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LGBT VETERAN HEALTH CARE
Female Veterans: Lesbian and Bisexual Health Care
Lesbian and bisexual Veterans face increased health risks and unique challenges in accessing quality healthcare. There are an estimated 1 million lesbian, gay, and bisexual Veterans in the United States. Many of these Veterans may receive care at the VHA. We are working to be a national leader in health care for LGBT Veterans and assure that high-quality care is provided in a sensitive, respectful environment at VHAs nationwide. The following is a list of the top things lesbian and bisexual women Veterans should discuss during their VHA visits.
1. COME OUT TO YOUR HEALTH CARE PROVIDER
In order to provide you with the best care possible, your VHA doctor should know you are lesbian or bisexual. It should prompt him/her to ask specific questions about you and offer appropriate health screens. If your provider does not seem comfortable with you as a lesbian or bisexual woman, ask for another VHA provider. Coming out to your providers is an important step to being healthy. For frequently asked questions about privacy, see Your Privacy Matters on page 3.
2. MENTAL HEALTH
Depression and anxiety affect lesbian and bisexual women at a higher rate than heterosexual women. Veterans are also at higher risk of some mental health problems than nonVeterans. Lesbian and bisexual women may be more at risk for PTSD and chronic stress from discrimination. Living with this stress can worsen depression and anxiety and may also contribute to thoughts of suicide. These problems may be more severe for women who remain "in the closet" or who do not have adequate social supports. Culturally-appropriate mental health services for lesbian and bisexual women for the prevention, early detection, and treatment of these conditions should be available at your VHA. If you are in crisis, please call 911, go to your nearest Emergency Room, or call the Veterans Crisis Line at 1-800-273-8255 (press "1" after you call).
3. SUBSTANCE USE/ALCOHOL
Heavy drinking and substance use are common among lesbian and bisexual women. Alcohol and drug misuse can lead to serious health, relationship, employment, and legal problems. Problems with drinking or drug use may oc PTSD, depression, or other medical conditions. Fortunately, there are proven methods to help Veterans recover from alcohol or drug misuse, including mutual help groups and more intensive treatments. VHA has many resources to help Veterans (including lesbian and bisexual Veterans) and their loved ones answer questions, find support, get treatment, and recover. cur in response to stress, and/or in combination with
4. TOBACCO USE
Lesbian and bisexual women use tobacco at higher rates than heterosexual women. Tobacco-related health problems include lung disease and cancer, heart disease, high blood pressure, and many other serious problems. All lesbian and bisexual women should be screened for and offered culturally-appropriate prevention and cessation programs for tobacco use. VHA has programs to help you quit smoking. Talk to your provider about how VHA can help or call 1-855-QUIT-VET to get started. Get text messages to help you quit smoking from SmokefreeVET—text the word VET to 47848 or visit http://smokefree.gov/VET to sign up.
LESBIAN AND BISEXUAL HEALTH CARE
5. SEXUALLY TRANSMITTED INFECTIONS (STIS)
STIs occur in sexually active lesbian and bisexual women. Some STIs can be cured (syphilis, gonorrhea, chlamydia, pubic lice), and some can be effectively treated but not cured (HIV, hepatitis, human papilloma virus, herpes). Barrier protection (e.g., dental dams, condoms) reduces the risk of STIs. Risk of exposure increases with the number of sexual partners. Because you can have an STI without symptoms, and transmit it to others, screening is important.
» » HIV/AIDS
Women who have sex with men are at an increased risk of HIV infection. Condom use can reduce the risk of receiving or transmitting HIV. Pre-Exposure Prophylaxis (PrEP) is one strategy for reducing the risk of getting infected with HIV. If you are not HIV positive, discuss with your VHA provider whether PrEP is best. If you are HIV positive, you need to be in care with an HIV provider.
» » HEPATITIS IMMUNIZATION AND SCREENING
If you have sex (with partners of any gender) you are at risk of exposure to the viruses that cause the serious liver conditions known as hepatitis. These infections can lead to very serious long-term issues such as liver failure and liver cancer. Immunizations are available to prevent two of the three viruses (hepatitis A and B). Barrier protection use and not sharing needles are effective at reducing the risk of viral hepatitis and is currently the only means of prevention for the hepatitis C virus. If you have hepatitis C, talk to your provider about the new treatments that can cure this infection.
» » HUMAN PAPILLOMA VIRUS (HPV)
HPV is the most common STI in the United States. HPV infection can cause cervical, vaginal, and vulvar cancers, anal cancer, cancer of the back of the throat, and genital warts. Barrier protection use greatly reduces the risk of HPV.
6. BREAST, OVARIAN, CERVICAL, AND UTERINE CANCER
Lesbian and bisexual women are likely to have risk factors for breast cancer, such as not having children or having children later in life, being overweight, and excessive alcohol use. Lesbian and bisexual women are also more likely to have risk factors for certain types of gynecological cancers compared to heterosexual women, such as smoking, less use of birth control pills, and being overweight. Lesbian and bisexual women are less likely to get mammograms or receive pelvic exams and pap smears than heterosexual women. Regular screenings are part of routine VHA care and can lead to early diagnosis when diseases are most curable.
