Take Pride in Your Health: Tips from a Primary Care Physician – Washington Blade


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Take Pride in Your Health: Tips from a Primary Care Physician
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Navigating health care can be daunting, especially for those who identify as LGBTQ+. Historically, the LGBTQ+ community has been marginalized and discriminated against, which has led to mistrust and unease for many who seek medical care. 
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Navigating health care can be daunting, especially for those who identify as LGBTQ+. Historically, the LGBTQ+ community has been marginalized and discriminated against, which has led to mistrust and unease for many who seek medical care. 
In Washington, DC, individuals identifying as LGBTQ+ comprise 9.8% of the population, a greater percentage than in any state. Individuals from this community are almost three times more likely to report poor quality of care and discrimination by healthcare providers. Nearly three in 10 of those who identify as transgender reported being refused healthcare because of their gender identity. Patients who identify as LGBTQ+ are less likely to seek preventive services such as cancer screenings and treatment for chronic conditions. And are more than two times more likely to delay getting care.
As we recognize Pride Month, I want to offer a few suggestions for finding healthcare providers committed to care equity and navigating the healthcare system so you can get the support you need to be healthy. Below are three tips to guide your care.
Find a doctor who’s an ally: The first important step is to find a doctor with whom you can speak honestly about your sexual health, gender identity, and health concerns. Look for a caring practitioner with special expertise in treating the LGBTQ+ population. Review the physician’s profile, looking for their level of interest and experience in treating the LGBTQ+ community. To get started with a new provider, I suggest scheduling a meet-and-greet appointment with a primary care provider to review your personal medical history, family history, specific concerns and health goals.  From there, you and your doctor can establish a health regimen that includes any necessary lab work, screenings, and office visits to best support your total health. Gender-affirming healthcare, if desired, should be discussed. 
Kaiser Permanente offers Pride Medical at Capitol Hill Medical Center, a welcoming, judgment-free, compassionate, and supportive medical practice devoted to meeting the unique health care needs of adult patients who identify as LGBTQ+. Kaiser Permanente’s gender-affirming care program, Gender Pathways, takes an innovative approach to providing care to transgender, nonbinary, and gender-expansive patients. Their services include behavioral health care, hormone replacement therapy, and gender-affirming surgeries. 
Know your risk factors: Understanding the unique health needs within the LBGTQ+ community is key to staying healthy. As people within the LGBTQ+ population face daily discrimination, some cope with these challenges by using tobacco and substances. In fact, there are higher rates of substance abuse for individuals who identify as LGBTQ+ than among heterosexual adults.Some populations within the LGBTQ+ community have a higher risk of sexually transmitted diseases, including HIV. The LGBTQ+ population also has a higher risk of developing certain cancers.To address your specific health risks and goals, your doctor can develop an individualized care plan that will include preventative screenings and routine appointments designed to identify and address problems early, leading to better health outcomes.Kaiser Permanente’s electronic medical record system proactively identifies the need for general health screenings and sends personalized reminders.
Manage your mental health: At Kaiser Permanente, we encourage preventive health measures to avoid developing health conditions like heart disease or cancer – and the same goes for mental health. Members of the LGBTQ+ group are more than twice as likely as cisgender heterosexual adults to have a mental health condition, such as depression or anxiety disorders. And, adults who identify as transgender are nearly four times as likely as cisgender adults to have a mental health condition. You can manage stress through exercise and using self-care digital apps, such as Calm or myStrength, free to Kaiser Permanente members. These tools can guide meditation and find support for building resilience, setting goals, and making minor changes to improve sleep, mood, and relationships. Prioritize frequent exercise, talking to someone you trust, journaling, and making time for self-care. As always, talk to your doctor if your mood or behavior changes affect your ability to participate in everyday activities.
You can become a self-advocate and receive the healthcare you need by establishing a rapport with a doctor you trust, knowing your specific health risks, and managing your mental health. Live a joyful, healthier life by seeking support from a primary care doctor and maintaining your routine screenings. Learn more about Pride Medical and LGBTQ+ care at Kaiser Permanente here. 
Dr. Keith Egan, a primary care physician at Kaiser Permanente and assistant medical director of Pride Medical at Capitol Hill.
Monkeypox cases rise amid calls for equitable treatment & vaccine equity
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As of June 16th, 2,166 cases of monkeypox have been recorded globally, spanning 37 countries, including places where it is not usually seen. The United States currently has 100 recorded cases of monkeypox — California, New York, and Illinois are hot spots with 21, 17, and 13 cases respectively. 
Infections are currently concentrated in Europe: the U.K. has reported 524 cases, and Spain, Germany, Portugal, and France have reported 313,303, 241, and 183 cases respectively. Many of the infections in Europe and the Americas can be traced back to LGBTQ+ events where men gathered — specifically a LGBTQ+ fetish festival in Belgium and a gay pride event in the Canary Islands. 
