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These men (who tend to be younger, lower-income, and more racially diverse) are also less likely to report discussing HIV with doctors or getting tested for HIV.
To date, there has only been one likely case of female-to-female sexual transmission of HIV in the United States.42 However, HIV is an issue that affects lesbians as well as bisexual women, since individuals who identify as lesbian may still have sexual relationships with men, and lesbians and bisexual women are also at risk of HIV via transmission modes that do not involve sexual contact (such as injection drug use).
STI rates are higher among some LGB groups than heterosexuals, and rates have been increasing for some infections.
Could impact access to care for LGB Individuals.180
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Obesity rates are higher among lesbian and bisexual women compared to heterosexual women, but are lowest among gay men. Other studies have looked beyond self-identification, to include behavior and attraction, and obtained higher estimates, including one that found that 10% of adults reported experience with same-sex partners.11 In addition, a recent analysis indicates that standard survey measures appear to significantly underestimate non-heterosexual identity and same-sex sexual experiences.12
Racial and ethnic minorities, young people, and women are more likely than their counterparts to identify as LGBT (Figure 1).13
The Youth Risk Behavior Surveillance System (YRBSS), a nationally representative survey of high school students, asks about sexual identity and sex of sexual contacts.
Furthermore, among lesbians, gay men, bisexual men and women, and transgender people, there are subpopulations based on race, ethnicity, socioeconomic status, geographic location, age, and other factors. Any opinions, findings, conclusions, or recommendations expressed in this publication are those of the author(s) and do not necessarily reflect the view of the organizations or agencies that provided support for this project.
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IOM (Institute of Medicine).
Another nationwide study found a reported 41% prevalence of suicide attempts among the transgender population.55
Research suggests that MSM have higher use of certain substances. In 2011, states were given the option to extend these “spousal impoverishment” protections to married same-sex couples and domestic partners.149 After Windsor, such protections were required for married same-sex couples in marriage equality states.
Research reflects the impact of these barriers. Twelve states (CA, CO, DE, HI, IL, ME, MN, NV, NY, OR, RI, VT, and WA) plus DC prohibit discrimination based on sexual orientation and gender identity in private health insurance.132 New Jersey provides protection on the basis of sexual orientation but not gender identity in private health insurance.133 Nineteen states (CA, CT, CO, DE, HI, IL, MA, MD, MI, MN, NJ, NV, NY, OR, PA, RI, VT, and WA) and DC prohibit transgender exclusions in health insurance through legislation or regulation.134 Twenty states (CA, CO, CT, DE, HI, IL, IA, ME, MD, MA, MN, NV, NJ, NM, NY, OR, RI, UT, VT, and WA) plus DC prohibit discrimination by private employers on the basis of sexual orientation and gender identity and another two states (NH and WI) prohibit discrimination based only on sexual orientation.135
Health Insurance Marketplaces: Windsor also affected eligibility for assistance for same-sex couples in all ACA health insurance marketplaces (whether federally-facilitated or state based).
It is expected that with the Obergefell ruling, all states will be required to apply these protections to married same-sex couples.
Coverage of transgender services has also been expanded in federal programs. In a survey of LGB people, more than half of all respondents reported that they have faced cases of providers denying care, using harsh language, or blaming the patient’s sexual orientation or gender identity as the cause for an illness.89 Fear of discrimination may lead some people to conceal their sexual orientation or gender identity from providers or avoid seeking care altogether.
For transgender persons, discrimination may be as personal as refusing to use the patient’s chosen name or as structural as providers’ lack of knowledge about how to provide appropriate care to transgender people.
Additionally, new private plans are now required to cover recommended preventive services without cost sharing. For example, MSM account for more than eight in ten (82%) new gonorrhea and primary and secondary syphilis cases when the gender of sex partner is known. LGB students were also less likely to report condom use during last sexual intercourse than heterosexual students (48% v.
Windsor overturned a portion of DOMA and required the federal government to recognize legal same-sex marriages for the first time. The Administration on Aging also added a sexual orientation and gender identity questions to the National Survey of Older Americans Act (OAA) Participants. This could be especially meaningful as sexual orientation protections remain unspecified under Section 1557 and because gender identity protections under 1557 are threatened by ongoing litigation.
Windsor on Skilled Nursing Facility Benefits for Medicare Advantage Enrollees170
After Windsor, clarifies that same-sex married beneficiaries in Medicare Advantage plans who each need care in a skilled nursing facility can receive care at same facility, as applicable to married beneficiaries more generally.
Department of Labor, Wage and Hour Division- The Family and Medical Leave Act171
As a result of the Windsor ruling, the DOL finalized a rule in 2015 that expanded the definition of “spouse” to include all legally married same-sex couples for purposes of providing workplace protections to employees if they take time off to care for a family member in the event of illness or birth of a child.
Other
Presidential Memorandum- Hospital Visitation172
Executive order and subsequent regulations173 in 2010 stating that hospitals receiving funds from Medicaid and Medicare are to respect the rights of patients to designate visitors, including same-sex partners (whether married or not) and others designated by legally valid advance directives.
Regulations issued in November 2010 supports enforcement of the right of patients to designate the person of their choice, including a same-sex partner, to make medical decisions on their behalf should they become incapacitated.
Centers for Medicare and Medicaid Services Memorandum 13-42-NH: Reminder- Access and Visitation Rights in Long Term Facilities174
LTC facilities must ensure that all individuals, including same-sex partners (whether married or not), seeking to visit a resident be given full and equal visitation privileges, consistent with resident preferences within reasonable restrictions that safeguard residents.
Centers for Medicare and Medicaid Services- Medicaid Spousal Impoverishment Protections175
In 2011, states were given the option to extend protections to include married same-sex spouses and domestic partners.
The ACA expands access to health insurance coverage for millions, including LGBT individuals, and contains specific protections related to sexual orientation and gender identity, although recent actions taken by the Trump Administration have sought to scale back some of these gains. In particular, research finds that on some measures, bisexual individuals have more limited access to care while lesbian and gay individuals have rates comparable to heterosexual adults (Figure 5).
For both men and women, the perpetrators were predominantly male.
Anti-LGBT bias also puts LGBT people at risk for physical violence. After experiencing a dramatic rise in new infections in the 1980s, efforts by the gay community and public health officials helped to bring HIV incidence down; however, in recent years, new infections among gay and bisexual men in the U.S.
have been on the rise, the only group for which infections are increasing (Figure 3).
In 2014, gay and bisexual men and other men who have sex with men (MSM), while representing an estimated 2% of the U.S. population, accounted for six in ten (61%) people living with HIV in the United States, and 70% of new HIV infections.34,35
Between 2008 and 2014, annual HIV infections stabilized among all MSM but this trend was not observed among all racial/ethinic groups.