American Medical Association Family Medical Guide - American Medical Association [240]
Discrimination and Coming Out
Gay people frequently face discrimination and stereotyping in the United States. Hate crimes and similar acts of violence pose a genuine threat. Between 5 and 10 percent of gay people report having experienced physical assault or abuse because of their sexual orientation, and almost half have been victims of some type of discrimination. This irrational fear of and prejudice against homosexuals is called homophobia.
Still, many gay people feel uncomfortable keeping their sexual orientation hidden. The process of recognizing and accepting being gay or lesbian and then telling other people about it is called coming out. This process can be difficult emotionally, not only for the gay person but also for his or her family and friends. The person’s parents may be alternately shocked, angry, and concerned for their child’s welfare as the child faces the difficulties of being part of a group that may be stigmatized. The gay person may fear rejection by his or her parents and other family members, friends, or coworkers. But for most gay people, coming out is a positive and healthy emotional experience because they no longer have to keep an important part of their life a secret.
If you have recently learned that a relative or friend is homosexual or bisexual, get information and emotional support from a group such as Parents, Families and Friends of Lesbians and Gays (PFLAG).
Health Issues
Some medical conditions are more prevalent among gay men than among the general population. For example, the incidence of some sexually transmitted diseases (STDs) such as gonorrhea (see page 480) and genital warts (see page 480) is higher in homosexual men who engage in unprotected anal intercourse. Infection with gonorrhea can increase the risk of infection with HIV (the virus that causes AIDS; see page 909) because infected tissue is more easily injured, allowing the virus to enter through tiny breaks in the tissue. Although most HIV-infected people worldwide are heterosexual, the majority of new cases in the United States are among gay men, especially young black men between ages 15 and 29. Many of these men do not know they are at risk for HIV infection and engage in unsafe sex—that is, they do not use condoms consistently or correctly (see page 478). Many young men who become infected do not know it—and they continue to practice unsafe sex, putting their sex partners at risk of infection.
Gay men are also at increased risk of infection with the hepatitis A and B viruses (see page 786). Hepatitis A can be transmitted in infected fecal matter during oral-anal intercourse (which also can transmit some bacterial infections and intestinal parasites). Hepatitis B can be transmitted in infected blood during unprotected anal or oral intercourse. Hepatitis B can become chronic (long-term), causing damage to the liver, including scarring (cirrhosis; see page 790) and liver cancer (see page 792). Effective vaccines are available against hepatitis A and B, but many gay men are unaware of their risks of contracting the viruses and also are unaware of the availability of the vaccines.
Some types of cancer—such as Kaposi’s sarcoma and some kinds of lymphoma (see page 625)—disproportionately affect people who are HIV-positive or who have AIDS because the virus attacks and weakens the body’s immune defense system. For this reason, the risk of anal cancer is also increased in men who are HIV-positive. The human papillomavirus (HPV), which causes genital warts (and cervical cancer in women),