No deaths have been reported, and most monkeypox cases are mild — symptoms include rashes, initial flu-like symptoms, and lesions or sores.
According to the CDC’s latest report, most of the reported cases have occurred in men who have sex with men, but monkeypox can be transmitted to anyone who has had close skin-to-skin contact with an infected person.
Although cases are currently concentrated in gay and bisexual men, Kyle Knight, senior LGBT and health researcher at Human Rights Watch, stressed the importance of managing the outbreak without stigmatizing gay men — or deepening the divide between wealthy and poor countries. 
“Whether it’s lessons drawn from HIV, Covid-19, or other public health issues, it is essential to place human rights at the center of the response to infectious disease outbreaks,” Knight said, in a statement.
In an email to the Blade, Dr. Sarah Henn, Chief Health Officer for Whitman-Walker Health, reiterated the need to spread awareness of monkeypox within the LGBTQ+ community while simultaneously eradicating stigma.
“When dealing with an outbreak of any infection it is important to recognize risk factors for infection and specific communities where the infection is being seen. This must be done without stigmatizing those affected. This is the delicate balance that public health authorities are currently trying to walk with the outbreak of monkeypox. There is nothing intrinsic to the monkeypox virus that makes it a sexually transmitted infection, but it is transmitted by close skin to skin contact with the pox lesions, which obviously sexual intimacy involves,” she said. 
“People in the queer community need to know what to look for and understand what the potential risks are to their own health. We want to empower the community to help control the outbreak and protect themselves from possible infection without creating stigma or unnecessary fear.”
In addition to its prevalence among gay and bisexual men, monkeypox has a history of unequal treatment options in poorer countries. While some wealthy countries have stockpiles of the smallpox vaccine leftover from when the disease was eradicated in the 1980s, the vaccine — which is effective against monkeypox — is currently unavailable on the entire continent of Africa, where monkeypox is an endemic disease.
Dr. Matshidiso Moeti, World Health Organization, (WHO) regional director for Africa, advocated for a unified global approach that includes vaccine equity.
“We must avoid having two different responses to monkeypox – one for Western countries which are only now experiencing significant transmission and another for Africa,” Moeti said. “We must work together and have joined-up global actions which include Africa’s experience, expertise and needs.”
In countries such as the U.S. and Canada, “ring vaccinations” are being used to prevent outbreaks, in which close contacts of infected people are given a smallpox vaccine within four days of exposure. This approach prevents serious infection and reduces the risk of further spread, but in places where smallpox vaccines are not readily available, it is not an option.
In Chicago, where the state of Illinois’s monkeypox cases are concentrated, officials are also focusing on providing information about prevention and safer sex to gay and bisexual men. With the San Francisco and New York Prides happening next weekend — the country’s two largest — the future of monkeypox outbreaks in the U.S. appears uncertain.
Guidance from the Chicago Department of Public Health encourages people attending “festivals or other summer events” to be mindful of skin-to-skin contact, get tested for monkeypox if exposed, and monitor for symptoms after exposure. Additionally, the CDPH has printed cards with links to the CDC health tips for gay and bisexual men, for organizers to hand out at events.
In Washington D.C., the outbreak is currently smaller — four cases to Chicago’s seven — but officials are still taking preventative measures to diagnose and treat the illness. 
“As of today, 4 cases of monkeypox have been diagnosed within the District of Columbia,” Dr. Henn said. “We are working closely with DC Health to screen people for monkeypox who are presenting with rashes that could possibly represent infection and have been coordinating with the city around vaccination of those who have been exposed to a diagnosed case.”
Most cases identified in gay or bisexual men
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On June 4, the D.C. Department of Health confirmed its first case of Monkeypox from a resident who recently travelled back from Europe. D.C. now joins 11 other states with this potentially deadly disease. So far, most cases have been identified in gay or bisexual men.
With Pride events taking place in D.C. and around the world this month, how concerned should we be? Is this the tip of the iceberg? Let’s break it down.
What is Monkeypox?
Monkeypox is caused by a virus similar to its more deadly cousin Smallpox. Scientists identified Monkeypox in 1958 first in monkeys (hence the name) and later in humans in the 1970s. Despite the name, bush animals and rodents are the natural reservoir for the virus.
How did we first hear about this strain of Monkeypox?
In May, health officials first identified an outbreak of Monkeypox in Spain, which then spread to the U.K. While some women and children have developed the disease, most cases were disproportionally found in gay and bisexual men. Health agencies traced those exposures back to gay dance parties, saunas, and intimate activities.
What are the symptoms of Monkeypox?