7. FITNESS (DIET AND EXERCISE)
Problems with body image are common among bisexual women. Research also shows that lesbian women are 25% more likely to be overweight or obese compared to heterosexual women. Obesity is associated with higher rates of heart disease, cancers, and premature death and can lead to a number of health problems, including diabetes, high blood pressure, joint problems, and heart disease. Talk to your VHA provider about the MOVE! Weight Management Program.
8. HEART HEALTH
Heart disease is the leading cause of death for women. High blood pressure is related to cardiovascular disease and can be affected by stress, including stress from discrimination. High blood pressure can be managed with healthy lifestyle changes and medications. Smoking and obesity are two risk factors for heart disease common among lesbian and bisexual women. Getting your blood pressure checked regularly is important because high blood pressure often has no symptoms.
9. OLDER LESBIAN AND BISEXUAL WOMEN
Older lesbian and bisexual women are likely to have experienced stigma, discrimination and violence related to sexuality. Older lesbian and bisexual women who need assistance are less likely to receive care from adult children and may experience discrimination in nursing homes or community living centers or live in fear of that discrimination. VHA has non-discrimination policies in place to protect older lesbian and bisexual women and their partners in VA facilities.
10. INTIMATE PARTNER VIOLENCE (IPV)
IPV refers to violence and aggression between intimate partners which can include physical, sexual or psychological abuse or stalking. IPV can be a single event or last for many years. The impact of IPV can reach far beyond the actual or threatened violence or aggression. VHA has a number of resources available for women who have experienced IPV, including violence from same-sex partners. Military sexual trauma (MST) is the term used by VHA to refer to experiences of sexual assault or repeated, threatening sexual harassment that a Veteran experienced during her military service. Lesbian and bisexual women have higher rates of IPV and MST compared to heterosexual women. VHA offers effective therapies for mental health problems that commonly occur with IPV, such as PTSD, depression, anxiety and alcohol or drug use problems. Every VHA facility has providers knowledgeable about treatment for the after effects of MST.
YOUR PRIVACY MATTERS
I DON'T WANT ANYONE BESIDES MY PROVIDER TO KNOW THAT I'M LESBIAN OR BISEXUAL. WILL THIS INFORMATION BE SHARED?
Your VHA provider has been trained to keep your conversations confidential. You can also ask that this information not be entered into your medical record, although there may be important reasons for your other health care providers to know this information. Finding a provider you are comfortable with is essential to your health and wellness.
WHAT IF MY PROVIDER USES THE WRONG TERMS OR PRONOUNS WHEN REFERRING TO ME OR MY SPOUSE/PARTNER?
Your VHA provider may not know what terms you prefer to use. Let providers know how you describe yourself and your partner(s), and they will start to use those words. If they make a mistake, let them know! Your provider wants to make you feel comfortable, and using words that you prefer is an important first step.
DOES THE VHA HAVE RESOURCES TO HELP ME FIND A PROVIDER WHO IS COMFORTABLE WITH MY SEXUAL ORIENTATION?
Yes! Each facility will soon have a LGBT Veteran Care Coordinator, who can help you find a culturally competent provider. In addition, many VA facilities have LGBT Veteran Web pages. For a list of those Web pages, see here: www.patientcare.va.gov/LGBT/VAFacilities.asp
LESBIAN AND BISEXUAL HEALTH CARE
To find the VHA medical center or Vet Center nearest you, call 1-877-222-8387 or visit www.va.gov/directory. Every VHA has a LGBT Veteran Care Coordinator to assure you have access to appropriate treatment. They can assist you with finding providers, answering questions, and reporting problems if you encounter them.
LGBT PROGRAM OFFICE
The LGBT Program within the Office of Patient Care Services assists LGBT Veterans in accessing quality health care. Visit our website at http://go.usa.gov/cuth4
ADDITIONAL RESOURCES
ARE YOU A MEDICAL PROVIDER LOOKING FOR RESOURCES TO HELP PROVIDE CARE TO LGBT VETERANS?
Health Professionals Advancing LGBT Equality www.glma.org
The Fenway Institute–The National LGBT Health Education Center
ARE YOU A VETERAN LOOKING TO UNDERSTAND WHY YOUR SEXUAL ORIENTATION AND GENDER IDENTITY ARE IMPORTANT TO YOUR OVERALL CARE?
Centers for Disease Control and Prevention–LGBT Health www.cdc.gov/lgbthealth
DO YOU WANT MORE INFORMATION ON THE VA'S PATIENT CARE SERVICES LGBT PROGRAM?
The Lesbian, Gay, Bisexual and Transgender Program http://go.usa.gov/cuth4
! If you are in crisis, please call 911, go to your nearest Emergency Room, or call the Veterans Crisis Line at 1-800-273-8255 (press "1" after you call).
CONNECT WITH US:
SUBSCRIBE TO RECEIVE EMAIL UPDATES AT WWW.PATIENTCARE.VA.GOV
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ARE YOU A VETERAN LOOKING FOR GENERAL INFORMATION ABOUT THE PROGRAMS MENTIONED ABOVE?
Tobacco and Health www.publichealth.va.gov/smoking/index.asp
Viral Hepatitis www.hepatitis.va.gov
HIV/AIDS
MOVE! Weight Management Program www.move.va.gov