Behaviorally bisexual men and their risk behaviors with men and women. Journal of Urban Health, 86, 48-62.
- Institute of Medicine. (1999). Lesbian health: Current assessment and directions for the future. Washington, D.C.: National Academy Press.
- http://www.cdc.gov/ViolencePrevention/pdf/NISVS_SOfindings.pdf. Missing or empty
- "TEN THINGS Transgender persons SHOULD DISCUSS WITH THEIR HEALTH CARE PROVIDERS". Gay and Lesbian Medical Association. Retrieved 2008-12-28.
- The Yogyakarta Principles, Principle 17. The Rights to the Highest Attainable Standard of Health
- Khan, Liza (2013). "Transgender Health at the Crossroads: Legal Norms, Insurance Markets, and the Threat of Healthcare Reform". Yale Journal of Health Policy, Law, and Ethics 11 (2).
- http://2fwww.thetaskforce.org/downloads/resources_and_tools/ntds_report_on_health.pdf. Missing or empty
- http://indianlgbthealth.info/Authors/Downloads/Hijras_Discrimination_JSW_Chakrapani.pdf. Missing or empty
- http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2928103/. Missing or empty
- Perceived discrimination and depression among low-income Latina male-to-female transgender women. 2012.
- Women and HIV Prevention in Canada: Implications For Research, Policy and Practise.
- http://www.thetaskforce.org/downloads/reports/reports/ntds_full.pdf. Missing or empty
- http://www.scottishtrans.org/wp-content/uploads/2013/03/trans_mh_study.pdf. Missing or empty
- The Health of Sexual Minorities Public Health Perspectives on Lesbian, Gay, Bisexual and Transgender Populations.
- The Health of Sexual Minorities. Springer. p. 491.
- http://www.aclu.org/files/images/asset_upload_file155_30369.pdf. Missing or empty
- "APA Removes Gender Identity Disorder from DSM-V". Ms Magazine.
- Zucker, Kenneth; Robert Spitzer (2005). "Was the Gender Identity Disorder of Childhood Diagnosis Introduced into DSM-III as a Backdoor Maneuver to Replace Homosexuality? A Historical Note". Journal of Sex & Marital Therapy.
- The Health of Sexual Minorities. Springer.
- Health Care Utilization, Barriers to Care, and Hormone Usage Among Male-to-Female Transgender Persons in New York City. 2009.
- http://www.bgtransgender.com/Guidelines/guidelines-transgnder%20primcare.pdf. Missing or empty
- "The Health of Sexual Minorities Public Health Perspectives on Lesbian, Gay, Bisexual and Transgender Populations". The Health of Sexual Minorities.
- http://endtransdiscrimination.org/PDFs/NTDS_Report.pdf. Missing or empty
- http://www.medscape.com/viewarticle/571708. Missing or empty
- Continued Sexual Risk Behaviour in African American and Latino Male-to-Female Transgender Adolescents Living with Hiv/Aids: A Case Study. 2011.
- http://www.thelancet.com/journals/laninf/article/PIIS1473-3099%2812%2970326-2/fulltext?_eventId=login. Missing or empty
- HIV Prevalence and Associated Risk Behaviors in New York City’s House Ball Community. June 2008.
- http://www.aidsalliance.org/publicationsdetails.aspx?id=90623&dm_t=0,0,0,0,0. Missing or empty
- http://www.nationallgbtcancernetwork.com/media/pdf/1_in_4_trans_turned_away.pdf. Missing or empty
- The Need for Transgender Health Content in the Pharmacy Curriculum.
- Transgender Health And HIV Prevention: Needs Assessment Studies from Transgender Communities Across the United States. p. 6.
- "Family Acceptance of Lesbian, Gay, Bisexual and Transgender Youth Protects Against Depression, Substance Abuse, Suicide, Study Suggests".
- "TEN THINGS LESBIANS SHOULD DISCUSS WITH THEIR HEALTH CARE PROVIDERS". Gay and Lesbian Medical Association. Retrieved 2008-12-28.
- "TEN THINGS GAY MEN SHOULD DISCUSS WITH THEIR HEALTH CARE PROVIDERS". Gay and Lesbian Medical Association. Retrieved 2008-12-28.
- "Depression in the Gay Community". Gay.com News. Retrieved 2008-12-28.
- "The History of AIDS and ARC" at the LSU Law Center
- "A Cluster of Kaposi's Sarcoma and Pneumocystis carinii Pneumonia among Homosexual Male Residents of Los Angeles and Orange Counties, California. MMWR, 31(23);305-7 (June 18, 1982)". Retrieved 2007-01-24.
- Statistics from the Ministry of Health, Labor and Welfare
- Go VF, Srikrishnan AK, Sivaram S, et al. (March 2004). "High HIV prevalence and risk behaviors in men who have sex with men in Chennai, India". J. Acquir. Immune Defic. Syndr. 35 (3): 314–9. PMID 15076248. doi:10.1097/00126334-200403010-00014.
- Lee HC, Ko NY, Lee NY, Chang CM, Ko WC (May 2008). "Seroprevalence of viral hepatitis and sexually transmitted disease among adults with recently diagnosed HIV infection in Southern Taiwan, 2000-2005: upsurge in hepatitis C virus infections among injection drug users". J. Formos. Med. Assoc. 107 (5): 404–11. PMID 18492625. doi:10.1016/S0929-6646(08)60106-0.[dead link] Increased Risk for Entamoeba histolytica Infection and Invasive Amebiasis in HIV Seropositive Men Who Have Sex with Men in Taiwan
- UNAIDS 2006 report on the global AIDS epidemic, Chapter 05, June 2006
- Blood Donations from Men Who Have Sex with Other Men: Questions and Answers
- Estimated numbers of persons living with HIV/AIDS at the end of 2006, by race/ethnicity, sex, and transmission category—33 states with confidential name-based HIV infection reporting, Center for Disease and Control Prevention
- "Strange Bedfellows: HIV-Related Stigma Among Gay Men in Australia". Stigma, Discrimination and Living with HIV/AIDS. 2013.
- "Sexual Health, HIV, and Sexually Transmitted Infections among Gay, Bisexual, and Other Men Who Have Sex with Men in the United States". AIDS and Behaviour. 2011.
- HIV Risk and Perceptions of Masculinity among Young Black MSM. 2013.
- Addictions in the Gay and Lesbian Community, Jeffrey R. Guss, Jack Drescher, Published by Haworth Press, 2000, ISBN 0-7890-1037-2, ISBN 978-0-7890-1037-7
- http://www.dal.ca/content/dam/dalhousie/pdf/ace-women-health/3/ACEWH_rethinking_LGBTQ_health.pdf. Missing or empty
- Fish, Julie. "Navigating Queer Street: Researching the Intersections of Lesbian, Gay, Bisexual and Trans (LGBT) Identities in Health Research". Sociological Research Online.