Symptoms often start with headache, fever, muscle aches, and swollen lymph glands. Within 1-3 days of the fever, a rash with blisters typically develops on the face, hands, and soles of the feet. In more recent cases, however, patients have seen lesions around the mouth and groin only. The lesions can appear flat or raised, fluid filled and then slough off into a scab, lasting 2-4 weeks. While most cases go away without treatment, Monkeypox can be deadly with a death rate of 3-6%.
How does Monkeypox spread?
In the past, most Monkeypox outbreaks outside of Africa were caused by imported animals. Now, the virus has appeared to spread between people within a community. Monkeypox virus is transmitted in several ways with the most common coming from direct skin-to-skin or mouth-to-skin contact with an infected person, infected animal, or a contaminated surface or linens. Ulcers or lesions are particularly infectious. Monkeypox is not a sexually transmitted illness, but can transmit during sexual contact.
Why are more gay men being seen with Monkeypox?
While there is a disproportionate rise in Monkeypox cases among the LGBTQ community, Monkeypox is not a “gay disease.” It can be transmitted between anyone.
Stigmatizing the virus has dangerous consequences and will only make matters worse. That said, the virus was likely introduced first in the gay community and then spread. Secondly, most Monkeypox cases have been identified in STI clinics. Because of positive sexual health awareness and practices, gay and bisexual men are more frequently screened for STIs and seek evaluation when new rashes occur.
What do I do if I think I have Monkeypox?
If you develop a fever, swollen lymph glands and a rash, you should contact your healthcare provider and self-isolate.
So is this a big deal?
Maybe — but it’s still early.
We are learning more about the severity of this Monkeypox strain. What we know so far is Monkeypox is not COVID-19, and scientists have already developed a vaccine. However, with the sudden emergence of Monkeypox outside where the virus is typically found demonstrating person to person spread, healthcare professionals and the public are appropriately concerned.
So what does this all mean?
Know the facts about Monkeypox to reduce your risk. Avoid close intimate contact with individuals who have symptoms. Wash your hands and clean surfaces in high traffic areas. And if you develop new skin rashes or unexplained blisters, isolate and alert your healthcare provider. For more, visit WHO.

Dr. N. Adam Brown is an emergency physician, COVID expert, health communicator, and strategist.
Legal experts diverse on degree of threat to marriage
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Fears that same-sex marriage and other LGBTQ rights could be on the chopping block are at a new high after a leaked draft opinion from the U.S. Supreme Court that would explicitly overturn precedent in Roe. v. Wade, although the degree of perceived danger differs among legal observers.
Although language in the leaked draft by U.S. Associate Justice Samuel Alito, which was published late Monday by Politico and confirmed as “authentic” by the Supreme Court, specifically distances the potential ruling from Obergefell v. Hodges, the general reasoning against finding unenumerated rights in the U.S. Constitution could apply to challenges to the landmark 2015 marriage decision.
Karen Loewy, senior counsel for the LGBTQ group Lambda Legal, told the Washington Blade if the draft decision were to become final it would “have no good implications” for either the Obergefell or Lawrence decisions.
“The analysis that Justice Alito has laid out really calls into question the sort of underlying liberty and dignity jurisprudence that really was the underpinning of cases like Lawrence and Obergefell,” Loewy said. “It requires a really cramped vision of what is constitutionally protected, that is tied to histories of oppression that are really, really concerning.”
Alito obliterates long-standing precedent, as defined in the 1973 Roe. v. Wade decision and subsequently affirmed in the 1992 decision in the Planned Parenthood v. Casey, finding a woman’s right to have an abortion is protected under the 14th Amendment.
“We hold that Roe and Casey must be overruled,” Alito writes. “The Constitution makes no references to abortion, and no such right is implicitly protected by any constitutional provision, including the one on which the defenders of Roe and Casey now chiefly rely — the Due Process Clause of the 14th Amendment.”
Alito makes clear for the Supreme Court to find any unenumerated rights under the 14th Amendment, the right must be “deeply rooted in this Nation’s history and tradition” and “implicit in the concept of ordered liberty.”
Such an analysis would directly impact LGBTQ rights found under the 14th Amendment. In fact, three separate times over the course of the draft opinion, Alito compares the right to abortion to rights for LGBTQ people as defined by the U.S. Supreme Court.
Those references, however, aren’t to threaten those decisions, but to bolster the case for overturning precedent as established by Roe and limit the impact of the draft opinion.
“Roe’s defenders characterize the abortion right as similar to the rights recognized in past decisions involving matters such as intimate sexual relations, contraception, and marriage,” Alito writes, “but abortion is fundamentally different, as both Roe and Casey acknowledged, because it destroys what those decisions called ‘fetal life’ and what the law now before us describes as an ‘un-born human being.’”
In another instance, Alito includes Obergefell and Lawrence among a multitude of cases in a multi-page footnote giving examples of where the Supreme Court has decided to overturn precedent, which the draft opinion would do for Roe v. Wade. Another time, Alito rejects arguments from the U.S. solicitor general that abortion and marriage are connected, asserting “our decision concerns the constitutional right to abortion and no other right.”
Loewy, however, said the fundamental nature of the draft opinion, despite Alito’s rejection that abortion is comparable to LGBTQ rights, undermines that analysis no matter how many times he articulates it.
“The third time is where he offers a fig leaf saying, ‘This analysis is just about abortion rights. It’s not about anything else,’ and so suggests that it would leave untouched a case like Obergefell, when the analysis that he has offered in this opinion clearly leads to the opposite result,” Loewy said.
Indeed, the sweeping nature of Alito’s reasoning against finding unenumerated rights under the Constitution has led some observers to believe the draft was written by Alito alone and without the input of the other eight justices, which could mean the final decision would be a consensus different from the opinion that was leaked. (Upon publishing the leaked opinion, however, Politico did report the Supreme Court has five justices who will vote in favor of overturning Roe, which means without question such a ruling has a majority.)
Not all observers see the opinion in the same way and are interpreting Alito’s references to Obergefell and Lawrence as less threatening.
Dale Carpenter, a conservative law professor at Southern Methodist University who’s written about LGBTQ rights, downplayed the idea the draft opinion against Roe would be a prelude to overturning Obergefell based on Alito’s words denying the connection.
“The opinion tries to make it clear that it does not affect other unenumerated rights, like Lawrence and Obergefell and other fundamental rights cases, like contraceptive cases and other marriage cases,” Carpenter said. “So that’s comforting, I think, to LGBT rights advocates. Second, it says that there’s a fundamental distinction between those other cases and the abortion cases in that the abortion cases involve fetal life or potential life. And so, that I think, is a ground for setting a difference between them.”
Carpenter, however, conceded the mode of analysis in the opinion overturning Roe “is not very friendly to unenumerated rights like marriage and sexual intimacy,” so while Obergefell and Lawrence may face no immediate threat “there might be a longer term concern about decisions like those.”
A follow-up ruling from the Supreme Court rolling back the right for same-sex couples to marry would be consistent with a 2020 dissent from Alito and U.S. Associate Justice Clarence Thomas essentially declaring war on the Obergefell decision, urging justices to revisit the case to make greater accommodations for religious objections.
Jim Obergefell, the lead plaintiff in the marriage equality case and now a candidate for a seat in the Ohio state legislature, said in a statement after the leak of the draft Alito opinion he was fearful that the same forces seeking to overturn precedent for abortion rights would go after LGBTQ rights next.
“It’s also concerning that some members of the extreme court are eager to turn their attention to overturning marriage equality,” Obergefell said. “The sad part is in both these cases, five or six people will determine the law of the land and go against the vast majority of Ohioans and Americans who overwhelmingly support a woman’s right to make her own health decisions and a couple’s right to be married.”
The Supreme Court, of course, couldn’t willy nilly reverse the Obergefell decision, which would require some case or controversy to wind its way through the judicial system before justices could revisit the ruling. Mostly likely, such a hypothetical case would be a state passing a law banning same-sex marriage or simply declaring it would no longer allow same-sex couples to wed in defiance of the Obergefell decision.
No state, however, is engaged in a serious effort to challenge marriage rights for same-sex couples. The last such challenge was in 2020 and from the solicitor general of Indiana, who was seeking to challenge the decision on the basis of birth certificates for the children of women in same-sex marriages. Even the current 6-3 conservative majority on the court declined to hear the case.
Additionally, as polls demonstrate, the nation is in a different place with abortion rights compared to the right for same-sex couples to marry. A recent Fox News poll found six in 10 registered voters still think the U.S. Supreme Court should uphold Roe v. Wade, but more than half of those responders favored banning abortions after 15 weeks. Comparatively, a Gallup poll in September 2021 found support for marriage equality is at a record high of 70 percent and, for the first time, a majority of Republicans back same-sex marriage.
A question also remains about what the draft opinion means for decisions on LGBTQ rights that have yet to come before the Supreme Court but may come at a later time, such as a legal challenge to the “Don’t Say Gay” measure recently signed into law by Florida Gov. Ron DeSantis.
Carpenter said he doesn’t think the observers can glean anything about a potential ruling on the “Don’t Say Gay” law based on the fact the legal challenge would be different than challenges to abortion or same-sex marriage.
“That kind of challenge would more than likely be brought under the First Amendment,” Carpenter said. “And I don’t see the First Amendment being affected by the Dobbs decision. I suppose that someone might want to bring an Equal Protection challenge to the ‘Don’t Say Gay’ law in Florida, but it just doesn’t seem like it would have an immediate impact on even that kind of claim.”
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